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WESTCON-04
<br />LGLEASON
<br />1
<br />ARL CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMY)
<br />12/16/2015
<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 />Collinsworth, Alter, Lambert, LLC
<br />23 Eganfuskee Street
<br />Suite 102
<br />Jupiter, FL 33477
<br />CONTACT Lori B. Gleason
<br />PHONE 561 776-9001 FAX No):561 427-6730
<br />No,
<br />E-MAIL
<br />(
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A : Amerisure Insurance Co
<br />19488
<br />INSURED
<br />West Construction, Inc.
<br />318 South Dixie Highway
<br />Suite 4-5
<br />Lake Worth, FL 33460
<br />INSURER B: North River Insurance Company
<br />21105
<br />INSURER c Travelers Property & Casualty Co. of America
<br />25674
<br />INSURER D:
<br />$ 1,000,000
<br />INSURER E:
<br />INSURER F :
<br />•
<br />LAJV CRHU CJ vu�.0 w.-..�........-�. ..
<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 POLIC ES 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 />ADDL
<br />INSD
<br />SUER
<br />WVD
<br />POLICY NUMBER
<br />(MM/UDDY EFF
<br />�)
<br />POUCY EXP
<br />( MM DD YYYY)
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL UABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />TU RENItD
<br />DAMAGPREMISES
<br />X
<br />OCCUR
<br />CPP20857740201
<br />01/01/2015
<br />01101/2016
<br />PREMISES (Ea occurrence)
<br />$ 100,000
<br />CLAIMS -MADE
<br />X
<br />XCU & Contractual
<br />MED EXP (Any one person)
<br />$ 5,000
<br />X
<br />Broad Form Prop. Dam
<br />PERSONAL 8 ADV INJURY
<br />$ 1,000,000
<br />LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L
<br />AGGREGATE
<br />X
<br />PRO
<br />LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />POLICY
<br />OTHER:
<br />JECT
<br />AUTOMOBILE UABIUTY
<br />{Ea COMBINEDDt) SINGLE LIMIT
<br />$ 1,000,000
<br />A
<br />X
<br />CA12999291801
<br />01/01/2015
<br />01/01/2016
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />ALL OWNED
<br />SCHEDULED
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />AUTOS
<br />_
<br />X
<br />AUTOS
<br />ED
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />HIRED AUTOS
<br />AUTOS
<br />PIP Coverage
<br />$ 10,000
<br />X
<br />UMBRELLA UAB
<br />X
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />B
<br />EXCESS LIAB
<br />OCCUR
<br />CLAIMS
<br />5811038172
<br />01/01/2015
<br />01/01/2016
<br />AGGREGATE
<br />$ 20,000,000
<br />-MADE
<br />DED
<br />X
<br />RETENTION $ 0
<br />$
<br />WORKERS COMPENSATION
<br />X
<br />PER
<br />STATUTE
<br />OTH-
<br />ER
<br />A
<br />AND EMPLOYERS' LIABILITY Y / N
<br />WC204157409
<br />01 /01/2015
<br />01 /01 /2016
<br />E.L. EACH ACCIDENT
<br />1,000 000
<br />$ r
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />In NH)
<br />N
<br />N / A
<br />E.L. DISEASE - EA EMPLOYEE
<br />1 000,000
<br />$ r
<br />(Mandatory
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />C
<br />C
<br />Rented/Leased Equip.
<br />Inland Marine
<br />QT6609215L272TIL15
<br />QT6609215L272TIL15
<br />01/01/2015
<br />01/01/2015
<br />01/01/2016
<br />01/01/2016
<br />Limit 200,000
<br />Scheduled Equipment
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is requi ed)
<br />The Certificate Holder is named as additional insured including products and completed operations for general liability per form CG7048, automobile liability,
<br />and umbrella liability when required by written contract. General Liability and Auto Liability are primary and non contributory when required by written
<br />contract. Waiver of subrogation applies to general liability per CG7049, automobile liability, umbrella liability, and workers' compensation when required by
<br />written contract. Umbrella extends over general liability, auto liability and employer's liability. Should any of the above described policies be cancelled,
<br />notice will be delivered in accordance with the policy provisions.
<br />RE: Bid No. 2016008; Skeet and Trap facility Improvements for the Indian River County Public Shooting Range.
<br />CERTIFICATE HOLDER
<br />Indian River County
<br />1801 27th Street
<br />Vero Beach, FL 32960-3388
<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 />deo B gym n
<br />"v114/01)
<br />© 1988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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