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PATE (MMlOD/YYYY) ACOW. CERTIFICATE OF LIABILITY INSURANCE 12 / 3012009 PRODUCER ( 504 ) 455 - 4545 FAX : ( 504 ) 888 - 6645 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE F �. lsworth Corporation HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 36 S , I - lo Service Road Box.O P , . ox 8210 P , 0BLA 70011 - 8210 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Landmark American Ins , Omni. Pinnacle , LLC INSURER B: QBE Specialty Ins . Co . 90 Glen Court INSURERc: Landmark American Ins , INSURER D: New Hampshire Ins , Co . Pearl River LA 70452 INSURER EIronshore Specialty Ins . THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWfiHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. rAA GA LIMIT SHOWN MAY Fi VE 8EE '.-REDUCED BY I POLICY EFFECTIVE P"mmioDrfY Al POLICY NUMBER GATE MMlDDIYY LIMA' TYPE OF INSURANCE GENERAL LIABILITY LHA106822 EACHOCCURRENCE s 1 , 000 , 000 DAMAGES ( RENTED S 50 , D00 X COMMERCIAL GENERAL LIABILITY PREMISES Fa Dcturrenee OCCUR Blanket Add ' 1 Instared 6 5 / 7 / 2009 MED EXP An one erson 5 51000 CLAIMS MADE 1 000 000 Blanket Waives Of Subrog PERSONAL & VINJURy s r r as rei^ti red by written GENERAL AGGREGATE S 2 r 000 r 000 GENT AGGREGATE LIMIT APPLIES PER: contract . G PRODUCTS - COMP/OP AG S 2r000 , 000 PRO- POUCY X JECT LOC AUTOMDBILE LIABILITY COMBINED SINGLE LIMIT S 11000 : 000 J (Ea accident) ANY AUTO $ ALL OWNED AUTOS 450004423 5 / 7 / 2009 5 / 7 / 2010 BODILY INJURY S (Per person) X - SCHEDULED AUTOS X HIREDAUTOS Blanket Add ' 1 Insured & BODILY INJURY s (Per accidenly X NON OWNED AUTOS Blanket Waiver o£ Subzog as required by written PROPERTY DAMAGE $ (Per acddenl) contract . AUTO ONLY - EAACCIOE14T S GARAGE LIABILITY OTHER THAN EA AC '' —, ANY AUTO AUTO ONLY: AGG 5 s 7 , 0001000 EACH OrCURRENQE EXCESSIUMBRELLA LIABILITY 7 , 000 r 000 X OCCUR FICLAIMS MADE AGGREGATE S S C DEDUCTIBLE LHA04B773 5 / 7 / 2009 5 / 7 / 2010 5 s p5r RETENTION s1O , DO0 x WCSTATU-CRYLIMU5DTH• I ER D WORKERS COMPENSATION AND WCOG1117789 ] On r (WO EMPLOYERS' LIABILITY - Blanket Waiver of SubrI9 / 21 /:2 (010 E. L. EACH ACCIDENT S ANY PROPRIETORIPARTNERIEXECUTIVE E, LDISEASE - EAEMPLOYEE S 11000_1000 OFFICERIMEMBEREXCLUDED? as recl fired by written 9 / 21 / 2010 If yes, describe under contract . Incl USL6H E.LDISEASE - POLICY LIMIT S 1 , 000 , 000 SPECIAL PROVISIONS helow E 016NB0918001 5 / 7 / 2009 5 / 7 / 2010 Lnol OTHER CONTRACTORS Per Occurrence 2 , 000 r 000 POLLUTION LIABILITY Alle to 4 , 000 , 000 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES!EXCLUSIONS ADDED BY ENDDRSEMENTJSPEC1AL PROVISIONS It is agreed that the certificate holder is named as Additional Insured on the General Liability Policy , as requited by written contract . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Indian River County Public Works bept . EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1801 27th Street 30 DAYS WRITTEN NOTICE TO THE CERTIFlCATE HOLDER NAMED TO THE LEFT, BUT Vero Beach , FL 32960 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION on LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Apt me Holly Mehrtens / HMM CIA RD CORPORATION 1988 ACORD 25 ( 2001108) Page 1 Df 2 INS025 ponoea