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OP ID: TJ A�.------ 1,- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/06/2016 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 Stuart Insurance, Inc. 3070 S W Mapp Fax: 772-286-9389 Palm City, FL 34990E Rick Halcomb, CIC, ARM CONTACT Tani Jacobson NAME: (AJC No Ext):772-286-4334 FAX (A/C, No): 772-286-9389 -MAIL tjacobson@stuartinsurance.net ADDRESS: PRODUCER TIMOR -1 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Timothy Rose Contracting, Inc. 1360 Old Dixie Hwy SW, Ste 106 Vero Beach, FL 32962 INSURER A :Westfield Insurance 24112 INSURER B INSURER C : CMM6079889 INSURER D : 06/06/2017 K.MED INSURER E $ INSURER F : DAMAGE TO RENTED PREMISES (Ea occurrence) E CERTIFICATE 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER DlPOLICY EFF {MMIDYYYY) POLICY EXP (MMIDD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X OCCUR CMM6079889 06/06/2016 06/06/2017 K.MED EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500,000 CLAIMS -MADE EXP (Any one person) $ 5,000 X X GEN'L —1 Contractual Liab PERSONAL &ADV INJURY $ 1,000,000 Inc! XCU GENERAL AGGREGATE $ 2,000,000 AGGREGATE LIMIT APPLIES PER: POLICY X PROT- JECLOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X X X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS PIP 10000 CMM6079889 06/06/2016 06/06/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ A x UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE CMM6079889 06/06/2016 06/06/2017 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 DEDUCTIBLE RETENTION $ - $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N / A WC STATU-10TH- TORY LIMITS ER E.L. EACH ACCIDENT $ below E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Contractors Equip CMM6079889 06/06/2016 06/06/2017 Rented Equipment 50,000 $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 Indian River County 1801 27th St Vero Beach, FL 32960 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 ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD