Laserfiche WebLink
i <br />T Iliii(DR- i OP ID: TJ <br />III/FE O„UhL['urL ISUAINCE <br />-------- ---- — -- -- <br />DATE (MMIDDYYYY)C--R <br />cis/ a5I20'i 9 <br />----- ------------ — <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF 1NFORiVIATION ONLY AND CONFERS 1\10 EIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE=. DOES NOT AFFIRM/IATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER. THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CON.TRACf BETWEE=N THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCE=R, 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 172-286-4334 <br />Stuart Insurance, Inc. <br />3070 S W Mapp <br />Palm City, FL 34990 <br />Rick Halcomb, CIC, ARM <br />_ <br />Co NTACT Tani Jacobson <br />PHONE772-286.4334 JFAX 772-286-9389 <br />(A1C, No, Ext): (A/C, No): <br />aooREss. tjacobson@stu.ai-tinsu-rancL-.net <br />A <br />)( <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURERA:Everest Denali Ins CO 16044 <br />INSURED <br />Timothy Rose Contracting Inc <br />1360 Old Dixie HwV SW, Ste 106 <br />Vero Beach, FL 32962 <br />NSURERS: National Union Fire Insurance i9445 <br />INSURER C: Markel American 28932 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />-INSURER D: <br />INSURER E: <br />$ '100,000 <br />INSURER F: <br />MED EXP An one person)$ <br />COVERAGES CERTIFICATE_ NUIVIRER: RF -VISION nil MBEQ0 <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 />DDL <br />INSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY EXP <br />MM/DD/Yl'W <br />LIMITS <br />A <br />)( <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE )( OCCUR <br />Contractual Liab <br />CF3GL00172191 <br />06/06/2019 <br />06/06/2020 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />PREMISES aoccurence <br />$ '100,000 <br />)( <br />)( <br />MED EXP An one person)$ <br />5,000 <br />11iCIXCU <br />PERSONAL BADV INJURY <br />$ 1,000,000 <br />AGGREGATE LIMIT APPLIES PER : <br />PRO- <br />POLICY )( PRO- ❑LOC <br />JECT <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GEN'L <br />PRODUCTS - COMP/OPAGG <br />2,000,DDO <br />$ <br />$ <br />_ <br />OTHER: <br />A <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />1,000,000 <br />$ <br />}( <br />ANYAUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />CF3CA00'143191 <br />06/06/2019 <br />06/06/2020 <br />BODILY INJURY Per person <br />$ <br />BODILY INJURY Per accident <br />$ <br />)( <br />)( <br />HIRED )' NON -OWNED <br />AUTOS ONLY X AUTOS ONLY <br />PIP $1D000 <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />UMBRELLA LIAB <br />)( <br />OCCUR <br />EACH OCCURRENCE <br />$ 3,000,000 <br />}( <br />EXCESS LIAR <br />CLAIMS -MADE <br />[BBIE035882715 <br />06/06/2019 <br />06/06/2020 <br />AGGREGATE <br />$ 3,000,000 <br />DED I I RETENTION$ <br />$ <br />- <br />WORKERS COMPENSATIONPER <br />AND EMPLOYERS' LIABILITY Y/ N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />If yes, describe under <br />N/A <br />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 />DESCRIPTION OF OPERATIONS below <br />C <br />Contractors Equip <br />MKEM31M0051334 <br />06/06/2019 <br />06/06/2020 <br />Rented <br />50,000 <br />1% DED, 1191N $1000 <br />Equipment <br />$1000 ded <br />DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) <br />Grading of Land/Site Prep - State of Florida, <br />SA IIIc P I. --'i <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLE=D BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IPI <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />cull.! zb © 1988-2015 ACORN CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />