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SHNSI AN -03 HHASSFI 1 '44COR6W CERTIFICATE OF LIABILITY INSURANCE `--�� DATD/1YYY) 100/8/2/8/2019 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 R V Johnson Agency, Inc. 2041 SE Ocean Blvd Stuart, FL 34996 CONTACT Carol Rzaca - Ext. 233 NAME: PHONE FAX (A/C, No, Ext): (772) 287-3366 (A/c, No):(772) 287-4255 E-MAIL SS: crzaca@rvjohnson.com ADDRE INSURERS AFFORDING COVERAGE NAIC # INSURER A: Southern Owners Insurance 10190 72436125 INSURED INSURER B: National Indemnity CO. 20087 INSURER C : StarStone National Ins Co. Harborside Financial Ctr Sunshine Land Design, Inc. INSURER D: Bridgefield Employers Ins. 10701 3291 SE Lionel Terrace , Stuart, FL 34997 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JEC 7 LOC INSURER E: INSURER F: COVERAGES CFRTIFICATF NIIMRFR• RFVISInN NI IMRF:P- 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 TR TYPE OF INSURANCE ADDL IN D SUBR WVD POLICY NUMBER POLICY EFF MM DD YYY POLICY EXP MM DD YY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR X Blk Addl Insured 72436125 ]/30/2018 ]/30/2020 EACH OCCURRENCE $ 1'000'000 DAMAGE TO RENTED 100,000 PREMISES Ea oc urr nce $ MED EXP An one person)$ 5,000 X Blk Waiver PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JEC 7 LOC GENERAL AGGREGATE $ 2'000'000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E n $ 1'000'000 X ANY AUTO OWNED SCHEDULED AUTOS ONLY X AUTOS 74APB003312 7/30/2019 7/30/2020 BODILY INJURY Per person)$ BODILY INJURY Per accident $ X X HIRED NON -OWNED AUTOS ONLY UAUTOS ONLY PIP _$10,000 X OOO-$125,000/$300, PROPERTY DAMAGE Per accident $ $ C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1'000'000 EXCESS LIAB CLAIMS -MADE 170854191ALI 8/10/2019 7/30/2020 AGGREGATE $ 1'000,000 DED X RETENTION$ 10,000 1,000,000 D WORKERS COMPENSATIONOTH- AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N FFICER/MEMBER EXCLUDED? ❑ Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 830-56011 11/1/2018 11/1/2019 X PER TAT TE 1 1 ER E.L. EACH ACCIDENT $ 1'000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: Indian River County Bid No. 2019076 - IR Blvd and Grand Harbor Blvd Signalization Indian River County Florida is included as additional insured with respect to general liability and auto liability. 30 days notice of cancellation, except 10 days notice of cancellation for non-payment of premium. G 1y88-2015 AGORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Indian River County 1801 27th Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Vero Beach, FL 32960 AUTHORIZED REPRESENTATIVE lJ ArnRn 9S rDnia/nif G 1y88-2015 AGORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD