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RJSULLI-01 SEESK
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (M
<br />1 /23//201201YYY)
<br />3
<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 />'.OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />_PRESENTATIVE 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 />- . .. --
<br />PRODUCER CONTACT
<br />NAME: Martha Kuveikis
<br />Insurance Office of America - JUP j PHONE 561 776-0660 FAX
<br />Abacoa Town Center (A/c No, Ext1 ( ) (A/C, No): (5.61) 776-0670
<br />1200 University Blvd, Suite 200 E-MAIL M
<br />Jupiter, FL 33458 ADDRESS:artha.Kuveikis@ioausa.com
<br />_ INSURER(S) AFFORDING COVERAGE NAIC #
<br />- INSURERA.Admiral Insurance Company 24856
<br />INSURED INSURER B: American Economy Insurance Company _19690
<br />R J Sullivan Corp. INSURER C: Zenith Ins Co 1.3269
<br />2001 NW 22nd Street INSURER D :
<br />Pompano Beach, FL 33069 INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 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 ADDL SUBR -
<br />LTR TYPE OF INSURANCE POLICY EFF POLICY EXP
<br />INSR WVD _ POLICY NUMBER (MM/DD/VYYY) (MM/DD/YYYY) LIMITS
<br />GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY FEIECC1198300 12/28/2012 12/28/2013 DAMAGE -TO RENTED 50 000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Job: West Regional WWTP Anaerobic Tanks Odor Control System Design
<br />Indian River County Board of County Commissioners is additional insured with respect to General Liability as required by written contract. 30 day Notice of
<br />Cancellation, 10 day for non-payment of premium, in accordance with policy provisions.
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<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 />Indian River Board of County Commissioners
<br />1800 27th Street
<br />Vero Beach, FL 32960 l
<br />© 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />CLAIMS X
<br />PREMISES IEa occurrence)
<br />$ ,
<br />-MADE OCCUR
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />- -- -
<br />GENE RALAGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />POLICY X PRO -
<br />— JECT _Loc - -
<br />- -
<br />CPL PL
<br />$ 1,000,000
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />EaaccidentZ
<br />1,000,000
<br />X ANY AUTO
<br />02CE2286311
<br />12/28/2012 12/28/2013
<br />_
<br />BODILY INJURY (Per person)
<br />$
<br />$
<br />ALL OWNED SCHEDULED
<br />—
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />$
<br />(PER ACCIDENT)
<br />UMBRELLA LIAB OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />A
<br />X EXCESS LIAB CLAIMS -MADE
<br />FEIEXS1198400
<br />12/28/2012 12/28/2013
<br />AGGREGATE
<br />$
<br />DED X RETENTION $
<br />General Aggrega
<br />$ 5,000,000
<br />WORKERS COMPENSATION
<br />X WC STATU- OTH-
<br />C
<br />AND EMPLOYERS' LIABILITY Y / N
<br />TORY LIMITS ER _
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? N / A
<br />Z068832107
<br />1/1/2013 1/1/2014
<br />E.L. EACH ACCIDENT
<br />$ 500,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 500,000
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 500,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Job: West Regional WWTP Anaerobic Tanks Odor Control System Design
<br />Indian River County Board of County Commissioners is additional insured with respect to General Liability as required by written contract. 30 day Notice of
<br />Cancellation, 10 day for non-payment of premium, in accordance with policy provisions.
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<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 />Indian River Board of County Commissioners
<br />1800 27th Street
<br />Vero Beach, FL 32960 l
<br />© 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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