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MELVIN BUSH CONSTRUCTION, INC. A�--SRO CERTIFICATEMELVINI OP ID: S9 OF LIABILITY INSURANCE DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE OL E/RO HIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to PRODUCER the terms and conditions of the policy, certain policies may require an Brown 8 Brown of Florida, Inc. 1201 W Cypress Creek Rd # 130 P.O. Box 5727 Ft. Lauderdale, FL 33310-5727 Michael Gorham INSURED Melvin Bush Construction, Inc. Attn: Johanne Bush 2748 SW Casella Street Port St. Lucie, FL 34953 COVERAGES THIS IS TO CERTIFY THAT THE INDICATED NOTWITHSTANDIN CERTIFICATE MAY BE ISSUED EXCLUSIONS AND CONDITIONS INSR LTR C A B TYPE OF INSURANCE GENERAL LIABILITY X CERTIFICATE NUMBER: endorsement. A statement on this certificate does not confer rights to the CONTACT NAME: PHONE A/C No Ext E-MAIL ADDRESS. 954-776-2222 INSURER S) AFFORDING COVERAGE INSURER A : FCCI Commercial Ins Co INSURER B. Bridgefield Employers Ins. Co INSURER c. National Trust Insurance Co. INSURER D : INSURER E . INSURER F: FAX C No : 954-776-4446 NAIC # 33472 10701 20141 POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREDENASION M D ABO EBER: FOR THE POLICY PERIOD G ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. A" SUER POLICY EFF POLICY EXP MM/DD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO - LOC AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED AUTOS HIRED AUTOS UMBRELLA LIAB EXCESS LIAB SCHEDULED AUTOS NON -OWNED AUTOS DED RETENT ON $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below OCCUR CLAIMS -MADE Y/N 1 N/A POLICY NUMBER GL0011663 CA0018245 83026276 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD RE: Bid No -2014045 - 69th Street Bridge Indian river County is listed as an Addi General Liability if required by written non-contributory as respects any other i CERTIFICATE HOLDER Indian River County Building Department 1800 27th Street Building 'B' Vero Beach, FL 32960 ACORD 25 (2010/05) 04/17/2014 04/17/2014 01/01/2014 04/17/2015 04/17/2015 01/01/2015 101, Additional Remarks Schedule, if more space is required) Over IRFWCD Lateral G Canal tional Insured with respect to contract. Coverage is primary and assurance INDIANI CANCELLATION LIMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) $ $ 1,000,000 300,000 MED EXP (My one person) $ PERSONAL 8 ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG 10,000 1,000,000 $ 2,000,000 $ COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ 2,000,000 1,000,000 BODILY INJURY (Per accident) PROPERTY DAMAGE (PER ACCIDENT) EACH OCCURRENCE AGGREGATE X WC STATU- T•RY IM - E.L. EACH ACCIDENT OTH E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ 1,000,000 1,000,000 1,000,000 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 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD