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ACC7Kl�k' CERTIFICATE OF LIABILITY INSURANCE L...--' ATE(MM/DD/YYYY) 12/30/2019 r 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 Jeffrey Rendel (AJG)_NAME: c/o Arthur J. Gallagher Risk Management Service 250 Tequesta Drive CONTACT PHONE FAX A/C No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # Tequesta, FL 33469 INSURER A: Zurich -American Insurance Company 16535 INSURED Matrix PEO Holdings, LLC Alt. Emp: Timothy Rose Contracting Inc INSURER B : - INSURER C : 9016 Phillips Hwy Jacksonville, FL 32256 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 20FLO911002506 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER EFF MM/DDY/YYYY) POLICY EXP (MMIDDIYYYYt LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE D OCCUR EACH OCCURRENCE $ DAMAGE R N _ PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- F JECT LOC POTHER: PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS DAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- X AND EMPLOYERS' DABILITYYIN STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 A ANYPROPRIETORIPARTNERIEX OFFICER/MEMBER EXC UDED?ECUTIVE ❑ N/A WC 67-02-840-01 01/01/2020 01/01/2021 (Mandatory In NH) If yes, describe under E.L. DISEASE - EA EMPLOYEd $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS below Location Coverage Period: 01/01/2020 01/01/2021 Client# 10978 -FL DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Timothy Rose Contracting Inc. Coverage is provided for only those co -employees 1360 Old Dixie Hwy SW Suite 106 of, but not subcontractors Vero Beach, FL 32962 to: !`COTI Cl/�ATr ri�� rrr Indian River County 1801 27th Street Vero Beach, FL 32960 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE w iyoa-LU10 ACUKU CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD