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SECTION 00620 -Sample Certificate of Liability Insurance CERTIFICATE OF LIABILITY INSURANCE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE INSURED COMPANY A- COMPANY B- COMPANY C- COMPANY D- COMPANY E- COVERAGES 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 ACCORDED 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. POLICY INSR POLICY EFFECTIVE POLICY EXPIRATION LM TYPE OF INSURANCE NUMBER DATE MM/DD DATE MM/D/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A ❑COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any One Fire $ 50,000 ❑CLAIMS MADE-❑OCCUR MED.EXP.(Any One Person $ 5,000 ❑ PERSONAL&ADV INJURY $ 1,000,000 ❑ GENERAL AGGREGATE $ 1,000,000 ❑ PRODUCTS—COMP/OP AGG. $ 1,000,000 ❑ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A ❑ANY AUTO (Ea.Occurrence) $ 1,000,000 ❑ALL OWNED AUTOS _ BODILY INJURY __ _ ❑SCHEDULED AUTOS (Person) $ er P ❑HIRED AUTOS BODILY INJURY $ [INON-OWNEDAUTOS (Per Accident) ❑ PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY—EA ACCIDENT $ ❑ OTHER THAN EA ACC $ ❑ AUTO ONLY AGG $ A EXCESS LIABILITY EACH OCCURRENCE ❑ ❑CLAIMS MADE ❑DEDUCTIBLE AGGREGATE $ ❑RETENTION$ $ $ WORKER'S COMPENSATION AND A EMPLOYER'S LIABILITY ❑WC STATUTORY LIMITS E.L.EACH ACCIDENT $ 100,000 THE E.L.DISEASE—EA $ 500,000 PROPRIETOR/PARTNERS/ ❑INCL EXECUTIVE OFFICERS ARE: ❑EXCL E.L.DISEASE-POLICY LIMIT $ 100,000. OTHER: FULL REPLACEMENT COST BUILDER'S RISK OF THE WORK DESCRIPTION OF OPERATIONS/LOCATIONS VEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ADDITIONAL INSURED: INDIAN RIVER COUNTY 1801 27TM STREET VERO BEACH FL 32960-3388 00620-Sample Certificate of Liability Insurance REV 04-07 00620-1 F•\Public WorksIENGINEERING DIVISION PROJECTS\1619 Round Island Facility Paving\1-Admin\bid documents\Master Contract Documents\00620-Sample Certificate of Liability Insurance REV 04-07.doc Rev 05/01