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MANCTRA-02 RMFRRITT
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATEIMMIDDIYYYY)
<br />02(0512018
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS'UPON THE CtRTIFICATE 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(les) 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
<br />Collinsworth, Alter, Lambert, LLC
<br />23 Eganfuskee Street
<br />Suite 102
<br />Jupiter, FL 33477
<br />NAMEACT Suzanne Nelson
<br />PHONE
<br />(A/C, No, Ext): (561) 868-6291 IAAlc, No):(561) 427-6730
<br />AI DRlEss: Snelson@calilc.com
<br />POLICY NUMBER
<br />POLICY EFF
<br />IMM1DDfYYYYI
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />INSURER A:Amerisure Mutual Ins Co 23396
<br />A
<br />INSURED
<br />INSURER B:Brid efield Employers Ins Co 10701
<br />INSURER c.:AS en American Insurance Company 43460,
<br />Mancil's Tractor Service, Inc..
<br />8530 SW Jayme Way
<br />Palm City, FL 34990
<br />INSURER 0:
<br />EACH OCCURRENCE S 1,000,000
<br />INSURER E -
<br />INSURER F:
<br />COVERAGES CERTIFICATE III IMRGR• 0MR0 nn.
<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 I
<br />TYPE OF INSURANCE
<br />ADDL
<br />IND
<br />SUBR
<br />W VD
<br />POLICY NUMBER
<br />POLICY EFF
<br />IMM1DDfYYYYI
<br />POLICY EXP
<br />(MMIDDNYYYILIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE S 1,000,000
<br />CLAIMS -MADE ❑X OCCUR
<br />GL21078120002
<br />02/04/2018
<br />02/04/2019
<br />DAMAGE RENTED
<br />ante S 100,000
<br />MED EXP (Any oneperson) S 5,000
<br />PERSONAL& AOV INJURY S 1,000'000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />a E]
<br />GENERAL AGGREGATE S 2,000,000
<br />PRODUCTS =COMPIOPAGG S 2,000,000
<br />POLICY JEC LOC
<br />S
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />EO aBBIINdED SINGLE LIMIT S 1,000,000
<br />ANY AUTO
<br />CA21078110002
<br />02/04/2018
<br />02/04/2019
<br />BODILY INJURY Per erson S
<br />OWNED SCHEDULED
<br />BODILY INJURY Per accident S
<br />AUTOS ONLY AUTOS
<br />Ix
<br />HIRED X NON, ED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per acradent S
<br />PIP s 10,000
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE S 2,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />CU21078130002
<br />02/04/2018
<br />02104/2019
<br />AGGREGATE S 2,000,000
<br />DED I I RETENTIONS
<br />S
<br />B
<br />WORKERS COMPENSATION
<br />X PER OTH-
<br />AND EMPLOYERS' LIABILITY
<br />YIN
<br />TAT E ER
<br />E.L. EACH ACCIDENT S 1,000,000
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />83056494
<br />09/01/2017
<br />09/01/2018
<br />OF EXCLUDED?
<br />(Mandatory In NH)
<br />N / A
<br />E.L. DISEASE - EA EMPLOYEE S 1,000,000
<br />If yes, describe under
<br />E.L. DISEASE -POLICY LIMIT 5
<br />DESCRIPTION OF OPERATIONS below1,000,000
<br />C
<br />Equipment Floater
<br />IMZ364718
<br />02/04/2018
<br />02/04/2019
<br />LeasedlRented Equip 250,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />Certificate holder is included as an additional insured for ongoing and completed operations regarding general liability per form CG7048 and auto Liability
<br />when required by written contract. General Liability is primary and non-contributory when required by written contract. Waiver of subrogation applies to
<br />general liability, auto, and workers compensation when required by written contract. Umbrella extends over general liability, auto liability and employer's
<br />liability. Cancellation per policy terms and conditions.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Indian River County Board of County Commissioners THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />1840 25th Street
<br />Vero Beach, FL 32960
<br />AUTHORIZED REPRESENTATIVE
<br />AL;UKU ZO (ZU9b1W5) @ 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and loon are reaistprpri marke of ACnRn
<br />
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