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TIMOR -1 OP ID: TJ
<br />�--� CERTIFICATE OF LIABILITY INSURANCE
<br />FIE (..'DD/YYYY)
<br />0312212018
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsernent(s).
<br />PRODUCER 772-286-4334
<br />Stuart Insurance, Inc.
<br />3070 S W Mapp
<br />Palm City, FL 34990
<br />Rick Halcomb, CIC, ARM
<br />CCiOMNTACT Tani Jacobson
<br />PHONE 772-286-4334 FAx 772-286-9389
<br />(A/C, No, Ext): (A/C, No):
<br />ADORIEss: tfacobson stuartinsura nce.net
<br />POLICY EXP
<br />LIMITS
<br />A
<br />INSURERS AFFORDING COVERAGE
<br />NAIC p
<br />INSURER A : Westfield Insurance Co,
<br />24112
<br />INSURED Timothy Rose Contracting Inc
<br />1360 Old Dixie Hwy SW, Ste 106
<br />INSURER B
<br />S 1,000,000
<br />INSURER C
<br />Vero Beach, FL 32962
<br />INSURER D:
<br />INSURER E
<br />PDAMAGE REM SETOERENTE a occur ence
<br />S 500,000
<br />INSURER F
<br />CLAIMS -MADE � OCCUR
<br />y
<br />COVERAGES CFRTIFICATF NHMRFR• owlclnnl LII InAn CID
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVEFORTHE 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,
<br />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 />ILTR NSR
<br />TYPE OF INSURANCE
<br />DDL
<br />UBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />S 1,000,000
<br />PDAMAGE REM SETOERENTE a occur ence
<br />S 500,000
<br />CLAIMS -MADE � OCCUR
<br />y
<br />CMM6079889
<br />06/06/2017
<br />06/06/2018
<br />X Contractual Liab
<br />MED EXP An one person)$
<br />5,000
<br />X Incl XCU
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY [X]PRp ❑
<br />GENERAL AGGREGATE
<br />$ 2 ,000,000
<br />PRODUCTS - COMP/OPAGG
<br />$ 2,000,000
<br />JECT LOC
<br />Emp Ben.
<br />1,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />E n
<br />1,000,000
<br />$
<br />X ANY AUTO
<br />OWNED SCHEDULED
<br />y
<br />CMM6079889
<br />06/06/2017
<br />06/06/2018
<br />BODILYINJURY Per erson
<br />$
<br />BODILY INJURY Per accident
<br />$
<br />AUTOS ONLY AUTOS
<br />HIRED pp
<br />X
<br />PROPERTY AMAGE
<br />Per accident
<br />$
<br />AUTOS ONLY AUU ONLDY
<br />X PIP $10000
<br />EACH OCCURRENCE
<br />3,000,000
<br />$
<br />A
<br />X UMBRELLA LAB X OCCUR
<br />EXCESS LAB CLAIMS -MADE
<br />CMM6079889
<br />06/06/2017
<br />06/06/2018
<br />DED RETENTION$
<br />AGGREGATE
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />PER OTH-
<br />Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTI VE
<br />TAT T R
<br />pFF IC ER/MEMBER EXCLUDED? ❑ N / A
<br />(Mandatory in NH)
<br />E.L. EACH ACCIDENT
<br />$ _
<br />if yes, tlescribe untler
<br />E.L. DISEASE EA EMPLOYEE
<br />$
<br />DESCRIPTION OF OPERATIONS below
<br />A Contractors Equip
<br />E.L. DISEASE - POLICY LIMIT
<br />CMM 0610612017 06/06/2018 Rented
<br />50,000
<br />Equipment
<br />$1000 ded
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: Indian River County Bid No. 2018026,
<br />37th to 53rd Street
<br />Indian River Blvd Sidewalk from
<br />Indian River County is additional insured with respect to general liability
<br />and auto liability
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />IRED-1
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
<br />BEFORE
<br />Indian River County
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Purchasing Division
<br />1800 27th St
<br />Vero Beach, FL 32960,;
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 f?n1F/nz1
<br />(� c f C�_
<br />9The ACORD name and logo are registered marks of A 015 CORD CORPORATION. All rights reserved.
<br />ACORD
<br />
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