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OP ID: TJ ACRO' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/09/2016 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 CONTNAMEACT Tani Jacobson Stuart Insurance,Inc. 3070 S W Map F (A/C.No Ext):772-286-4334 PHONE 'FAX, o): 772-286-9389 Palm City,FL,CIC, A DRESS:tjacobson stuartinsurance.net Rick Halcomb,CIC,ARM PRODUCER CUSTOMER ID u:TIMOR-1 INSURER(S)AFFORDING COVERAGE NAIC p INSURED Timothy Rose Contracting, Inc. INSURER A:Westfield Insurance 24112 1360 Old Dixie Hwy SW, Ste 106 INSURER B Vero Beach, FL 32962 INSURER C INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN SR I -A DL SUBR LTR TYPE OF INSURANCE EXP POLICY NUMBER MMIDDY/YYYY MM DDEFF POLICY/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE 5 1,000,00 A X COMMERCIAL GENERAL LIABILITY X CMM6079889 06/0612016 06/06/2017 PREMISES Ea occurrence $ 500,00 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,00 X Contractual Liab PERSONAL BADV INJURY $ 1,000,00 X Incl XCU GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY X PRO JE LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 A X ANY AUTO CMM6079889 06/06/2016 06106/2017 (Ea accident) BODILY INJURY(Per person) 5 ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (PER ACCIDENT) $ X NON-OWNEDA'JTOS $ X PIP 10000 $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,00 � A EXCESS LIAR CLAIMS-MADE AGGREGATE $ 3,000,00 CMM6079889 06/06/2016 06106!2017 DEDUCTIBLE $ RETENTION 5 $ WORKERS COMPENSATION WC STATU- PTH AND EMPLOYERS'LIABILITY IMI I ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N I A (Mandatory In If E.L.DISEASE-EA EMPLOYE 5 yes,describe under nd DESCRIPTION OF OPERATIONS below A Contractors Equip CMM6079889 06/06/2016 06/06/2017�RentedLIMIT $ 50,000 Equipment $1000 ded DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESAttach ACORD 101,Additional Remarks Schedule,if more space Is required) RE: 8th Street Sidewalk Improvements 58 Avenue to 21st Court Indian River County is additional insured with respect to General Liability. 30 days notice of cancellation, 10 days for non-payment CERTIFICATE HOLDER CANCELLATION INDIR-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Indian River County ACCORDANCE WITH THE POLICY PROVISIONS. Board of County Commissioners 1800 27th Street AUTHORIZED REPRESENTATIVE Vero Beach 32960 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD