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40 A O RO CERTIFICATE OF LIABILITY INSURANCE DATE10/24/13YY) 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 ADDITIONAL INSURED, the policy(ies) must be endorsed . If 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 NAMTACT Orestes Llorente Entrust Insurance PHONNo E . (305) 265-0112 ac No): (305) 265-0101 1431 Ponce De Leon Blvd E-MAIL info@agencyentrust.com Coral Gables, FL 33134 INSURERS AFFORDING COVERAGE NAIC # Phone (305) 265-0112 Fax (305) 265-0101 INSURER A : International Insurance Company of Hannover INSURED INSURER B : Evanston Insurance Company OAC Action Construction Corporation INSURER C : 12540 SW 130 Street #2-3 INSURER D : INSURER E : Miami , FL 33186 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. INSR TYPE OF INSURANCE ADD UBR POLICY POLICY NUMBER MM DD/YEFF POLICY EXP YYY MM/DD/YYYY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 17000, 000. 00 COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISESSEa occurrence) $ 50, 000.00 F—] f ] 06/04/2013 06/04/2014 CLAIMS-MADE OCCUR IG011000990-01 MED EXP (Any one person $ 5, 000. 00 A F1 PERSONAL PERSONAL & ADV NJURY $ 11000, 000.00 ❑ GENERAL AGGREGATE $ 21000, 000. 00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2 , 000, 000. 00 ❑ POLICY © PRO ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ❑ ANY AUTO BODILY INJURY (Per person) $ ❑ ALL OWNED ❑ AUTOS ULED BODILY INJURY (Per accident $ AUTOS ❑ HIRED AUTOS ElAUUTOSWNED (Per ac icRdenDAMAGE $ ❑ ❑ 1 $ ❑ UMBRELLA LIAB ❑ OCCUR XOVA691713 EACH OCCURRENCE $ 41000 , 000. 00 B ❑ EXCESS LIAB ❑ CLAIMS-MADE 04/25/2013 06/04/2014 AGGREGATE $ 4 , 000 , 000. 00 ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION ElWC STATU-LIMITS ❑ 0TH- ER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E . L. EACH ACCDENT $ OFFICERIMEMBER EXCLUDED? ❑ N / A (Mandatory in NH ) E . L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E. L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101 , Additional Remarks Schedule, if more space is required) Additional Insured : Indian River County - 30 days Notice of Cancellation Required . General Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Indian River County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Historic DodgetoWn Room Renovations 3901 26th Street AUTHORIZED REPRESENTATIVE Vero Beach , Florida 32960 © 1988-2010 ACORD CORPORATION. All rights reserved . ACORD 25 (2010/05) QF The ACORD name and logo are registered marks of ACORD