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�^.�,,,..•—*,� LAWRLEE-01 RROLLS
<br />Af QR Q'" DATE(MMIDD/YYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE 8/19/2020
<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 POLICIES
<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) 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 _CONTACT Diane Traynor
<br />....... ...--- --
<br />CAL Risk Management PHONE 561 776 9001 ac, No :561 427-6730
<br />23 Eganfuskee Street I (EAiMc, No, Ext)(561) _. 1
<br />Suite 102 ADDRE s, Dtraynor@callle,corn
<br />_.,__.
<br />Jupiter, FL 33477
<br />111 CIIOCOI CI ACCAD nI1Jn rn1lCC ATF IJAI('. }1
<br />INSURED
<br />Lawrence Lee Construction Services, Inc.
<br />50 NE Dixie Hwy
<br />Suite #A-6
<br />Stuart, FL 34994
<br />F:
<br />Admiral Insurance
<br />rnvcr Acno !`CDYtCIPATC 1Jltaa12CD• RFVIA111M MIIMRFR•
<br />10335
<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 I TRTYPE
<br />OF INSURANCE
<br />IVSD WV
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />A !
<br />X COMMERCIAL GENERAL LIABILITY
<br />i
<br />EACH OCCURRENCE
<br />$ 1'000'000
<br />DAMAGE TO RENTED
<br />pREM15Es (Ea occurrence) I
<br />300,000
<br />$
<br />1
<br /><1 1'-
<br />CLAIMS -MADE �X OCCUR
<br />X X.C.0 Contractual5,000
<br />......_...�. ._.,..,._._ ..
<br />y
<br />X X ,CA00003577001
<br />1
<br />8128/2019
<br />8/2812020
<br />MED EXP An one�erscm
<br />S
<br />PERSONAL &ADV INJURY.,
<br />1 600,000
<br />_GEN1_ AGGREGATE LIMIT APPLIES PER I
<br />POLICY I X. 1 !ERCT 1 LOC
<br />i
<br />r
<br />GENERAL AGGREGATE _
<br />PRODUCTS COMPIOP AG
<br />$ 21060'000
<br />2'666'666
<br />OTHER: cappted at $5,000,000
<br />B
<br />AUTOMOBILE LIABILITY
<br />i
<br />I
<br />I
<br />COMBINED SINGLE LIMIT
<br />a I n$
<br />1,000,000
<br />X ANY AUTO
<br />5193054600
<br />8128/2019 !
<br />6/2812020
<br />BODILY INJURY_(Por pPrsan)_.._i_$_.........._._
<br />......................._...._.................
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />3
<br />;
<br />!
<br />BODILY INJURY Per accident)
<br />$
<br />(Per accident)DAMAGE
<br />—�--
<br />I $
<br />RE p pV� E
<br />.......... AUTOS ONLY .._.._.. AUTOS ATYY
<br />i
<br />PIP
<br />$ 10,000
<br />A
<br />UMBRELLA LIAB X OCCUR
<br />I
<br />EACH OCCURRENCE
<br />$ 2'600'000
<br />AGGREGATE_.
<br />$ _
<br />X
<br />EXCESS UAe CLAIMS.
<br />ExCESS
<br />GX00000253101
<br />612612019
<br />I 8/2612020
<br />...
<br />_.. __ ..........
<br />Den X RETENTIONS 0
<br />1
<br />ProdlComp Agg
<br />t 2,000,000
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />YIN
<br />ANY PROPRIE"fORIPARTNEWEXECUI IVE 1
<br />QFFICEWMEMegEER EXCLUDED?
<br />andatory in NH) _--�
<br />X.
<br />� N (A';.
<br />19646923
<br />8/28/2019
<br />8/28/2020
<br />i
<br />X SEAT T ERH
<br />_
<br />E.L. EACH ACCIDENT
<br />E.L_DISEASE.,,EA EMPLOYEE
<br />--------
<br />1 000,000
<br />) $
<br />1,000,000
<br />It yes, describe and P,r
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,666'666
<br />D
<br />Pollution Liability
<br />IPECO05270901
<br />9/13/2019
<br />8/2812020
<br />$1M Occur/Aggregate
<br />2,000,000
<br />D
<br />Professional Liabili
<br />i
<br />I
<br />'PECO05270901
<br />9/13/2019
<br />i
<br />! 8/28/2020
<br />$1M Ocur/Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more sL�ace is required)
<br />Project Name: Hobart R.O. Water Treatment Plant Chemical Tanks Replacement, 7751 58th Ave., Vero Beach, FL 32967
<br />Certificate Holder is added as an additional insured for general liability, auto liability and pollution liability when required by written contract. Per project
<br />aggregate applies when required by written contract. General Liability and Auto Liability are primary and non-contributory when required by written contract.
<br />Waiver of subrogation applies to general liability, auto liability and employers liability. Umbrella extends over General Liability, Auto Liability and Workers
<br />Compensation policies. Cancellation applies as per policy terms, conditions and exclusions.
<br />RPRTIFIRATP I -Int 11PR rA1drFl I ATInM
<br />ACORD 25 (2016/03) © 1988.2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Indian River Count a Political Subdivision of the State of
<br />Y.
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Florida
<br />1801 27th Street
<br />AUTHORIZED REPRESENTATIVE
<br />Vero Beach, FL 32960
<br />ACORD 25 (2016/03) © 1988.2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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