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ACOR D®CERTIFICATE OF LIABILITY INSURANCE
<br />5/18/201"7 '
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ,
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Frank H. Furman, Inc.
<br />1314 East Atlantic Blvd.
<br />P. 0. BOX 1927
<br />Pompano Beach FL 33061
<br />CONTACT
<br />NAME:
<br />PHONE (954) 943-5050 FAX (954)943-5417
<br />EMAILDDRE .SANDI@furmaninsurance.com
<br />- INSURERS AFFORDING COVERAGE NAIC#
<br />INSURER ANational Fire Ins of Hartford 20478
<br />INSURED
<br />Advanced Roofing Inc; Advanced Leasing Inc
<br />1950 N W 22 St
<br />Ft Lauderdale FL 33311
<br />INSURER B.Valley Forge Insurance Company 20508
<br />INSURER C'American Guarantee and Liab 26247
<br />INSURER D:Brid efield Employers Ins Co 10701
<br />INSURERE:Continental Casualty Co 20443
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER Apr 17 w/ forms REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />D
<br />BR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMI DIYYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCLRRENCE $ 11000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />DAMAGE TC RENTED 100,000
<br />P E MIS.a o c rren e $
<br />A
<br />CLAIMS -MADE FX_I OCCUR
<br />X
<br />Y
<br />6017071866
<br />/1/2017
<br />1/1/2018
<br />MED EXP (Aiy one person) $ 15, 000
<br />PERSONAL &ADV INJURY $ 11000,000
<br />X Per Proj Agg
<br />Contractual Liability &
<br />X Contractual & XCU
<br />GENERALA3GREGATE $ 2,000,000
<br />road Form PD Damage &
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG $ 2,000,000
<br />CU Liability Included
<br />17
<br />POLICY X PRO- LOC
<br />$
<br />AUTOMOBILE
<br />LIABILITYEa
<br />aBINEDt SINGLE LIMIT 11000,000
<br />B
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />X
<br />Y
<br />6017071849
<br />/1/2017
<br />1/1/2018
<br />BODILY INJURY (Per accident) $
<br />X
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />Per accident)$
<br />X
<br />Nonown-Phy Dm
<br />$
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />UC930367415
<br />EACH OCCLRRENCE $ 25, 000, 000
<br />C
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />mb is excess of all
<br />AGGREGATE $ 25, 000, 000
<br />DED X RETENTION zer
<br />$
<br />overage incl WC
<br />/1/2017
<br />1/1/2018
<br />D
<br />WORKERS COMPENSATION
<br />Y
<br />WC STATU- OTH-
<br />AND EMPLOYERS' LIABILITY YIN
<br />X I Y LIM
<br />E.L. EACH A;CIDENT $ 11000,000
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? IKN
<br />I A
<br />E.L. DISEASE - FA EMPLOYE $ 1,000,000
<br />(Mandatory in NH)
<br />083056020
<br />1/1/2017
<br />1/1/2018
<br />If yes, describe under
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />E
<br />INSTALLATION FLOATER
<br />4016260407
<br />/1/2017
<br />1/1/2018
<br />Any In, Jobsite $2,000,000
<br />5% WIND/HAIL DED$1000.AOP
<br />Any One Occurrence $2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I. VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
<br />Bid No. 2017040; Project Number: 1705; Project: Indian River County Administration Complex Buildings A &
<br />B Roof Replacement Indiian River County, 1800 & 1801 27th Street, Vero Beach, FL 32960. Indian River
<br />County, Engineer, and others as required by written contract are known as an Additional Insured as
<br />respects to General Liability and Automobile Liability as required by written contract subject to policy
<br />terms and conditions. Waiver of Subrogation in favor of the aforementioned Additional Insureds as
<br />respects to General Liability, Automobile Liability and Workers Compensation as required by written
<br />contract subject to policy terms and conditions. Umbrella is excess of GL, AL, and EL. 30 days N.O.C.
<br />f%cnTicl�A u
<br />^'" """'L;^ CANCELLATION
<br />purchasing@ircgov.com
<br />Indian River County
<br />Public Works Department
<br />1801 27th Street
<br />Vero Beach, FL 32960
<br />ACORD 25 (2010105)
<br />INS025 oninnF%m
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />Dirk DeJong/CS
<br />©1988-2010 ACORD CORPORATION. All rights reserved.
<br />T1- Ar:f1R11 names and Inns aro runic}arnH mar4c of Ar:rlpn
<br />
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