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`Illh .+//�� CERTIFICATE OF LIABILITY INSURANCE OP TM DATE (MM/DD/YYYY) <br /> 06 / 04 / 10 <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( les ) must be endorsed . If SUBROGATION IS WAIVED , subject <br /> to <br /> the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer <br /> rights to the <br /> certificate holder in lieu of such endorsement( s ) . <br /> PRODUCER NAME: <br /> Huckleberry , Sibley & Harvey PHONE <br /> FAX <br /> Insurance & Bonds , Inc . (EAIc, No Ext) : (A1C No) : <br /> 1020 N Orlando Ave , Suite 200 ADDRESS : <br /> Maitland FL 32751 PRODUCER <br /> CUSTOMER ID #: SPSCO02 <br /> Phone : 407 - 647 - 1616 Fax : 407 - 628 - 1635 INSURER(S) AFFORDING COVERAGE NAIC # <br /> INSURED <br /> INSURER A : Amerisure Insurance Company 19488 <br /> SPS Contracting , Inc . INSURER B : Amerisure Mutual Insurance Co 23396 <br /> Deborah & Dennis Smith <br /> 9015 Americana Rd . S # 1 INSURERC : <br /> Vero Beach FL 32 9 6 � INSURER D : <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 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 THE TERMS , <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ip <br /> ILTR p <br /> TYPE OF INSURANCE INSR WVDI POLICY NUMBER ( MMIDD/YYYY) ( MMIDOLtD ) LIMITS <br /> GENERAL LIABILITY i EACH OCCURRENCE S 110001000 <br /> UAMA I X COMMERCIAL GENERAL LIABILITY IGL2054579 06 / 06 / 10 06 /06 / 11 PREMISES��•E <br />occcu ILL) <br /> S 300 , 000 <br /> ~— CLAIMS-MADE a OCCUR MED EXP (Any one person) I S 10 , 000 <br /> XPERSONAL 8 ADV INJURY S 1 , 000 , 000 <br /> GENERAL AGGREGATE 5 2 , 000 , 000 <br /> i GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S 2 , OOO , OOO <br /> POLICY }{ PECROT LOC $ <br /> J <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> (Ea accident) S 1 , 000 , 000 <br /> A X ANY AUTO CA2054576 06/06 / 10 06 / 06 / 11 <br /> BODILY INJURY (Per person) S <br /> ALL OWNED AUTOS <br /> BODILY INJURY (Per accident) 1 5 <br /> SCHEDULED AUTOS <br /> PROPERTY DAMAGE s <br /> L X I HIRED AUTOS (Per accident) <br /> X NON-OWNED AUTOS S <br /> Ii S <br /> B X UMBRELLA UAB }{ OCCUR I CU2054580 06 / 06 / 10 106 / 06 / 11 EACH OCCURRENCE S 5 , 000 , 000 <br /> EXCESS LIAB <br /> CLAIMS-MADE , ! AGGREGATE s5 , 000 , 000 <br /> I DEDUCTIBLE S <br /> X ' RETENTION S 0 S <br /> A WORKERS COMPENSATION IWC2054H5106 / 06 / 10 106 / 06 / 11X <br /> AND EMPLOYERS' LIABILITY Y / N 1 TORY LIMITS ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVEF ! �'i E . L. EACH ACCIDENT 5 1 , 000 , 000 <br /> OFFICER/MEMBER EXCLUDED? N 1 A <br /> ( Mandatory In NH ) E . L. DISEASE - EA EMPLOYEE S1 , 000 , 000 <br /> If yes, describe under <br /> DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT 5 1 , 000 , 000 <br /> A Rented/ Leased Equi I CPP2054578 06 / 06 / 10 106 / 06 / 11 Coverage 500 , 000 <br /> A Installation Float CPP2054578 106 / 06 / 10 106 /06 / 11 Coverage 100 , 000 <br /> DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101 , Additional Remarks Schedule, if more space Is required ) <br /> Re : 58th Avenue Roadway Modifications , Indian River County <br /> Certificate holder is listed as additional insured with regards to general <br /> liability . see next page for revised cancellation clause . <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> INDRIVC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Indian River County AUTHORIZED REPRESENTATIVE <br /> 1801 27th Street <br /> Vero Beach FL 32960 - 3388 � --- <br /> © 1988 .20TJ9 ACORD CORPORATION . All rights reserved . <br /> ACORD 25 ( 2009/09 ) The ACORD name and logo are registered marks of ACORD <br />