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ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE ( MMIDD/YYYY) 6/13/2011 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 A NAME: Rachel Bulloch J Smith Lanier & Co of Newnan A/CPHONE Ext . 770 683 -1048 ac, Noy 770 683 -1010 P . O . Box 71429 AE-MAIL rbulloch@jsmithianier. com Newnan , GA 30271 -1429 PRODUCER 770 683 -1000 CUSTOMER ID II: INSURER(S) AFFORDING COVERAGE NAIC If INSURED INSURER A : Employers Mutual Casualty Compa 21415 TAG Grinding Services , Inc . INSURER B : Great American Insurance Compan 16691 J W B Leasing Co. , Inc . Indian Harbor Ins . Co. 36940 1113 Horseshoe Bend Rd . INSURER c Dadeville , AL 36853 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 . INSR ADDLBR POLICY EFF POLICY EXP TYPE OF INSURANCE POLICY NUMBER MMIDD MM/DD LIMITS A GENERAL LIABILITY 3K74918 7/27/2010 07/27/2011 EACH OCCURRENCE $ 1 000 000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY ( FL Only) PREMISES Ea occurrence $ 100 , 000 CLAIMS-MADE F x1 OCCUR MED EXP (Any one person ) $ 5 , 000 X PD Ded : 500 PERSONAL B ADV INJURY $ 1 , 000 , 000 GENERAL AGGREGATE $2 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2, 000, 000 17 POLICYFX PRCT O- LOC I $ A AUTOMOBILE LIABILITY 3E74918 7/27/2010 07/27/2011 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 11000 , 000 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Par accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS $ $ B X UMBRELLA LIAB X OCCUR SUB019398800 8/09/2010 08/09/2011 EACH OCCURRENCE s4, 000 , 000 EXCESS LIAB CLAIMS-MADE AGGREGATE s4, 000 , 000 DEDUCTIBLE $ X RETENTION 10 , 000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N FR ANY PROPRIETORIPARTNER/EXECUTIVE❑ NIA E.L. EACH ACCIDENT $ D? OFFICER/MEMBER EXCLUDE (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ C Equipment Floater UM00000165MA10A 7/27/2010 07/27/2011 Limit Per Policy C Leased/Rented Eqp UM00000165MA10A 7/27/2010 07/27/2011 $ 100 , 000 / $ 5 , 000 Ded DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101 , Additional Remarks Schedule, if more space Is required) Coverage Continued : Pollution Liability - Carrier: American Safety Indemnity Company ( See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Indian River County Board of SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Commissioners THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS . 1800 27th Street Vero Beach , FL 32960 AUTHORIZED REPRESENTATIVE m19 - 09 ACORD CORPORATION . All rights reserved . ACORD 25 (2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD #S1222403/M1221720 HXS