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<br />�nL>�r. �I f��� ,:������i_= ��" �x.����:$�@�_.�.1 if �i�\I,��s:�.,��o�-r����o�____
<br />DATE(MMIDDNYYY)
<br />06/051'/_01°.
<br />THIS CE=RTIFICATE IS ISSUED AS A IhATTER OF INFORMATION OIJI_Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTE=ND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETLNELN 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 13 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 endorselnent(s).
<br />PRODUCER 772-236-4334
<br />Stuart Insurance, Inc,
<br />S it Mapp
<br />Pal
<br />Palm city, FL 3ass0
<br />Rick Halcomb, CIC, ARM
<br />_
<br />cANTncT Tani Jacobson
<br />PHONE 7'72.2.86••4334 FAx 772-2_36-9389
<br />(AIC, No, Ext): (AIC, Ido):
<br />E-MAIL ,-tjaco bson stuartmsurance.net
<br />ADDR
<br />INSURER(S) AFFORDING COVERAGE MAIC if
<br />DAMAIGSETORaENTufD $ '100,000
<br />INSURER A: Everest Denali Ins Co 16044
<br />INSURED
<br />Timoth Rose Contracting Inc
<br />1360 Ofd Dixie H181N, Ste 106
<br />Beach, FL 32962
<br />INSURER B: National Union Fife Insurance 19445
<br />INsuRER c : Markel American T8_932Vero
<br />_
<br />INSURER D
<br />GENERAL AGGREGATE S 2,000,000
<br />INSURER E
<br />INSURER F:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE 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 />L7
<br />A
<br />TYPE OF INSURANCE
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE Y OCCUR
<br />X Contractual Liab
<br />ADDL
<br />INSD
<br />SUB
<br />UBR
<br />POLICY NUMBER
<br />"
<br />CF3GL00172191
<br />POLICY EFF
<br />M /DDlWYI'
<br />06/OG/2019
<br />POLICY EXP
<br />MI h'Yl'Y'
<br />06/06/2020
<br />LIMITS
<br />EACH OCCURRENCE $ 1,000,000
<br />DAMAIGSETORaENTufD $ '100,000
<br />MED EXP An one person)S 5,000
<br />X
<br />IITCI XCU
<br />PERSONAL&ADVItdJURY 1,000,000
<br />GENTAGGREGATE LIMITAPPLIES PER:
<br />F-1711 0 POLICY j �T F]LOC.
<br />GENERAL AGGREGATE S 2,000,000
<br />PRODUCTS-COMPIOPAGG S 2,000,000
<br />$
<br />SINGLE LIMIT 1,000,000
<br />i S
<br />A
<br />OTHER:
<br />AUTOMOBILE LIABILITYCOMBINED
<br />)� ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />)� AUTOS ONLY Y NUTOS ONLY
<br />)( PIP $10000
<br />CF3G/�00'143191
<br />06/06/2019
<br />06/06/202_0
<br />_
<br />BODILY INJURY Per parson) $
<br />BODILY INJURY Per accident $
<br />PeOr accRdenDAMAGE $
<br />UMBRELLA LIAB )� OCCUR
<br />)( EXCESS LIAB CLAIMS -MADE
<br />BE035882715
<br />06/06(2.019
<br />06/06/2020
<br />S
<br />EACH OCCURRENCE $ 3,000,000
<br />AGGREGATE $ 3,000,000
<br />DED RETENTION$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNER/EXECUTIVE
<br />OFFICERIMEMBER EXCLUDED? ❑
<br />I fvyes, d ory bI and
<br />If yes, describe under
<br />NIA
<br />-
<br />PER OTH-
<br />ER
<br />E.L. EACH ACCIDENT S
<br />E.L. DISEASE - EA EMPLOYE ° S
<br />E.L. DISEASE - POLICY LIMIT $
<br />Rented 50,000
<br />Equipment $1000 ded
<br />C
<br />DESCRIPTION OF OPERATIONS below
<br />Contractors Equip
<br />1 DED, 1t111iN $1000
<br />MtCL11/131M0051334
<br />06/06/2019
<br />06/06/2020
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />Grading of Land/Site Prep -State of Florida
<br />SAMPLA
<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 />wvr�u c� ttu Iulua) 01988-2.015 ACORD CORPORATION, All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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