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spevilic Waiver.
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<br />CERTIFICATE OF INSURANCE
<br />RE. 0830-39944
<br />ISSUED TO: Indian River County BOCC
<br />1.800 27th Street
<br />Vero Beach, FL 32960
<br />lr *d c�i'eld "� l��,yc�t;,��
<br />Insurance R..'of��pa Fv,
<br />Metilhc•r of I ihem' \Itntcil ttruup
<br />Pilve i cil '
<br />1 -N,0 -1 -)ti' -40's
<br />(tii, it (ahti-id?r,il
<br />Fay 1611
<br />Producer: Marc H. Wll(lcr
<br />Connpany: Herndon & Associates Insura;ice,
<br />Address- P O] Box }6u`8'
<br />Lakeland, FL 33£302-360£1
<br />Phone: (863) 688-5495
<br />This is to certify that Tri Sure Corporation P.O. Box 653 Auburndale FL 33823-06,53, being subject to the pre vis;ons of
<br />the Florida Workers' Compensation Law, has secured the payment of any workers' compensation benefits .clue by insurincl
<br />their, risk with this Bridgefield Employers Insurance Company.
<br />POLICY NUMBER
<br />EFFECTIVE DATE
<br />EXPIRATION DATE
<br />08-10-39944
<br />October 25, 2008
<br />October 25, 2009
<br />WC Statutory Lrrnits--State of Florida
<br />Ernpioyers Liability
<br />500,000
<br />500,000
<br />500,000
<br />(Each Accident)
<br />(Disease—Fadi Employee)
<br />(Disease -Policy Lnmt)
<br />"Subrogation against Indian River County BOCC shall be waived as respects Workers' Compensation and Employers'
<br />Liability Insurance."
<br />lob: Reuse Water Main Extension BID No 2009046 -UCP No 2830
<br />This certificate is not a policy and of itself does not afford any insurance. Nothing contained in this certificate shall be
<br />construed as amending, extending, or altering coverage not afforded by the policy shown above or atford!ng Insurance to
<br />any insured not named above.
<br />The policy of insurance listed above has been issued to the named insured for the policy period Indicated.
<br />Notwithstanding any requirement, terra or condition of any contract or other document to which this certificate may
<br />pertain, the insurance made available by the described policy in this certificate is subject to only the terms, exciusions and
<br />conditions of such policy. Paid claims may have reduced the shown limits.
<br />If the policy described above is cancelled before the expiration date indicated; the issuing company will endeavor to
<br />mail 30 days' written notice to the certificate holder named above, although if cancellation is for n;;npaycrient of prenlmn'r,
<br />then the issuing company will endeavor to mail 30 days' written notice to the certificate holder. In ary event, the Issuing
<br />company, its agents, and representatives accept no obligation of liability of any kind For fariure to Inall such notice.
<br />Date Aucfust 18, 2000
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