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2011-005
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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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1 / 17 / 2011 09 : 25 Lion Insurance LION INSURANCE COMPANY -► Timothy Rose Contracting , Inc . 1 / 1 <br /> Date <br /> CERTIFICATE OF LIABILITY INSURANCE 1 / 17/2011 <br /> Producer: Lion Insurance Company This Certificate is Issued as a matter of Information only and confers no rights <br /> 2739 U . S . Highway 19 N . upon the Certificate Holder. This Certificate does not amend, extend or alter <br /> Holiday , FL 34691 the coverage afforded by the policies below. <br /> ( 727 ) 938 -5562 Insurers Affording Coverage NAIC +� <br /> Insured : South E= ast Personnel Leasing , Inc . Insurer A : Lan Insurance Company 11075 <br /> 2739 U . S . Highway 19 N . Insurer B : <br /> Holiday , FL 34691 Insurer C : <br /> Insurer D : <br /> Insurer E : <br /> Coverages <br /> epolicies o insurance listed below have b aonissued to the insured named above for fine policy pen o indicated NotwThsten ing anN requi rem ent, term or <br />cond ibono a my contractor other documentwt respect to which <br /> this certificate maybe issued or may pertain , the insurance afforded by the policies descnbed herein is subject to all the terms , exclusions , and conditions <br /> of such policies Aggregate limits shown may have been reduced by <br /> paid claims <br /> INSR ADDL Policy Effective Policy Expiration Date Limits <br /> LTR INSRD Type of Insurance Policy Number Date <br /> ( MM/DD/YY) ( MM/DD/YY) <br /> GENERAL LIABILITY <br /> Each Occurrence <br /> Commercial General Liability <br /> Damage to rented premises (EA <br /> Claims Made ❑ Occur occurrence ) <br /> Med Exp <br /> General aggregate limit applies per : Personal Adv Injury <br /> Policy ❑ Project ❑ LOC General Aggregate <br /> Products - Comp/Op Agg <br /> AUTOMOBILE LIABILITY Combined Single Limit <br /> (EA Accident) <br /> Any Auto <br /> Bodity Injury <br /> AN Owned Autos <br /> (Per Person) <br /> Scheduled Autos <br /> Hired Autos Bodily Injury <br /> Non-Owned Autos (Per Accident) <br /> Property Damage <br /> (Per Accident) <br /> EXCESS/UMBRELLA LIABILITY Each occurrence <br /> Occur ❑ Claims Made Aggregate <br /> Deductible <br /> A Workers Compensation and WC 71949 01 /01 /2011 01 /01 /2012 x WC Statu- OTH- <br /> Employers' Llabiily I tory Limits I ER <br /> Any proprietor/partner/executiveoMearlmember E . L . Each Accident $ 1 ,0001000 <br /> excluded? <br /> E . L . Disease - Ea Employee 31 .000000 <br /> If Yes, describe under special provisions below. <br /> E . L . Disease - Policy Limits $ 1 ,00C ,000 <br /> Fother Lion Insurance Company is A. M . Best Company rated A- ( Excellent). AMB <br /># 12616 <br /> Descriptions of Operations/LocationsIVehicies/Exclusions added by Endorsement/Special Provisions : Client ID : 31 .615 -108 <br /> Coverage only applies to active employee( s) of South East Personnel Leasing, Inc . that are leased to the following "Client Company" : <br /> Timothy Rose Contracting, Inc . <br /> Coverage only applies to injuries incurred by South East Personnel Leasing, Inc . active employee(s) while working in Florida . <br /> Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity . <br /> A list of the active employee( s) leased to the Client Company can be obtained by faxing a request to ( 727) 937- 2138 or by calling ( <br />727) 938- 5562 . <br /> Project Name : BARRIER ISLAND REUSE WATER SYSTEM , IMPROVEMENTS & SR 510 REUSE WATER SYSTEM IMPROVEMENTS, INDIAN RIVER COU <br /> FAX: 772- 564-7888 & 772- 770-5140 / ISSUE 01 - 17- 11 ( SD) <br /> Bectin Date : 2 ,/4/2009 <br /> CERTIFICATE HOLDER CANCELLATION <br /> INDIAN RIVER COUNTY DEPARTMENT OF UTILITY SERVI Should arty of the above described policies be canceled before the expiration date thereof , the issuing <br /> insurer volt <br /> endeavor to mail 30 days mitten notice to the cemhcate holder named to the left, but fatlure to do so shall impose no <br /> PURCHASING DIVISION obligation or liability of arty kind upon the insurer . Its agents or representatives <br /> 1601 27TH ST . <br /> VERO BEACH, FL 32960 <br />
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