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--� ,�C"R[�® DATE{MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 07/03/2012 THIS CERTIFICATE 1S 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 endorsements). PRODUCER CONTACT Peggy ggY Peterson Winchester Insurance, Inc'. PHONE (407 365-5556 0jA/ No):{407} 366-4431 1425 W. Broadway t S.R. 42 6) E-MAADDRESS:Peggy@ winches terinsurance.com P.O. Box 620969 INSURER(S)AFFORDING COVERAGE NAIC# Oviedo FL 32762-0969 INSURERA:Southern Owners Insurance Co 10190 INSURED AG--SCAPE Services, Inc. INSURER a-.Normandy_Harbor Insurance Co 13012 1344 33rd Avenue SW INSURER C: INSURER D: Indian River INSURER E: Vero Beach FL 32968- 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 ADDL I3R POLICY NUMBER MMJ�DI EFF POLICY EXP YY LIMITS A GENERAL LIABILITY 14682--72025369 5/20/2012 5/20/2013 EACH OCCURRENCE $ l,Doo,000 X COMMERCIAL GENERAL LIABILITY / / / F)TMAGET RENTED PREMISES Ea occurrence $ 300,000 CLAIMS-MADE lil OCCUR / / / / MED EXP{Any one person} $ 10,000 PERSONAL 8 ADV INJURY $ 11000,0d 0 GENERAL AGGREGATE $ 21000,000 GEN'L AGGREGATE LIMIT APPLIES PER: / / PRODUCTS-COMPIOP AGG $ 21000,000 X POLICY 0 PRC-JECT LOC / / I / $ A AUTOMOBILE LIABILITY 14682--72025369 5/20/2012 5/20/2013 EC COMBINED SINGLE LIMIT $ 11000,000 ANY AUTO / / / / BODILY INJURY{Per person} $ ALL OWNED SCHEDULED / / 1 I BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED / 1 / / PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ 1 I $ A X UMBRELLA LIAB X OCCUR 0"823-507`00 5120/2012 5/20/2013 EACH OCCURRENCE $ 110001000 EXCESS LIAB CLAIMS-MADE / / I / AGGREGATE $ 1,000,000 DED I X I RETENTION$ 500 Completed Operations Agg $ 110001000 B WORKERS COMPENSATION NHFL 124241 5/19/2012 5/19/2013 X WC STATU- OTH- AND EMPLOYERS'LIABILITYEB ANY PROPRIETORIPARTNERIEXECUTIVE YIN I I I I E.L.EACH ACCIDENT $ 500 000 OFFICER/MEMBER EXCLUDED? N 1 A (Mandatory in NH) / / 1 I E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 1 I I 1 DESCRIPTION OF OPERATIONS below E.L.DISEASE_POLICY LIMIT $ 500 000 x Contractors Equipment 14682-72025369 5/20/2012 5/20/2013 Inland Marine 1 1 1 I DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD'IIN,Additional Remarks Schedule,if more space Is required) Project name: Sand Ridge Golf Course CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Indian River County 5300 73rd Street AUTHORIZED REPRESENTATIVE Vera Beach FL 32967- ACORD 2967-- ACORD 25(2010105) @ 1988-2010 ACORD CORPORATION. All rights reserved. INS025{201005}.01 The ACORD name and logo are registered marks of ACORD SmeadSoft Reprint Date:Monday,January 11,2016-09:21:59-OfficialDocuments:9069,Attachment Id 1,Page 56