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Ili*. 4 47'31A47 <br />111AIFlt llFr.r)r)? <br />ACORD,. CERTIFICA LIABILITY INSURAi <br />DATE13/20(MM/DDffYYY) <br />-:OF .0"E <br />7/16 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CER fIFICATE 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 />CONTACT <br />NAME: <br />BB&T Insurance Services, Inc. <br />PA/qHONE AX <br />_L__, No, Ext 407 691-9600 J"rtAIC No): 888-635-4183 <br />PO Box 4927 <br />E-MAIL <br />Orlando, FL 32802-4927 <br />1 ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSU'RER A � �itl`D al Trust Insurance Compan <br />120141 <br />.407 691-9600 <br />INSURED �INSURER B: FFVA Mutual Insurance Company 10385 <br />I <br />- _ _ __ <br />Blue Goose Construction LLC <br />INSURER C: FOCI Insurance Company 10178 <br />P. O. Box 14709 INSURER D: <br />Fort Pierce, FL 34979-4709 —_ -_ .—__— ____ _­ - <br />�INSURER <br />E: <br />1 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 AFFDRDED 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 />T14—SR bDLTs_uBN _POLICY ­EFF_*r­POLICY EXP <br />LTR --�INSR JWVD � NUMBER L, LIMITS <br />TYPE OF INSURANCE POLICY MM/DDfYYYY) (MMIDDf" <br />[ <br />A X1 COMMERCIAL GENERAL LIABILITY X GL00176832 3/0 $1000000 <br />, = <br />EACH _,_ n. <br />—1 CLAIMS-MADELx I OCCUR <br />X PID Ded:5,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER, <br />i [ _-X1 PRO- r- I <br />I POLICY JECT i LOC <br />OTHER: <br />C AUTOMOBILE LIABILITY X CA002925602 <br />- 1 <br />X1 ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />NON -OWNED <br />X HIRED AUTOS X AUTOS <br />AX� UMBRELLA LIA � <br />X OCC <br />UR <br />UMB002066502 <br />EXCESS LIAB CLAIMSMADE <br />I DIED j Xj RETENTION $10000 <br />B WORKERS COMPENSATION <br />� AND EMPLOYERS' LIABILITY Y N T I WC84000311432016A <br />I ANY PROPRIETOP/PARTNER/EXECUT.VE*- N/A <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory In NH) <br />If yes, describe under <br />(01/2016 <br />03!01!201 <br />RAMAGE To RENTED <br />PREMISES Fn occurrence) 1$1001.900 <br />MED EXP (Any one person) $ 5 000 <br />PERSONAL & ADV INJURY $11,000,000 <br />GENERAL AGGREGATE $2,000,000 <br />PRODUCTS - COMP/OP AGG $2,000,000 <br />COMBINED SINGLE LIMIT <br />(Ea acctclentL <br />BODILY INJURY (Per person) <br />��Si,c 00,000 <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />/0112016103/01/2017_ <br />EACH OCCURRENCE <br />$10000,001 <br />AGGREGATE <br />$10,000,001 <br />L:[O�TH. ' $ <br />1/01/2016 01/01/201�il-MTUTE - r <br />E.L. EACH ACCOENT$1,000000 <br />_J <br />_ ­ !-L= __ — E.1_ DISEASE - EA EMPLOYEE 1 $1,000,000 <br />E,L. DISEASE -POLICY LIMIT $1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Re: Bid #2016032 -South County Water Treatment Plant Well No. 7 Raw Water Pipeline <br />I Earlier Notice of Cancellation Provided by Us form #IL 011 (12106). <br />Additional Insured status is granted as respects to General Liability if required by written contract or <br />(See Attached Descriptions) <br />TC IJA1 f1CC IAlkle-Cl I AT111M <br />Indian River County <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />1800 27th Street <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Vero Beach, FL 32960 <br />AUTHORIZED REPRESENTATIVE <br />------------- <br />(0 1988-2014 ACUKD (;URPILIKA1 ION. All rights reservecl. <br />ACORD 25 (2014101) 1 of 2 The ACORD name and logo are registered marks of ACORD <br />#S16516110/M15703808 MOCCI <br />