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2011-005
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Entry Properties
Last modified
1/11/2016 1:50:29 PM
Creation date
10/1/2015 1:32:59 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
01/11/2011
Control Number
2011-005
Agenda Item Number
12.J.1
Entity Name
Timothy Rose Construction,Inc.
Subject
Barrier Island Reuse Water System Improvements
SR510 Reuse Water Systerm Improvements
Area
SR 510,77th St.
Supplemental fields
SmeadsoftID
9203
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From Tani Jacobson FaXID: STUINS- FAX01 Page 2 of 2 <br /> Date : 01 /17/ 11 11 : 32 AM Page : 2 of 2 <br /> AEOR CERTIFICATE OF LIABILITY INSURANCE OPID TJ LDATE (MM/DD/YYYY) <br /> THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER . T7S17 / 11 <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 certcats holder Is aFMITIONAL INSURED, the policy(les) must be endorsed. , subject to <br /> the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder In lieu of such endorsement(s). <br /> PRODUCER <br /> NAME : <br /> Stuart Insurance , Inc , INC, No, Ext ) : (A/C. No ) : <br /> 3070 S W Mapp ADDRESS : <br /> Palm City FL 34990 cusTOMERIDs: TIMOR- 1 <br /> Phone : 772 - 286 - 4334 Fax : 772 - 286 - 9389 INSURER( S ) AFFORDING COVERAGE NAICs <br /> INSURED <br /> INSURER A : Harleysville Insurance Group 14168 <br /> Timothy Rose <br /> Contracting , Inc . INSURER B <br /> 1360 old Dixie Hwy SW INSURER C : <br /> Vero Beach FL 32952 <br /> 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 CONTRACTOR 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 <br /> LTR TYPE OF INSURANCE INSR Vii POLICY NUMBER <br /> (MM/DD/YYW) ( MM/DDlYYW) LIMBS <br /> GENERAL LIABILITY <br /> EACH OCCURRENCE $ 11000 , 000 <br /> A X COMMERCIAL GENERAL LIABILITY GL00000049465A 06 /06 /10 06 /06 /11 PREMISES ( Ea occurrence ) $ 100 , 000 <br /> CLAIMS-MADE F_X] OCCUR MED EXP (Any one person ) $ S1000 <br /> X Contractual Liab X PERSONAL 6 ADV INJURY $ 11000 , 000 <br /> X Incl XCU GENERAL AGGREGATE s2 , 000 , 000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER . PRODUCTS - COMP/OP AGG $ 21000 , 000 <br /> POLICYFX JECT LOC $ <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT $ 1 000 <br /> A X ANY AUTO BA00000049464A 06 /06 /10 06 /06 /11 ( Ea accident) r — r 000 <br /> BODILY INJURY ( Per person ) $ <br /> ALL OWNED ALTOS <br /> BODILY INJURY (Per accident ) $ <br /> SCHEDULED AUTOS PROPERTY DAMAGE <br /> X HIRED AUTOS ( Per accident ) $ <br /> X NON- OWNED AUTOS $ <br /> $ <br /> A UMBRELLA UAB X OCCUR CM800000049462A 06 /06 / 10 06 /06 /11 EACH OCCURRENCE $ 31000 , 000 <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ 31000 , 000 <br /> DEDUCTIBLE <br /> RETENTION $ $ <br /> RKERS COMPENSATION <br /> AND EMPLOYERS' LIABILITY YIN TORY UMITS ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E L EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory In NH ) E L DISEASE - EA EMPLOYEE $ <br /> if yes . describe under <br /> DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ <br /> A Contractors Equip Cl2MI676 06 /06 / 10 06 /06 /11 Rented 50 , 000 <br /> Equipment $ 1000 ded <br /> DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101 , Additional Remarks Schedule, N more apace is required ) <br /> Grading of Land/ Site Prep - State of Florida RE : Barrier Island Reuse Water <br /> System Improvements & SK510 Reuse Water SytemImprovements " Indian River <br /> Souncy Dept of Utility Services is additional insured with respect to <br /> general liability <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> IRCBD - 1 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Indian River County <br /> Dept of Utility Svcs AUTHORaZGDREPRESENTATTVE <br /> Purchasing Div <br /> 1801 27th St % <br /> Vero Beach FL 32960 <br /> @"088-2009ACdftTO_R17MATION . All rights reserved. <br /> ACORD 25 ( 2009109 ) The ACORD name and logo are registered marks of ACORD <br />
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