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IMOR-1
<br />OP ID: TJ
<br />1
<br />A (C4C:)R®°
<br />ieft...... CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />05/31/2018
<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 />Rick Halcomb, CIC, ARM
<br />CONTACT Tani Jacobson
<br />PHONE 772-286-4334 I FAX 772.286-9389
<br />(AIC, No, Ext): (AIC, No):
<br />E-MAIL tjacobson@stuartinsurance.net
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A :Westfield Insurance Co.
<br />24112
<br />INSURED Timothy Rose Contracting Inc
<br />1360 Old Dixie Hwy SW, Ste 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 />500,000
<br />$
<br />INSURER F :
<br />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 />LTRINSD
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />WVA
<br />POLICY NUMBER
<br />POLICY EFF
<br />(MM/DDIYYYY)
<br />POLICY EXP
<br />(MMIDD/YYYYI
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CMM6079889
<br />06/06/2018
<br />06/06/2019
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence)
<br />500,000
<br />$
<br />CLAIMS -MADE
<br />X
<br />OCCUR
<br />EXP (Any one person)
<br />$ 5,000
<br />X
<br />Contractual LiabMED
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />X
<br />Inc! XCIJ
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L
<br />AGGREGATE
<br />POLICY
<br />OTHER
<br />X
<br />LIMIT APPLIES
<br />78,
<br />PER:
<br />LOC
<br />PRODUCTS - COMP/OPAGG
<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 $10000
<br />X
<br />SCHEDULED
<br />AUTOS
<br />AUTO ONLY
<br />CMM6079889
<br />06/06/2018
<br />06/06/2019
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />1,000,000
<br />$
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />(Per PROPERTYDAMAGE$
<br />$
<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 />$
<br />DED
<br />RETENTION $
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITYY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVENIA
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />/ N
<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 more space is required)
<br />Grading of Land/Site Prep - State of Florida dfeshoh@ircgov.com
<br />CANCELLATION
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />IRCBD-1
<br />Indian River County
<br />1801 27th St
<br />Vero Beach, FL 32960
<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 />ENTATIVE
<br />AUTHORIZED REPRES,,,,,„6--______
<br />7,I
<br />(,l `' •C f
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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