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�R CERTIFICATE OF LIABILITY INSURANCE OPID J5 DATE (MM/DD/YYYY) 1012 to THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND , EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S ) , AUTHORIZED REPRESENTATIVE OR PRODUCER , AND THE CERTIFICATE HOLDER . IMPORTANT : If the certificate holder Is an ADD=NAL INSURED, the policy(les) must be endorsed , f SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Brown & Brown of Florida , Inc . PHONE FAX 5900 N . Andrews Ave . # 300 F- �"O Ex') (AJC ' "°)` P . O . BOX 5727 ADDRESS: PRODUCER Ft . Lauderdale FL 33310 - 5727 CUSTOMER ID i<: MELVIN1 Phone : 954 - 776 -2222 Fax : 954 -776- 4446 INSURER(S) AFFORDING COVERAGE NAICi INSURED INSURERA : Ameri. sure Mutual Ins , Co . 23396 Melvin Bush Construction , Inc . INSURER B : Federal Insurance Co 20281 2748 SW Casella Street Port St . Lucie FL 34953 INSURER C : Bridgefield Employers Ins . Co . 10701 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER : REVISION NUMBER : THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (M DID/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 , 000 , 000 A X COMMERCIAL GENERAL LIABILITY GL2029043 04 / 17 / 10 04 / 17 / 11 PREMISES (Ea occurrence) $ 300 , 000 CLAIMS-MADE FxI OCCUR MED EXP (Any one person) $ 10 , 000 X $ 1000 Deductible X PERSONAL & ADV INJURY $ 1F0001000 GENERAL AGGREGATE s2 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG s2 , 000 , 000 POLICY X JE� LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 000 000 (Ea accident) r r A X ANY AUTO CA1386638 04 / 17 / 10 04 / 17 / 11 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ C WORKERS COMPENSATION 083026276 01 / 01 / 10 01 / 01 / 11 R AND EMPLOYERS' LIABILITY TORY LIMITSI ER ANY PROPRIETOR/PARTNER/EXECUTIVF[::] E .L. EACH ACCIDENT $ 1 , 000 , 000 OFFICERIMEMBER EXCLUDED? 4 / A (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 1 , 000 , 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 , 000f 000 B Contractors Equip 6637063 04 / 17 / 10 04 / 17 / 11 Sched $ 2 , 003 , 864 1 , 000 DED/ 16 Try WIND DED Lsd/ rntd $ 500 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101 , Additlonal Remarks Schedule, If more space Is required) B : 8th Street Sidewalk Improvements from US - 1 to 6th Avenue , Project # 0744 . The Certificate Holder is an Additional Insured with respects to General Liability , if required by written contract . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE INDIAN1 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Indian River County BOCC AUTHORRED REPRESENTATIVE 1800 27th Street Vero Beach FL 32960 't'1 PORATION . All rights reserved . ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD