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Last modified
3/3/2016 8:04:42 PM
Creation date
10/5/2015 8:55:50 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
03/02/2010
Control Number
2010-059
Agenda Item Number
12.J.2
Entity Name
R.K. Contractors
Subject
Summerplace Petition Water Assessment Project 12.J.2.
Shell Lane East Agreement
Area
Summerplace, Shell Lane
Supplemental fields
SmeadsoftID
8221
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T <br /> L0.6G J/ V/ GViv 11111V 1V V S ui 1v .+ .-•, �..--•—_ �_ <br /> Page: 001 <br /> ACORD, CERTIFICATE OF LIABILITY INSURANCE 03/(0/20 <br /> PRODUCER (407)788-3000 FAX (407)788-7933 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Insurance Office of America, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR <br /> P.O. Box 162207 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Altamonte Springs, FL 32716-2207 <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED R.K. Contractors Inc. INSURER Bridgefield Employers Ins Co 10701 <br /> 2860 5. B rocksmi th Road INSURER B <br /> Ft. Pierce, FL 34945-4446 INSURER <br /> INSURER D <br /> INSURER E <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING <br /> ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR DD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br /> LTR NSR DA M D MMIDD <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ <br /> ( FS IFa oc"'rap- <br /> CLAIMS MADE ❑OCCUR MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ <br /> POLICY PRO- <br /> JECT LOC <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> ANY AUTO (Ea accident) $ <br /> ALL OWNED AUTOS BODILY INJURY <br /> SCHEDULED AUTOS (Per person) $ <br /> HIRED AUTOS BODILY INJURY <br /> NON-OWNED AUTOS (Per accident) $ <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> 7 ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY AGG $ <br /> EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ <br /> OCCUR CLAIMS MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND 0830-40508 12/31/200912/31/2010 X I WRY IMT OR <br /> EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 1,000,000 <br /> A ANYPROPRIETOR/PARTNER/EXECUTIVE <br /> OFF I CERIMEMBER EXCLUDED? E L DISEASE-EA EMPLOYE $ 1,000,000 <br /> If yes,describe under <br /> SPECIAL PROVISIONS below El DISEASE-POLICY LIMIT 1$ 1,000,000 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br /> 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br /> Indian River BOCC BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br /> 1800 27th Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, <br /> Vero Beach, FL 32790 [AUTHORIZED REPRESENTATIVEeff La os RICIAf� °w <br /> ACORD 25(2001108) OACORD CORPORATION 1988 <br />
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