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MELVINI OP ID: S9 '4� RSR CERTIFICATE OF LIABILITY INSURANCE DATE71MMIDDNYYY) 09/2014 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(ies) 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 Brown & Brown of Florida, Inc. 1201 W Cypress Creek Rd # 130 P.O. BOX 5727 Ft. Lauderdale, FL 33310-5727 CONTACT NAME: to N Ext : 954-776-2222 FAX No): 954-776-4446 E-MAIL ADDRESS: GENERAL LIABILITY Michael Gorham INSURERS AFFORDING COVERAGE NAIC q INSURER A: FCCI Commercial Ins Co 33472 INSURED Melvin Bush Construction, Inc. INSURER B: Bridgefield Employers Ins. Co 10701 Attn: Johanne Bush 2748 SW Casella Street INSURER C: National Trust Insurance Co. 20141 INSURER D: Port St. Lucie, FL 34953 INSURER E: 04/17/2014 INSURER F : DAMAGE TO RENTED PREMISES Ea occurrencel $ 300,000 COVERAGES CERTIFICATE NUMRER- RFVIRION mumRFR- 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. IXP LTR TYPE OF INSURANCE Building Department POLICY NUMBER MM/DDmYY POLICY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 C X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FKOCCUR GL0011663 04/17/2014 04/17/2015 DAMAGE TO RENTED PREMISES Ea occurrencel $ 300,000 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 POLICYIF X PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,00 Ea accident BODILY INJURY (Per person) $ A X ANY AUTO CA0018245 04/17/2014 04/17/2015 ALL OW NED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ PER ACCIDENT UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE83026276 OFFICER/MEMBER EXCLUDED? F—] (Mandatory In NH) N / A 01/01/2014 01/01/2015 X WC STATU- OTH- O IMI S R E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is listed as additional insured as respects general liability if required by written contract. Coverage is primary & NOn- Contributory as respects any other insurance. CERTIFICATE HOLDER CANCFI 1 ATION INDIAN1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Indian River Count Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 1801 27th Street, Bldg A Vero Beach, FL 32960 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD