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OP ID: MK Aco o= CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 09/30/2014 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 Phone: 772-286-4334 Stuart Insurance, Inc. Fax: 772-286-9389 3070 S W Mapp Palm City, FL 34990 Rick Halcomb, CIC, ARM NAME: CT Rick Halcomb OE _286-4334 FA(ax (A/PHc. NNo, Ext 772c, No): 772-286-9389 n DRESS: rhalcomb@stuartinsurance.net PRODUCER CUSTOMER ID #:TIMOR -1 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Timothy Rose Contracting, Inc. 1360 Old Dixie Hwy SW Vero Beach, FL 32962 INSURER A: Westfield Insurance 24112 INSURERS: CMM6079889 INSURER C: 06/06/2015 INSURER D : $ 1,000,000 INSURER E : $ 500,000 INSURER F : CLAIMS -MADE 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. 1LTR TYPE OF INSURANCE ADDL NSR S WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERALUABIUTY X COMMERCIAL GENERAL LIABILITY OCCUR CMM6079889 06/06/2014 06/06/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occunence) $ 500,000 CLAIMS -MADE X MED EXP (Any one person) $ 10,000 X Contractual Liab PERSONAL & ADV INJURY $ 1,000,000 X Inc! XCU GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: —1 POLICY X JR O- n LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X X X UABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CMM6079889 06/06/2014 06/06/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ A UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS -MADE CMM6079889 06/06/2014 06/06/2015 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC STATU- OTH- TORY LIMITS ER E.L EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Contractors Equip CMM6079889 06/06/2014 06/06/2015 Rented 50,000 Equipment $1000 ded DESCRIPTION OF OPERATIO S / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Grading of Land/Site Prep - State of Florida CERTIFICATE HOLDER CANCELLATION OLDDR-1 Old Dixie Highway Resurfacing Indian River County Board of Commissioners 1801 27th Street Beach, FL 32960ill SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Q_IVero pe...wejtifrvt ACORD 25 (2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD