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Ami " CERTIFICATE OF LIABILITY INSURANCE <br />8/25/2011 ' <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Stahl & Associates Insurance, Inc. <br />110 Carillon Parkway <br />St. Petersburg FL 33716 <br />CONTACT NancyRiche <br />NAME: y <br />PHONE (727)391-9791 uc No: (7]7)393-56]3 <br />AODReSS:nancy.richey@stahlinsurance.com <br />PRODUCER 00004990 <br />CUSTOMER ID Ill. <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURED <br />Odyssey Manufacturing Co. <br />1484 Massaro Blvd <br />Tampa FL 33619 <br />INSURERA:Westchester Surplus Lines Ins 10172 <br />INSURERS -Ace Fire Underwriters Ins Co 20702 <br />INSURERC:Zenith Insurance Company 13269 <br />INSURER D: <br />INSURER E : <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER:CL10121311632 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />A DL <br />BR <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDNYYY <br />POLICY EXP <br />MM/DD/YYYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ 1,000,000 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE ❑X OCCUR <br />924092975002 <br />10/1/2010 <br />10/1/2011 <br />GE <br />DAMPREMMISESS ( cRENTED 50,000 <br />Ea occurrence) $ <br />MED EXP (Any one person) $ 51000 <br />PERSONAL &ADV INJURY $ 11000,000 <br />GENERAL AGGREGATE $ 2,000,000 <br />GE14L AGGREGATE LIMIT APPLIES PER <br />PRODUCTS - COMP/OP AGG $ 2,000,000 <br />PRO- M LOC <br />X POLICY 7 <br />$ <br />B <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />08450377 <br />10/1/2010 <br />10/1/2011 <br />COMBINED SINGLE LIMIT <br />(Ea accident) $ 11000,000 <br />BODILY INJURY (Per person) $ <br />-- <br />BODILYINJURY (Per accident) $ <br />X <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />PROPERTY <br />(Peri accident) DAMAGE $ <br />PIP -Basic $ 10,000 <br />X <br />NON -OWNED AUTOS <br />Medical payments $ 51000 <br />UMBRELLA LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE $ 5,000,000 <br />AGGREGATE $ 51000,000 <br />X <br />EXCESS LIAB <br />CLAIMS -MADE <br />DEDUCTIBLE <br />$ <br />A <br />RETENTION $ <br />IG24092987001 <br />10/1/2010 <br />10/1/2011 <br />$ <br />L+ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory In NH) <br />N I A <br />Z066828607 <br />1/1/2011 <br />1/1/2012 <br />X I WC STATU- OTH- <br />IMIS FIR <br />E.L. EACH ACCIDENT $ 1,000,000 <br />E.L. DISEASE - EA EMPLOYE $ 1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT $ 1,_000, 000 <br />A <br />Pollution Liabilty <br />G24092999002 <br />10/1/2010 <br />10/1/2011 <br />Policy Aggregate Limit $1,000,000 <br />Ded $25,000 Ea Poll Cond <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) <br />RE: Bid #2011034 South Reverse Osmosis Plant Chemical System Upgrade. Indian River County is listed as additional <br />insured with respects to General Liability subject to policy forms & conditions. 30 day notice of cancellation <br />applies except 10 days for non-payment of premium. <br />purchasing@ircgov.com <br />Indian River County <br />Board of County Commissioners <br />1800 27th Street <br />Vero Beach, FL 32960 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />ly Petzold/WATERS�� P <br />AL:UKU Lto (LUUU/Uy) ©1988-2009 ACORD CORPORATION. All rights reserved. <br />INS025 (200909) The ACORD name and logo are registered marks of ACORD <br />