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-�-� I0R-1 OP ID: TJ <br />ACORO" <br />CERTIFICATE OF LIABILITY INSURANCE <br />DATE(M <br />05/155/20/20YYY) <br />18 <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 />CONTACT Tani Jacobson <br />NAME <br />- <br />PHONE 772-286-4334 FAX 772-286-9389 <br />(A/C, No, Ext): (A/C, No): <br />E-MAIL taco son stuartinsurance.net <br />ADDRE S: <br />Rick Halcomb, CIC, ARM <br />INSURERS AFFORDING COVERAGE NAIC p <br />INSURER A: Westfield Insurance Co. 24112 <br />INSURED Timothy Rose Contracting Inc <br />1360 Old Dixie Hedy SW, Ste 106 <br />INSURER B <br />CLAIMS -MADE X OCCUR <br />Vero Beach, FL 32962 <br />INSURER C ; <br />INSURER D <br />06/06/2017 <br />INSURER E: <br />DAMAGE TO RENTED SOO,000 <br />PR a occurrence $ <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 INSURANCEDDL <br />Indian River County <br />SUER <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXP <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE $ 1,000,000 <br />CLAIMS -MADE X OCCUR <br />Y <br />CMM6079889 <br />06/06/2017 <br />06/06/2018 <br />DAMAGE TO RENTED SOO,000 <br />PR a occurrence $ <br />MED EXP (Any oneperson) $ 5,000 <br />X Contractual Liab <br />X Incl XCU <br />PERSONAL BADV INJURY $ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY LX] jEo F—] LOC <br />GENERAL AGGREGATE $ 2,000,000 <br />PRODUCTS - COMP/OPAGG $ 2,000,000 <br />Emp Ben. $ 1,000,000 <br />OTHER: <br />A <br />AUTOMOBILE <br />LIABILITY <br />COMBIINdED SINGLE LIMIT $ 1,000,000 <br />BODILY INJURY Perperson) $ <br />X <br />ANY AUTO <br />y <br />CMM6079889 <br />06/06/2017 <br />06/06/2018 <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY Per accident $ <br />PerOaccidentDAMAGE $ <br />X <br />AUTOS ONLY X NON-OWNED <br />ONELYY <br />$ <br />X <br />PIP $10000 <br />A <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <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 RETENTION$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE F__l <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />If yes, describe under <br />N I A <br />- <br />PER OTH- <br />TAT TE I ER <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYE $ <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT $ <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: Indian River County Bid No. 2018043, 43rd Ave Bridge over IRFWCD South <br />Relief Canal Railing Repair. <br />-Indian River County is additional insured with respect to general liability <br />and auto liability <br />CERTIFICATE HOLDER CANCFI I ATInNI <br />IRCBD-1 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Indian River County <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Bldg Dept <br />AUTHORIZED REPRESENTATIVE <br />1801 27th St <br />Vero Beach, FL 32960 <br />AuuKu 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />