2012-091A - Laserfiche WebLink

Home Browse Search

From . Sarah FaXID . STUINS- FAX01 Page 1 of 1 Date : 5/ 102012 10 : 22 AM Page -1 of 1 ACORL7 ' I ID : SB �- CERTIFICATE OF LIABILITY INSURANCE I DATE (MMfDDIYYYY) 05/10/12 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 INSURERi AUTHORIZED REPRESENTATIVE OR PRODUCER , AND THE CERTIFICATE HOLDER , IMPORTANT: If the certlflcate holder Is an ADDITIONAL INSURED, the pollcy( lesy must be endorsed . If SUBROGATION IS WAIVED, subject to certificate holder In lieu of such endorsemenfls % the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certlflcaIt does not confer rights to the PRODUCER 772 -286-4334 Stuart Insurance , Inc, 772w2864334 3070 S W Mapp 772 -286 -9389 PHONE : FAX Palm City, FL 34990 EMAIL AIC No) : Rick Halcomb , CIC , ARM AD011 CUSTOMER ID / : TIMOR- 1 INSURED INSURER S AFFORDING COVERAGE NAIC 1 Timothy Rose INSURER A : Westfield Insurance Contracting , Inc . 24112 1360 Old Dixie Hwy SW INSURER 8 : Vero Beach , FL 32962 INSURER C : 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 . TRIM LTR TYPE OF INSURANCE POLICY NUMBER GENERAL LIABILITY MMIDDIYYYY) JMMIDDIYYYYI LIMITS A dXA COMMERCIAL GENERAL LIABILITY X CMM6079889 06/06/11 06/06/12 EACH OCCURRENCE $ 1 , 000, QQPREMISESEaoocccurrence $ 100, 00CLAIMSMADE OCCUR MED EXP ( Any one person ) $ 5, 00Contractual Liab PERSONAL 8 ADV INJURY $ 1 , 000, 00Incl XCU GENERAL AGGREGATE $ 21000100 GEN'L AGGREGATE LIMIT APPLIES PER PRO- PRODUCTS - COMP/OP AGG $ 21000, 00 POLICY X LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 , 000, 00 A X ANY AUTO CMM6079889 06/06/11 06/06/12 ( Ea accident) ALL OWNED AUTOS BODILY INJURY ( Per person ) $ SCHEDULED AUTOS BODILY INJURY ( Per accident ) $ X HIRED AUTOS PROPERTY DAMAGE $ ( Per accident ) X NON- OWNEDAUTOS $ UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 3 , 000, 00 EXCESS LIAB CLAIMS - MADE AGGREGATE— $ 31000, 00A CMM6079889 06/06/11 06 /06/1200 DEDUCTIBLE 5 RETENTION $ WORKERS COMPENSATION $ i/PW' C STATU - 0TH . I AND EMPLOYERS' LIABILITY YIN TORY LIMITS CT ANY PROPRIETORARTNERIEXECUTIVE g OFFICERIMEMBER EXCLUDED N f A ' E L EACH ACCIDENT ( Mandatory In NH) ----I- If yes , describe under j E L DISEASE - EA EMPLOYEE ' $ DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT I $ A ontractors Equip CMM6079889 I 06! 06111 06!06112 Rented 50,00 Equipment $ 1000 de DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101 , Additional Remarks Schedule, it more space Is required) Grading of Land/ Site Prep - State of Florida REF : Misc . Drainage Culvert Replacements ' Certificate holder is Additional Insured with respect to General Liability CERTIFICATE HOLDER CANCELLATION INDRC-4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Indian River County ACCORDANCE WITH THE POLICY PROVISIONS, 772-770 -5333 1801 27th St AUTHORIZED REPRESENTATIVE Vero Beach , FL 32960 O 1988-2009 ACORD CORPORATION . All rights reserved . ACORD 25 ( 2009 /09) The ACORD name and logo are registered marks of ACORD