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MELVINI OP ID:S9 '4`.4Ro CERTIFICATE OF LIABILITY INSURANCE D09/MM/ 09/10/22014014Y) 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(les) 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 CONTACT Brown&Brown of Florida,Inc. NAME: 1201 W Cypress Creek Rd#130 A/CNNo E.11:954-776-2222 ---TF-Ax No):954-776-4446 P.O.BOX 5727 E-MAIL Ft.Lauderdale,FL 33310-5727 ADDRESS: Michael Gorham INSURERS AFFORDING COVERAGE NAIC# INSURER A:FCCI Commercial Ins Co 33472 INSURED Melvin Bush Construction,Inc. INSURER B:Brid afield Employers Ins.Co 10701 Attn:Johanne Bush INSURER C:National Trust Insurance Co. 20141 2748 SW Casella Street Port St. Lucie,FL 34953 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICYFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YY MM/DD/Y GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 C X COMMERCIAL GENERAL LIABILITY GL0011663 04/17/2014 04/17/2015 PREMISESEa occurrence $ 300,00 CLAIMS-MADE �OCCUR 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 POLICY X PRO-MT L1 LOC $ AUTOMOBILE LIABILITY (CEO, SINGLE LIMIT 1,000,00 Ea accident A X ANY AUTO CA0018245 04/17/2014 04/17/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATIONX WC STATU- OTH- AND EMPLOYERS'LIABILITYI ER B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 83026276 01/01/2014 01/01/2015 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? ❑ N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 CANCELLATION INDIANI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Indian River Count THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 1801 27th Street,Bldg A AUTHORIZED REPRESENTATIVE Vero Beach,FL 32960 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD