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From . Margaret Kiess FaXID: 3TUINS- FAX01 Page 2 of 2 Date : 11 / 11 /2011 10 : 26 AM Page : 2 of 2 ACORO ' OP ID : MK �... - CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY ) 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 endorsements . PRODUCER 772 -286^ 334 CONTACT Stuart Insurance, Inc. NAME : ___ _ _ 3070 S W Map p 772 -286-9389 PHONEAIC No Ext : FAX Palm City, FL 34990 EMAIL _ (qtc, No Rick Halcomb, CIC, ARM ADDRESS : _ PRODUCER TIMOR- 1 CUSTOMER ID : RS NAIC ;K INSURED Timothy ROSE INSURE -- ( ) AFFORDING COVERAGE INSURER A : Westfield Insurance 24112 Contracting , Inc . — _ _ 1360 Old Dixie Hwy SW INSURER 6 : Vero Beach , FL 32962 INSURER 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 LTR TYPE OF INSURANCE POLICY NUMBER MMPOLLIDmYY MMLICY EXY LIMITS GENERAL LIABILITY EACH OCCURRENCE .$ 1 , 000100 A X COMMERCIAL GENERAL LIABILITY X CMM6079889 06106/11 06106/ 12 PREMISES Ea o currencej $ 100100 CLAIMS-MADE OCCUR MED EXP ( Any one person ) $ 51100 X Contractual Liab PERSONAL & ADV IN $ 1 , 000100 X Incl XCU — _ GENERALAGGP, EGATE $ 2, 000, 00 GEN' L AGGREGATE LIMIT APPLIES PER : PRODUCTS - COMP/OPAGG $ 21000, 00 POLICY X PRo- -- . — - - 7 LOC $ AUTOMOBILE LIABILITY 7COMBINED SINGLE LIMIT $ 1 , 000, 00 A X ANY AUTO CM M6079889 06/06/11 06106112 nq ALL OWNEDAUTOS BODILY INJURY ( Perperson ) $ SCHEDULED AUTOS BODILY INJURY ( Per acUdent ) $ $ X HIRED AUTOS PROPERTY DAMAGE (Per accident ) X NON-OWNED AUTOS -- --- UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 31000100 EXCESS LIAB CLAIMS-MADE A CMM6079889 06/06/11 06/06112 AGGREGATE $ 3, 000, 00 DEDUCTIBLE - RETENTION $ - MRKERS COMPENSATION $ WC STAT U- O AND EMPLOYERS' LIABILITY YIN TORY LIMIT" I I ERR ANY PROPPIETORIPARTNERIEXECUTIVE E . L . $ OFFICERIMEMBEP EXCLUDED? N I A EACH ACCIDENT (Mandatory in I If yes, describe under E . L. DISEASE - EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E. L . DISEASE - PDL ICY LIMIT $ A ontractors Equip CMM6079889 06/06/11 06/06/ 12 IRented 50100 11 1 ::n7Equipment $1000 de DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101 , Additional Remarks Schedule, if more space Is required) Grading of Land/Slte Prep - State of Florida *Certfficate holder Is Additional Insured with respect to General Liability. 30 day notice of cancellation � 10 day for non-pay. PROJECT: Trans - FL Greenway Trail CERTIFICATE HOLDER CANCELLATION INDRP-3 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. Purchasing 772-564 -7888 AUTHORIZED REPRESENTATIVE d 1800 27th Street / _- Vero Beach FL 32960 O 1988-2009 ACORD CORPORATION . All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD