2017-005B - Laserfiche WebLink

Home Browse Search

_— -1 OP ID TJ A�,,_� ®o CERTIFICATE OF LIABILITY INSURANCE DA01/24/2017TE Yi 01/24/2017 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 CONTACT Tani Jacobson Stuart Insurance,Inc. NAME: 3070 S W Mapp (A/CC,No Ext):772-286-4334 FA c Ne: 772-286-9389 Palm City,FL,CIC, E-MAIL tjacobson@stuartinsurance.net Rick Halcomb,CIC,ARM PRODUCER CUSTOMER ID p:TIMOR-1 INSURER(S)AFFORDING COVERAGE NAIC# INSURED Timothy Rose INSURER 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. INSR DDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 A X COMMERCIAL GENERAL LIABILITY X CMM6079889 06/06/2016 06106/2017 PREMISES Ea occurrence $ 500,000 CLAIMS-MADE Fx_1 OCCUR MED EXP(Any one person) $ 5,00 X Contractual Liab PERSONAL&ADV INJURY $ 1,000,00 X Incl XCU GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 17 POLICY X IPFc LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 A X ANY AUTO CMM6079889 06/06/2016 06106/2017 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULEDAUTOS PROPERTY DAMAGE X HIRED AUTOS (PER ACCIDENT) $ X NON-OWNEDAUTOS S X PIP 10000 $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 3,000,00 EXCESSLIAB CLAIMS-MADE AGGREGATE $ 3,000,00 A CMM6079889 06/06/2016 06106/2017 DEDUCTIBLE $ RETENTION S $ WORKERS COMPENSATION WC STATU- —70TH- AND EMPLOYERS'LIABILITY Y/N T RY IMIJER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE1 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ A Contractors Equip 71CMM6079889 06106/2016 06/06/2017 Rented 50,000 Equipment $1000 ded DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101 Addltioral Remarks Schedule,if more space Is required) RE: Bid No 2017013,43rd Ave Sidewalk Improvements from Aviation Boulevard to Airport Drive West.--Indian River County is additional insured with respect to general liability for ongoing and completed operations when required by written contract. CERTIFICATE HOLDER CANCELLATION IRCPD-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 Purchasing Division 1800 27th Street AUTHORIZED REPRESENTATIVE Vero Beach, FL 32960 �-- ©1988-2009 ACORD CORPORATION. All rights reserved ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD