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TIMOR -1 <br />OP ID: TJ <br />CERTIFICATE OF LIABILITY INSURANCE <br />DA04/18/201TE Y) <br />04/18/2018 <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 <br />Stuart Insurance, Inc. <br />3070 S W Mapp <br />Palm City, FL 34990 <br />CNAONTACT Tani Jacobson <br />ME: <br />PHONE 772-286-4334 FAX 772-286-9389 <br />(A/C, No, Ext): (A/C, No): <br />E-MAIL s: tjacobson stuartinsurance. net <br />Rick Halcomb, CIC, ARM <br />Y <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURER A: Westfield Insurance Co. 24112 <br />06/06/201$ <br />INSURED Timothy Rose Contracting Inc <br />1360 Old Dixie Hwy SW, Ste 106 <br />INSURER e <br />INSURER C <br />Vero Beach, FL 32962 <br />INSURER D: <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY FX PELT FILOC <br />INSURER E <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER: 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 />TYPE OF INSURANCE <br />DDL <br />NSD <br />UBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXPITR <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MADEX OCCUR <br />X Contractual Liab <br />Y <br />CMM6079889 <br />06/06/2017 <br />06/06/201$ <br />EACH OCCURRENCE $ 1'000'000 <br />DAMAGETORENTED 500,000 <br />PREMISES E o c «ence $ <br />5,000 <br />MED EXP An one person)$ <br />X Incl XCU <br />PERSONAL & ADV INJURY $ 1'000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY FX PELT FILOC <br />GENERAL AGGREGATE S 2,000,000 <br />PRODUCTS -COMP/OP AGG $ 2,000,000 <br />Emp Ben. 1,000,000 <br />OTHER: <br />A <br />AUTOMOBILE <br />X <br />X <br />X <br />LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />AUTOS ONLY X ATOS ONLYY <br />PIP $10000 <br />Y <br />CMM6079889 <br />06/06/2017 <br />06/06/2018 <br />EOMs INdeDt SINGLE LIMIT $ 1,000,000 <br />BODILY INJURY Per person $ <br />BODILY INJURY Per accident $ <br />PPReor c RdTnlDAMAGE $ <br />A <br />X <br />UMBRELLA LAB <br />EXCESS LAB <br />X <br />OCCUR <br />CLAIMS -MADE <br />CMM6079889 <br />06/06/2017 <br />06/06/2018 <br />EACH OCCURRENCE $ 3,000,000 <br />AGGREGATE $ <br />DED F—FRETENTION $ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />Mandatory in NH) <br />NIA <br />, <br />PER OTH. <br />I STATUTE ER <br />E.L. EACH ACCIDENT $ <br />A <br />If yes, rib <br />DESCRdescIPTIONe OFunder OPERATIONS below <br />Contractors Equip <br />CMM6079889 <br />06/06/2017, <br />06/06/2018 <br />E.L. DISEASE - EA EMPLOYEE $ <br />E.L. DISEASE - POLICY LIMIT S <br />Rented 50,000 <br />Equipment $1000 ded <br />DESCRIPTION OF OPERATIONS I 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. -Indian River County and Indian River Farms Water Control District are <br />additional insured with respect togeneral liability for ongoing and <br />completed operations and auto liability. 30 days notice cancellation, 10 <br />days non-payment <br />(`Curl Cl/"nrC ur�i nrn <br />Indian River County <br />Purchasing Division <br />1800 27th Street <br />Vero Beach, FL 32960 <br />ACORD 25 (2016/03) <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 />AUTHORIZED REPRESENTATIVE Q <br />Ily <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />