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/ , ® DATE(MM/DDNM) <br /> ACORO CERTIFICATE OF LIABILITY INSURANCE <br /> 7/20/2016 <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 CONTACT <br /> NAME: Angie Desormeaux <br /> Bowen, Miclette& Britt of Florida, LLCPHONE 407-647-1616 FAx ,•407-628-1635 <br /> 1020 N Orlando Avenue EMAIL <br /> Suite#200 Certificates@bmbinc.com <br /> Maitland FL 32751 INSURER(S)AFFORDING COVERAGE NAIC a <br /> INSURER A.Amerisure Mutual Insurance Company 23396 <br /> INSURED BARTHCONST INSURER B.Amerisure Insurance Company 19488 <br /> Barth Construction III, Inc. INSURER C. <br /> Barth Construction, Inc. <br /> 1717 Indian River Blvd#202 INSURER D. <br /> Vero Beach FL 32960 INSURER E. <br /> INSURER F. <br /> COVERAGES CERTIFICATE NUMBER: 521095552 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> A X COMMERCIALGENERALLIABILITY Y Y GL2018953 3/30/2016 3/30/2017 EACH OCCURRENCE $1,000,000 <br /> DAMAGE TO <br /> CLAIMS-MADE Fx-1 OCCUR PREMISES EaENTED occurrence $100,000 <br /> MED EXP(Any one person) $5,000 <br /> PERSONAL 8 ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> JE T F—]LOCPRODUCTS-COMP/OP AGG $2,000,000 <br /> POLICY a <br /> OTHER: $ <br /> B AUTOMOBILE LIABILITYY Y CA2018949 3/30/2016 3/30/2017 Ea accident $1,000,000 <br /> Ix <br /> ANY AUTO BODILY INJURY(Per person) $AUTOS NED SSC�HEEDULEDBODILY INJURY(Per accident) $ <br /> AOS <br /> HIRED AUTOS X NON-OWNED PR PERTY DAMA E $ <br /> AUTOS Per accident <br /> E <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB—___-CLAIMS-MADE——--- ----- AGGREGATE <br /> DED RETENTIONS $ <br /> B WORKERS COMPENSATION Y WC2018160 3/30/2016 3/30/2017X PER OTH- <br /> AND EMPLOYERS'LIABILITY STATE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE YNIA E.L.EACTUH ACCIDENT 5500,000 <br /> OFFICE <br /> RIMEMBER EXCLUDED? <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> The following policy provisions and/or endorsements form part of the policies of insurance represented by this certificate of insurance. The <br /> terms contained in the policies and/or endorsements supersede the representations made herein. Electronic copies of the policy provisions <br /> and/or endorsements listed below are available by emai ling. certificates@bmbinc.com <br /> When required by written contract,those parties listed in said contract, including the certificate holder, are added as an additional insured with <br /> respect to the general liability including ongoing and completed operations and the auto liability as afforded by the policy and/or <br /> See Attached. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Indian River County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 1800 27th Street ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Vero Beach FL 32960 <br /> AUTHORIZED REPRESENTATIVE <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />