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TIMOR -1 OP ID: TJ CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 0611212017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 772-286-4334 Stuart Insurance, Inc. 3070 S W Mapp CONTACT Rick Halcomb, CIC, ARM PHONE 772-286-4334 FAX 772-286-9389 (A/C, No, Ext): A/c, No Palm City, FL 34990 Rick Halcomb, CIC, ARM E-MAIL rhalcomb@stuartinsurance.net ADDRESS 06/0612017 06/06!2018 INSURERS AFFORDING COVERAGE NAIC ff INSURER A: Westfield Insurance Co. 24112 5,000 MED EXP An one person)_ INSURED Timothy Rose Contracting Inc 1360 Old Dixie Hwy SW, Ste 106 Vero Beach, FL 32962 INSURER B: INSURER C: GENERALAGGREGATE $ 2'000'000 PRODUCTS - COM P/OPAGG $ 2,000,000 INSURER D: INSURER E: AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS p AUTOS ONLY X AUTOS ONLYROPERTY 1XX PIP $10000 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR L TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF MI POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X occuR X Contractual Liab CMM6079889 06/0612017 06/06!2018 EACH OCCURRENCE $ 1,000'000 DAMAGE ro RENTED $ 500,000 5,000 MED EXP An one person)_ X Incl XCU PERSONAL &ADV INJURY 1,000,000 GEMLAGGREGATE LIMIT APPLIES PER: POLICY a jPo- El LOC OTHER: GENERALAGGREGATE $ 2'000'000 PRODUCTS - COM P/OPAGG $ 2,000,000 Emp Ben. $ 1,000,000 A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS p AUTOS ONLY X AUTOS ONLYROPERTY 1XX PIP $10000 CMM6079889 06/06/2017 06/06/2018 COMBINEDSINGLE LIMIT 11000,000 r' BODILY INJURY Per erson $ BODILY INJURY Per accident $ AMAGE Per accident E $ A X UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE CMM6079889 06106/2017 06/06/2018 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N PROPRIETOR/PARTNER/ECUTIVE ❑ PROPRIETOR/PARTNER/EXECUTIVE Mend tory in NH) EXCLUDED? Ifyes, desuibe under DESCRIPTION OF OPERATIONS below N / A PER OTH- TA UTE ER E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYE $ E.L. DISEASE- POLICY OMIT $ A Contractors Equip CMM6079889 06/06/2017 06106/2018 Rented 50,000 Equipment $1000 ded raC lilPTIONng o oL.aond ,' eN Y LOCArep TJYSJ oft�o l"IAc1a0RW1Ill itofi CI iregoV conn Schedule, may be attached if more space is required) IRCBD-1 Indian River County 1801 27th St Vero Beach, FL 32960 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN' ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD