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From : Tani Jacobson FaxiD: STUINS-FAX01 Page 2 of 2 Date : 12/13/10 03 : 21 PM Page :2 of 2 c�Q �,,,.,. CERTIFICATE OF LIABILITY I DATF { } THIS CERTIFICATE IS ISSUED AS A MATTER OF INF INSURANCE OP ID TJ INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER . THI$ 13 / 10 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 , the cart cafe er s anAL I SUt p cy es must a endorsed, If SUBRO the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the su ct to certificate holder In Ileu of such endorsement(s). PRODUCER NAME : Stuart Insurance , Inc . (A1C, No, Ent) : 3070 S W Mapp A(1VCNo1 Palm City FL 34990 ADDRESS : Phone : 772 -286 - 4334 Fax : 772 - 286 - 9389 CUSTOMER ID #. TIMOR- 1 INSURED INSURER(S ) AFFORDING COVERAGETimothy RoseINSURER A : Harl*psvillo insu:anca croup Contracting , , Inc . INSURER B : 1360 Old Dixie HWV SW Vero Beach FL 32 992 INSURER C INSURER D : INSURER E : COVERAGES INSURER F : 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 CONTRACTOR 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 , Ilm FA TYPE OF INSURANCE INSR POLICY NUMBER (MM/DDWIYY GENERAL LIABILITY ) (MMIDDIYYW) LIMITS EACH OCCURRENCE $ 1 , 0 0 0 , 0 0 0 !17 RCIAL GENERAL LIABILITY GL00000049465A 06 /06 /10 06 /06 /11 PREMISES ( Ea occurrence ) $ 100 , 000 AIMS MADE OCCUR MED EXP (Any one person ) $ 5 , Opp XContractual Liab x Incl XCU PERSONAL & ADV INJURY $ 1 , p 0 010 0 p GENERAL AGGREGATE $ 2 , 0 p 0 , 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER : POLICY X PRO. LOC PRODUCTS - COMP/OPAGG $ 2 , 000 , 00o AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A X ANY AUTO BA00000049464A 06 /06 /10 06 /06 /11 ( Ea accident) $ 1 , 000 , 000 ALL OWNED AUTOS BODILY INJURY ( Per person ) $ SCHEDULED AUTOS BODILY INJURY ( Per accident) $ X HIRED AUTOS PROPERTY DAMAGE ( Per accident) $ X NON-OWNED AUTOS $ A UMBRELLA LM X OCCUR CNBO0000049462A 06 /06 /10 06 /06 /11 EACH OCCURRENCE $ 3 , 000 , 000 EXCESS LlAB CLAIMS MADE AGGREGATE $ 3 ,r000 jr000 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION OTH- AND EMPLOYERS' LUUMITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ MIA E .L . EACH ACCIDENT $ (Mandatory In NH) E . L . DISEASE . EA EMPLOYEE $ If yes , describe under DESCRIPTION OF OPERATIONS below E . L . DISEASE - POLICY LIMIT $ A Contractors Equip Cl2M1676 06 /06 /10 06 /06 /11 Rented 50 , 000 Equipment $ 1000 ded DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101 , Additional Remarks Schedule, M more space Is required) Grading of Land/ Site Prep - State of Florida RE : Bid 2011012 , Quail Creek Subdivision CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE IRCBC - 1 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Indian River County Board of County Commissioners AUTHORIZED REPRESENTATIVE Attn : Purchasing Division t 18001 27th Street Vero Beach FL 32960 V11188-2009 Ac6ftTURPMATION . M rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD