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A� Roy CERTIFICATE OF LIABILITY INSURANCE 4/1312021 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 ADDITIONAE INSURED, the policy(les) 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(!). PRODUCER Prime Insurance Solutions, Inc. 3040 N. Wickham RD. CO ACT E: PHONE . (321) 259-7920 FA'1 N :321 259-7921 o�Ls : INSURER(S) AFFORDING COVERAGE MAIC# Suite 8 Melbourne FL, 32935 INSURER A: WESTCHESTER SURPLUS LINES INS. 10172 INSURED INSURER 8: INSURER C: J.S.R. ENTERPRISES EAST COAST LLC INSURERD: JSR FUELING TECHNOLIGIES, LLC INSURER E: 3505 TADLOCK AVE GRANT VALKARIA, FL 32950 INSURERF: 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. INSRTYPE LTRWVb OF INSURANCE ADD SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMIE Ea o=mncal $ 50,000 CLAIMS -MADE a OCCUR MED EXP Any one person) $ 5,000 XX G7176025A 002 11/09/20 11/09/21 $ 1,000,000 A PERSONAL BADV INJURY GEN% AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMPIOPAGG $ 2,000,000 ✓ POLICY JELOC OTHER: c D L LIM $ COMBAUTOMOBILE LIABILITY BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE $ er n AUTOS ONLY AUTOS ONLY $ UMBRELLALI iOCCUR EACH OCCURRENCE $ _ AGGREGATE _ $ . EXCESS UAS CLAIMS -MADE DED I I RETENTION b $ DTH - PAR11. WORKERS COMPENSATION E.L. EACH ACCIDENT $ AND EMPLOYERS' LIABILITY Y 1 N ANypROPWETOWPARTNERlEXECUTNE E.L DISEASE - EA EMPLOYE $ OF FICERIMEMBER EXCLUDED? ❑ (Mandatory In NH) NIA EL DISEASE - POLICY LIMIT $ B yes, describe under DESCRIPTION OF OPERATIONS below EACHAIM-$1,000,00 CONTRACTORS G7176025A 002 11/09/20 11/09/21 AGGREGATE-$2,IN70,000 A POLLUTION DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe aNachad If mora space Is required) A PROFESSIONAL LIABILITY G7176025A 002 11/09/20 11/09/21 EACH CLAIM $1,000,000 AGGREGATE $2,000,000 CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED {rGRi1rIVA1G nVwLc� ---- "' INDIAN RIVER COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1801 27TH STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. VERO BEACH, FL 32960 AUTHORIZED REPRESENTATIVE W-IyDD-LU 1.7 11liVR4J a.vRrvrw 11v1.. r.w nyuw .coc..`.+. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD