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r <br />yr <br />IMP <br />OP ID: TJ <br />��:"' CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/Y) <br />05/12/20152015 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />HOLDER. THIS <br />BY THE POLICIES <br />AUTHORIZED <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER Phone: 772-286-4334 <br />Stuart Insurance, Inc. <br />3070 S W Mapo Fax: 772-286-9389 <br />Palm City, FL 34990 <br />Rick Halcomb, CIC, ARM <br />NAMEACT Rick Halcomb <br />A/C. No. Ext)• 772-286-4334FAX <br />(Arc No): 772-286-9389 <br />E-MAREIL <br />ADDSS: rhalcomb@stuartinsurance.net <br />POLICY EXP <br />(MM DD//YYYY) <br />PRODUCER TIMOR -1 <br />CUSTOMER ID #: <br />INSURER(S) AFFORDING COVERAGE <br />A <br />INSURED Timothy Rose <br />Contracting, Inc. <br />1360 Old Dixie Hwy SW, Ste 106 <br />Vero Beach, FL 32962 <br />Cfl /r DAnce r-..--.-.....'.-.....--__ <br />INSURER A : Westfield Insurance <br />NAIC # <br />24112 <br />INSURER B <br />X <br />INSURER C: <br />CMM6079889 <br />INSURER D : <br />06/06/2015 <br />INSURER E : <br />$ <br />INSURER F : <br />PREM SESO(Ea EoNuT c <br />• <br />Ili. <br />I� <br />THIS <br />INDICATED. <br />CERTIFICATE <br />EXCLUSIONS <br />INSR <br />--""' ...... tItVIJION NUMLIEK: <br />IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LIR <br />TYPE OF INSURANCE <br />ADDL <br />INSR <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />(MMDO//YYYY) <br />POLICY EXP <br />(MM DD//YYYY) <br />LIMITS <br />A <br />GENERAL <br />X <br />LIABILITY <br />COMMERCIAL GENERAL <br />X <br />LIABILITY <br />OCCUR <br />X <br />CMM6079889 <br />06/06/2014 <br />06/06/2015 <br />EACH OCCURRENCE <br />$ <br />1,000,000 <br />PREM SESO(Ea EoNuT c <br />$ <br />500,000 <br />CLAIMS -MADE <br />MED EXP (Any one person) <br />$ <br />10,000 <br />X <br />X <br />GEN'L <br />Contractual Liab <br />PERSONAL & ADV INJURY <br />$ <br />1,000,000 <br />Inc! XCU <br />GENERAL AGGREGATE <br />$ <br />2,000,000 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY X PRO- <br />JEC7 LOC <br />PRODUCTS - COMP/OP AGG <br />$ <br />2,000,000 <br />$ <br />rII <br />A <br />AUTOMOBILE <br />X <br />X <br />X <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />CMM6079889 <br />06/06/2014 <br />06/06/2015 <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />$ <br />$ <br />Inl <br />II/ <br />A <br />UMBRELLA LIAB <br />EXCESS LIAB <br />X <br />OCCUR <br />CLAIMS -MADE <br />CMM6079889 <br />06/06/2014 <br />06/06/2015 <br />EACH OCCURRENCE <br />$ <br />3,000,000 <br />AGGREGATE <br />$ <br />3,000,000 <br />DEDUCTIBLE <br />RETENTION $ <br />$ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />Y! N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N / A <br />WC STATU- IOTH- <br />( TORY LIMITS ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />1DESCRIPTION <br />A <br />Contractors Equip <br />CMM6079889 <br />06/06/2014 <br />06/06/2015 <br />Rented <br />Equipment <br />50,000 <br />$1000 ded <br />OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />RE: 20th Ave & 16th Street Intersection Improvements (project 0225 <br />Indian River County and Indian River Farms Water Control District are <br />additional insured with respect to general liability. <br />CANCELLATION <br />IRCPD-1 <br />Indian River County <br />Board of County Commissioners <br />1800 27th Street <br />Vero Beach, FL 32960 <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 />ACORD 25 (2009/09) <br />© 1988-2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />