2017-032A - Laserfiche WebLink

Home Browse Search

OP ID: TJ CERTIFICATE OF LIABILITY INSURANCE DATE 912017Y) 03/09/2017 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 N Stuart Insurance,Inc. AME: Tani Jacobson 3070 S W Mapp p/C No Ext:772-286-4334 NE FAX No): 772-286-9389 Palm City,FL,CIC, E-MAIL SS.tjacobson@stuartinsurance.net Rick Halcomb,CIC,ARM PRODUCER TIMOR-1 CUSTOMER ID#: 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 ICY EXP LTR TYPE OF INSURANCE DD UBR POLICY NUMBER MM/DDNYYY MMLICY EFF LDDfYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X CMM6079889 06/06/2016 06/06/2017 PREMISES Ea occurrence $ 500,00 CLAIMS-MADE 1XI OCCUR MED EXP(Any one person) $ 5,00 X Contractual Liab PERSONAL&ADV INJURY $ 1,000,00 X Incl XCU GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY X J C LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 A X ANY AUTO CMM6079889 06/06/2016 06/06/2017 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ X HIREDAUTOS (PER ACCIDENT) X NON-OWNEDAUTOS $ X PIP 10000 $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000200 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,00 A CMM6079889 06/06/2016 06/06/2017 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION I WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITSI ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A E.L EACH ACCIDENT $ (Mandatory in NH) E.L DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Contractors Equip CMM6079889 06/06/2016 06/06/2017 Rented 50,000 Equipment $1000 de DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESAttach ACORD 101,Additional Remarks Schedule,if more space is required) RE: Bid No 2017026, Fischer Lake Island Water Assessment Project —Indian River County is additional insured for ongoing and completed operations when required by written contract.30 days notice of cancellation, 10 days for non-payment CERTIFICATE HOLDER CANCELLATION IRCBO-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. Board of County Commissioners 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