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'4� "r CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) I TYPE OF INSURANCE 04/22/2020 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 ICONTACT Jeffrey Rendel(FL091) c/o Arthur J. Gallagher Risk Management Service NAME: PHONE 561 746-5027 FAX (561)746-5028 A/c No Ext), ( ) A/c No E-MAIL ADDRESS: 250 Tequesta Drive Tequesta, FL 33469 INSURERS) AFFORDING COVERAGE NAIC # INSURERA: Zurich -American Insurance Company 16535 INSURED Matrix PEO Holdings, LLC Alt. Emp: Timothy Rose Contracting, Inc. INSURER B 9016 Phillips Hwy INSURER C: Jacksonville, FL 32256 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:20FLO91999443 REVISION NUMBER: 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 LTR I TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS COMMERCIALGENERALLIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY JECT r LOC GENERAL AGGREGATE $ PRODUCTS -COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY J PROPERTY DAMAGE Per accident $ 1 $ - 1 UMBRELLA LIAB 11 OCCUR EACH OCCURRENCE $ EXCESS LIP CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N OFFICER/MEMBER EXCLUDED?ECUTIVE ❑ NIA WC 67-02-840-01 01/01/2020 01/01/2021 X STATUTE EERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYE$ 1 ,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 Location Coverage Period: 01/01/2020 01/01/2021 Client# 10979 -FL DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Timothy Rose Contracting, Inc. Coverage iprovided for 1360 Old Dixie H SW Suite 106 only those c so -employees � of, but not subcontractors Vero Beach, FL 32962 to: CERTIFICATE HOLDER CANrFI I ATIOM Timothy Rose Contracting, Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1360 Old Dixie Hwy SW THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Suite 106 ACCORDANCE WITH THE POLICY PROVISIONS. Vero Beach, FL 32962 AUTHORIZ/EED7 REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD