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� 7 ® DATE (MMIDDIYYYY) <br /> ACOR" CERTIFICATE OF LIABILITY INSURANCE 10/25/2013 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the <br /> terms and conditions of the policy , certain policies may require an endorsement. A statement on this certificate does not <br /> confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> CONTACT <br /> PRODUCER THOMAS LEDWIDGE NAME: LOURDES MENDOZA <br /> PHONE <br /> 15225 NW 77TH AVE SUITE 205 _u+�c,No E� 305-822-2424 FivC <br /> No <br /> W& <br /> E-MAIL <br /> MIAMI LAKES , FL 33014 ADDREss: LOURDES(D_LEDWIDGEAGENCY. COM <br /> INSURER(S) AFFORDING COVERAGE NAIC # <br /> s INSURER A : State Farm Mutual Automobile Insurance Company 25178 <br /> INSURED OAC ACTION CONSTRUCTION CORP INSURER B : <br /> I <br /> 12540 SW 130TH ST STE 2 INSURER C : _ <br /> MIAMI FL 33186$266 INSURERD : <br /> INSURER E : _ <br /> INSURER F : <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY <br /> PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL <br /> THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. — <br /> INSR ADDL SUBR POLICY EFF POUCY EXP LIMITS <br /> LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY <br /> I GENERAL LIABILITY El El -]DA <br /> OCCURRENCE $ <br /> lSA WGSTOITE 7EI <br /> COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ _ <br /> CLAIMS-MADE El OCCUR MED EXP (Any one person) $ <br /> PERSONAL & ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ <br /> �� <br /> POLICY <br /> PRI- <br /> 1 LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 11000,000 <br /> A � F 948 1859-C29-59A 09129/2013 03129112014 (Ea accident) $ <br /> BODILY INJURY (Per person) $ <br /> ANY AUTO - <br /> ALL OWNED X TY SCHEDULED BODILY INJURY (Per accident) $ <br /> PROPERDAMAGE <br /> X MREDSAt1TOS X AUTOSNOWOWNED (Per accident) — $ - <br /> X ENOL $ <br /> UMBRELLA LIABOCCUR ❑ ❑ EACH OCCURRENCE $ <br /> EXCESS UAB CLAIMS-MADE AGGREGATE $ <br /> $ <br /> DED RETENTION $ <br /> WC STATU- OTH- <br /> WORKERS COMPENSATION TO Y LIMITSER <br /> AND EMPLOYERS' LIABILITY - <br /> ANY PROPRIETOR/PARTNERIEXECUTIVE Y / N EL- EACH ACCIDENT $ <br /> OFFICEMIEMBER EXCLUDED? ❑ N 1 A <br /> E. L. DISEASE - EA EMPLOYE $ <br /> (Mandatory In NH) '— <br /> If yes, describe under E. L. DISEASE - POLICY LIMIT $ <br /> El E <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, AddlUonal Remarks Schedule, If more space is required) <br /> ADDITIONAL INSURED: INDIAN RIVER COUNTY <br /> CERTIFICATE HOLDER CANCELLATION <br /> INDIAN RIVER COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> HISTORIC DODGETOWN ROOM RENOVATIONS ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 3901 26TH STREET AUTHORIZED REPRESENJp4TIVE <br /> VERO BEACH , FL 32960 � L <br /> © 1988-2010 ACO D C ORATION . All rights reserve <br /> ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.6 11 - t5-1010' <br />