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TIMORA OP ID: TJ <br />� l <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />144c"Jv"" <br />CERTIFICATE ®F LIABILITY INSURANCE <br />FDATE(MM/DD/YYYY) <br />TYPE OF INSURANCE <br />/03/2018 <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 endorsement(s). <br />PRODUCER 772-286-4334 NAMEPCT Tani Jacobson <br />Stuart Insurance, Inc. PHONE772-286-4334 FAX 772-286-9389 <br />No, Ext): (A/C, No): <br />3070 S W Mapp (A/C, <br />Palm City, FL 34990 E-MAIL ss:tjaco son stuartlnsurance.net <br />Rick Halcomb, CIC, ARM <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURERA:Westfield Insurance Co. 24112 <br />INSURED Timothy Rose Contracting Inc INSURERB: <br />1360 Old Dixie Hwy SW, Ste 106 <br />Vero Beach, FL 32962 INSURER C: <br />INSURER D: <br />INSURER E: <br />INSURER F: <br />rrnvBDACBc CEPTIFIreTF NUMBER: REVISION NUMBER: <br />vTHIS 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 />TYPE OF INSURANCE <br />DDL <br />NqDPOLICY <br />UBR <br />NUMBER <br />POLICY EFF <br />POLICY EXP <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />1800 27th Street <br />Vero Beach, FL 32960 <br />AUTHORIZED REPRESENTATIVE <br />EACH OCCURRENCE $ 1'000'000 <br />DAMAGE TO RENTED 500,000 <br />PREMISES Ea occurrence) $ <br />CLAIMS -MADE OCCURY <br />CMM6079889 <br />06/06/2017 <br />06/06/2018 <br />MED EXP (Any oneperson) $ 5'000 <br />X Contractual Liab <br />X Incl XCU <br />PERSONAL &ADV INJURY $ 11000'600 <br />GEN'LAGGREGATE LIMIT APPLIES PER: <br />POLICY [XI JECT E] LOC <br />OTHER: <br />GENERAL AGGREGATE $ 2'000'000 <br />PRODUCTS - COMP/OP AGG $ 2,000,000 <br />Emp Ben. $ 1,000,000 <br />A <br />AUTOMOBILE LIABILITY <br />' <br />COMBINED�EetSINGLE LIMIT $ 1,000,000 <br />BODILY INJURY Per person)$ <br />AUTO <br />CMM6079889 <br />06/06/2017 <br />06/06/2018 <br />BODILY INJURY Per accident $ <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />1XXANY <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLYPIP <br />pe0racc,gDAMAGE$ <br />$ <br />$10000 <br />A <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />- <br />EACH OCCURRENCE $ 3,000,000 <br />AGGREGATE $ <br />EXCESS LIAB <br />CLAIMS -MADE <br />CMM6079889 <br />06/06/2017 <br />06/06/2018 <br />DED I RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />H <br />ST 'T TE ER <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYE $ <br />OFFICER/MEMBER EXCLUDED? ❑N <br />(Mandatory in NH) <br />/ A <br />F . DISEASE -POLICY LIMIT $ <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />A <br />Contractors Equip <br />CMM6079889 <br />06/06/2017 <br />06/06/2018 <br />Rented 50,000 <br />Equipment $1000 ded <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />RE: 58th Ave Resurfacing/Reclamantion from North of 26th St to South of 49th <br />St. <br />Indian River County and Indian River Farms Water Control District are <br />additional insured with respect to general liability for ongoing and <br />completed operations. 30 days notice cancellation, 10 days non-payment <br />nr- 1 r,rA=: uni n=D CANCFI 1 ATinN <br />ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />IRCBO-1 <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 />Indian River County <br />Purchasing Division <br />1800 27th Street <br />Vero Beach, FL 32960 <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />