2017-005B - Laserfiche WebLink

Home Browse Search

V l/VVI LV I 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 CONTANAME:CT Tani Jacobson Stuart Insurance,Inc. Fax: 772-286-9389 PHONE FAX 3070 S W Mapp A/C No 772.286-4334 Ext): A/C No): 772-286-9389 Palm Cit FL 34990 E-MAIL City, ADDRESS:tjacobson@stuartinsurance.net Rick Halcomb,CIC,ARM PRODUCER CUSTOMER ID#:TIMOR-1 INSURERS)AFFORDING COVERAGE NAIC# INSURED Timothy Rose INSURER A:Westfield Insurance 24112 Contracting, Inc. INSURER B. 1360 Old Dixie Hwy SW,Ste 106 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. /NSR LTR TYPE OF INSURANCE INSR DDL EXP UBDR POLICY NUMBER MMIDPOLIDYIYYYY MMIDDYIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CMM6079889 06/06/2016 06/06/2017 PREMISES Ea occurrence AMAGE TO RENTED $ 500,00 CLAIMS-MADE Fx_1 OCCUR MED EXP(Any one person) $ 5,000 X Contractual Liab PERSONAL BADV INJURY $ 1,000,00 X Incl XCU GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 17 POLICY X J OT- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A X ANY AUTO CMM6079889 06/06/2016 06/06/2017 BODILY INJURY $ 1,000,00 BODILURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE' X HIREDAUTOS (Per accident) $ X NON-OWNED AUTOS $ X PIP 10000 $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,00 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,00 A _ CMM6079889 06106/2016 06/06/2017 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION VVC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER _ ANY PROPRIETOR/PARTNER./EXECUTIVE❑ N I A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ q Contractors Equip CMM6079889 06/06/2016 06/06/2017 Rented 50,000 Equipment $1000 ded DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Grading of Land/Site Prep - State of Florida CERTIFICATE HOLDER CANCELLATION IRCBD-1 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. 1801 27th St Vero Beach,FL 32960 AUTHORIZED REPRESENTATIVE—__ ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD