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<br />-�® CERTIFICATE OF LIABILITY INSURANCE
<br />DAT/19/2DIYYYY)-
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE
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<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
<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) most 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
<br />R V Johnson Agency, Inc.
<br />2041 SE Ocean Blvd
<br />Stuart, FL 34996
<br />CONTACT -
<br />d'
<br />PHONE FAX
<br />A1C, Ne, Ext : (772) 287-3366 (AIC, N.),(772) 287-4255
<br />E-MAIL , info@rvjohnson.com
<br />INSURER(§) AFFORDING COVERAGE NAIL H
<br />ADDL SUeR( POLICY EFF POLICY EXP -"""-------"-"-----
<br />_ TYPE OF INSURANCE I O 5,,� POLICY NUMBER M11 A DD LItAIT§
<br />_
<br />INSURER A: Mt. Hawley 37974
<br />A X COMMERCIAL GENERAL LIABILITY
<br />INSURED
<br />INSURER B: Owners Insurance Company 32700
<br />_
<br />INSURER c: Scottsdale Insurance Co. 41297
<br />PRP Construction. Group LLC
<br />PO Box 1830
<br />Indiantown, FL 34956-1830
<br />NsuRERD:FFVA Mutual Insurance Co. 10385
<br />INSURER E:
<br />INSURER F:
<br />------- -.
<br />•^ -� ,',- . "r, — I 1 numtst_K: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE
<br />INSURED NAMED ABOVE FOR THE POLICY
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR
<br />PERIOD
<br />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
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />TERMS,
<br />INSR ..__.____.........__.._._—.___..______.....___._.__
<br />ADDL SUeR( POLICY EFF POLICY EXP -"""-------"-"-----
<br />_ TYPE OF INSURANCE I O 5,,� POLICY NUMBER M11 A DD LItAIT§
<br />A X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $
<br />1,000,000
<br />CLAIMS -MADE a OCCUR tvtGLO190393 10126/2019 10/26/2020 nAMAC'E TO RENTED
<br />50,000
<br />RFMi� nr-uurenc S
<br />MED EXP An one erser. $
<br />5,000
<br />- PERSONAL B ACV INJURY S
<br />1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE g
<br />-_I POLICY PE F
<br />2,000,000
<br />L" - I CT LOG
<br />PRODUCTS-COMP/OP.AGG s
<br />2,000,000
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT ,
<br />--I-II $
<br />1,000,000
<br />ANY AUTO
<br />X5068939600
<br />4/15/2019
<br />4/15/2020
<br />OWNED j' SCHEDULED
<br />AUTOS ONLY I X
<br />i
<br />BODILY INJURY Per erson 5
<br />BODILY INJURY fPer accidenn 5
<br />X
<br />AUTOS
<br />HIRED N
<br />X.,
<br />PROPERTY DAMAGE
<br />AU70S ONLY AU070S40NLDY
<br />.
<br />Per accident S"
<br />C
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />—_.......__._._...__ S
<br />r EACH OCCURRENCE $
<br />5,000,0001
<br />X
<br />EXCESS LIAR
<br />CLAIM§ -MADE
<br />XLS0112083
<br />10/26/2018
<br />10/26/2020
<br />DED RETENTION S -
<br />AGGREGATE 5
<br />5,000,0-00�
<br />D
<br />WORKERS COMPENSATION
<br />-X
<br />s
<br />5,000,000
<br />AND EMPLOYERS' LIABILITY
<br />PER OTH-
<br />ANY PROPRIETORIPARTNER/EXECUTIVE
<br />WC840.0029850-2019A
<br />11/9/2019
<br />11/9/2020
<br />SYAT T F PQ
<br />E.L- EACH ACCIDENT S
<br />500,000H
<br />OFFICERIMEMBER EXCLUDED? I - - r
<br />(Mandatory in NH) LN]
<br />NIA
<br />E.L. DISEASE -EA EMPLOYEES
<br />SO 0,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY UM1T S
<br />500,000
<br />I
<br />i
<br />-
<br />DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD Idt, Additional Remarks Schoduld, Inay bo attached it mare space Is required)
<br />Re: Indian River County Bid No. 2020016
<br />43rd Avenue Sidewalk from Airport Drive West to 41st Street
<br />Blanket Additional Insured applies under the General Liability. 30 day notice of Cancellation except non
<br />Indian River County. Blanket
<br />payment of premium 10 day notice applies In favor of
<br />Additional Insured applies on the Automoblle when it is required by a written
<br />Contract or agreement.
<br />CERTIFICATE HOLDER
<br />_ renlr•cl 1 nTrn.r
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Indian River County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />1800 27th Street ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Vero Beach, FL 32960
<br />ACORD 25 (2016/03)
<br />AUTHO��(RIIZZED REPRESENTATIVE
<br />y p`J �-tusr'o'-
<br />9 1988-2015
<br />The ACORD name and logo are registered marks. ofCORD CORPORATION. All rights reserved.
<br />ACORD
<br />
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