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TIMOR -1 <br />OP ID: T <br />,.CORD' CERTIFICATE OF LIABILITY INSURANCE <br />�� <br />DATE04/23/2019Y) <br />04/23/2019 <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 />Rick Halcomb, CIC, ARM <br />CONTACT Tani Jacobson <br />PHONE 772-286-4334FAX 772-286-9389 <br />(A/C, No, Exll: I (AIC, No): <br />E-MAILDSS; tjacobson@stuartinsurance.net <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURER A : Westfield Insurance Co. <br />24112 <br />ENSURED <br />I Imoth Rose Cont r ctin Inc <br />1360 Ord Dixie HwX SW, she 106 <br />Vero Beach, FL 32962 <br />INSURER B ; Travelers <br />CMM6079889 <br />INSURER C : <br />06/06/2019 <br />INSURER D : <br />$ 1,000,000 <br />INSURER E : <br />CLAIMS -MADE X <br />INSURER F : <br />DAMAGE TO RENTED <br />PREMISES (Ea occurrence) <br />COVERAGES <br />• <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 <br />TYPE OF INSURANCE <br />ADDL <br />INSD <br />SUBR <br />WVDIMM/DD/YYYY) <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXP <br />(MM/DD/YYYYI <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />X <br />CMM6079889 <br />06/06/2018 <br />06/06/2019 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE X <br />OCCUR <br />DAMAGE TO RENTED <br />PREMISES (Ea occurrence) <br />$ 500,000 <br />X <br />Contractual Liab <br />MED EXP (Any one person) <br />$ 5,000 <br />X <br />' Incl XCU <br />PERSONAL R ADV INJURY <br />$ 1,000,000 <br />GEN'L <br />AGGREGATE <br />POLICY X <br />OTHER: <br />LIMIT APPLIES PER: <br />JECOT LOC <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS - COMP/OP AGG <br />$ 2,000,000 <br />Emp Ben.$ <br />1,000,000 <br />A <br />AUTOMOBILE <br />X <br />X <br />X <br />LIABILITY <br />ANY AUTO <br />OWNED <br />AUTOS ONLY <br />AUTOS ONLY <br />PIP $10000 <br />X <br />SCHEDULED <br />AUTOS <br />AUUTOS ONLDY <br />X <br />CMM6079889 <br />06/06/2018 <br />06/06/2019 <br />COMBINED SINGLE LIMIT <br />(Ea accideA) <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />$ <br />$ <br />BODILY INJURY (Per accident) <br />PROPERTY DAMAGE <br />(Per accident) <br />B <br />X <br />UMBRELLA LIAB <br />EXCESS LIAB <br />X <br />OCCUR <br />CLAIMS -MADE <br />ZUP-61M977995-18-NF <br />06/06/2018 <br />06/06/2019 <br />EACH OCCURRENCE <br />$ 3,000,000 <br />AGGREGATE <br />$ <br />DED RETENTION$ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITYY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />andatory In tJ Vi) <br />I( es, describe under <br />DESCRIPTION OF OPERATIONS below <br />/ N <br />N / A <br />PER OTH- <br />STATUTE _ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />E.L. DISEASE -POLICY LIMIT <br />$ <br />A <br />Contractors Equip <br />CMM6079889 <br />06/06/2018 <br />06/06/2019 <br />Rented <br />Equipment <br />50,000 <br />$1000 ded <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mo e space is requi ed) <br />RE: Old Dixie Hwy/Highland Drive, Project 1362 <br />—Indian River County is additional insured with respect to general liability <br />and auto liability <br />r`C DTICIt` A TC ural nrn <br />CANCELLATION <br />Indian River County <br />1801 27th St <br />Vero Beach, FL 32960 <br />ACORD 25 (2016/03) <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 />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />© 1988-2015 ACORD CORPORATION. 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