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ACCORD®, CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) I_ 1 /LV17 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(les) 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 endorsement(s). PRODUCER Stahl & Associates Insurance Inc. CONTACT Debbie MacGillivray rat a Fxtl, (863) 688-5495 la A.), (863) 688-4344 91 Lake Morton Drive AIL ADDRESS:debbie.macgillivray@stahlinsurance.com P 0 Box 3 608 Lakeland FL 33802 INSURER(S) AFFORDING COVERAGE NAIC # INsuRERA:Southern Owners Insurance Co 10190 INSURED Tri Sure Corporation PO Box 653 Auburndale FL 33823 INSURER El :Owners Insurance Co 32700 INsuRERc:Bridgefield Employers Ins Co 10701 INsuRERD:Travelers Casualty Ins Co 25674 INSURER E : COMMERCIAL GENERAL LIABILITY INSURERF: CERTIFICATE NUMBER:10/25/14 Master • 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 ADDL INSR SUBR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD//YYYYYI LIMITS GENERAL; LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES $ 300,000 A CLAIMS -MADE X OCCUR X 20006717 10/1/2014 10/1/2015 (Ea occurrence) MEDEXP(Anyoneperson) $ 10,000 PERSONAL 8, ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2 , 000 , 000 TI POLICY n JECOT- n LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 B X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS 5000671700 10/1/2014 10/1/2015 BODILY INJURY (Per accident) $ HIRED AUTOS _ NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ X PIP $10,000 BFCGL $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS -MADE AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 5000671701 10/1/2014 10/1/2015 $ c WORKERS COMPENSATION_WC AND EMPLOYERS' LIABILITY STATU- TORY LIMITS OTH- ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? Y / N N/A E.L. EACH ACCIDENT $ 500,000 00 (Mandatory ) If 0830-54046 10/25/2014 10/25/2015 E.L. DISEASE - EA EMPLOYEE $ 500,000 yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 A D Installation Floater Leased & Rented 20006717 6609D916895 10/1/2014 10/1/2014 10/1/2015 10/1/2015 Limit $50,000 Limit $250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Project: 12' Transmission Water Main on 107th Avenue in Vero Lake Estates Indian River County is additional insured on the general liability if required by written contract. CERTIFICATE HOLDER CANCELLATION Indian River County 1800 -27th Street Vero Beach, FL 32960 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Marc Wilder/MACG ACORD 25 (2010/05) INS025l9ntnns) m ©1988-2010 ACORD CORPORATION. All rights reserved. The, At non names and Innes are, re,nie+e,re,ei marine of A(:r1Rr1