2011-204A - Laserfiche WebLink

Home Browse Search

From Tani Jacobson FaxID:STUINS-FAX01 Page 2 of 2 Date:9/23/2011 11:00 AM Page:2 of 2 AICO'RO" V CERTIFICATE OF LIABILITY INSURANCE OP ID: TJ DATE (MMIDDN YYY) 09/23111 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 andnrswninnin l PRODUCER CONTACT Stuart Insurance, Inc. 772-2864334 NAME: 3070 S W Mapp 772-286-9389 PAHOFE EK FAX Palm City, FL 34990 E.M L (A/C, Not: Rick Halcomb, CIC, ARM ADDRESS: PRODUCER TIMOR -1 CUSTOMER ID t INSURER(S) AFFORDING COVERAGE NAIC t __ INSURED Timothy Rose INSURER A: Westfield Insurance _ 24112 Contracting, Inc. INSURER B 1360 Old Dixie Hwy SW Vero Beach, FL 32962 INSURERC: INSURER D: INSURER E INSURER F ; COVERAGES rCRTICII`ATC KII IRADCD• - --""- --"— IV —'"'--"' RCYWIVIVfVUMtltK: 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LTR POLICY NUMBER MMIODIYYYY MMIDDIYYYY LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Contractual Llab X CMM6079889 06/06/11 06/06/12 EACH OCCURRENCE $ 1,oO0,00 X DAMAGE 7U777rn' PREMISES Ea occurrence $ 100100 MED EXP (Anyone person) $ 5100 X PERSONAL & ADV INJURY $ 10000100 X Incl XCU GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER. FR0- LOC POLICY 41 PRODUCTS- COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CMM6079889 06106/11 06/06/12 COMBINED SINGLE LIMIT Ea accident) $ 19000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ' PROPERTY DAMAGE (Per accident) $ X X $ A A UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE N/A CMM6079889 CMM6079889 06/06/11 06/06/11 06/06/12 06/06/12 EACH OCCURRENCE $ 31000,00 AGGREGATE $ 3,000,000 DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERJEXECUTIVEE.L. Of yes. describe ntlP�.CERIMEMBER EXCLUDED? and ❑ (Mandatory In er DESCRIPTION OF OPERATIONS below ontractors Equip WC STATU- OTH- TORY LIMITS ER $ EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ E L DISEASE- POLICY LIMIT Rented Equipment $ 50,00 $1000 de DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Grading of Land/Ske Prep - State of Florida RE:Indlan River Blvd & 17t St Intersection Improvements -Indian River County Is additional Insured for general liability (30 days notice of cancellation) :141 a:1 IRCBC-1 Indian River County Purchasing Division 1800 27th Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Vero Beach, FL 32960 THE EXPIRATION DATE THEREOF, NOi10E WILL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2009 ACORD CORPORATION. Ail rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD