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ACORO CERTIFICATE OF LIABILITY INSURANCE `"'----- DATE(MM/DDIYYYY) 5/27/2015 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(les) must 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 SUNZ Insurance Solutions LLC ID: (Essential) c/o Essential HR, Inc. dba First Star HR 4455 LBJ Freeway, Suite 1080 Dallas, TX 75244 NAMEACT Jennifer Hauqer PHONE FAX (A/C. No. Extl: 972-404-0295 LA/C, No): EMAIL ADDRESS: jennifer.hauger(cDfirststarhr.com LIMITS NAIC # INSURER(S) AFFORDING COVERAGE INSURER A : SUNZ Insurance Company 34762 INSURED Essential HR Inc FirstStar HR 4455 LBJ Freeway Suite 1080 Dallas TX 75244 INSURER B : Aspen Re - London - Best Rating "A" INSURER c : Catlin Syndicate - Lloyds - Best Rating "A" EACH OCCURRENCE INSURER o : Brit Syndicate - Lloyds - Best Rating "A" INSURER E INSURER F : CERTIFICATE NUMBER: 24827288 REVISION NUMBER: 1 I MIS 15 10 GERTIFY 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 INSD SUBR MD POLICY NUMBER POLICY EFF (MMIOD/YYYY) POLICY EXP (MMIDDIYYYY) LIMITS 1 1 COMMERCIAL GENERAL LIABIUTY .".J�/^�� EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES $ (Ea occurrence) MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECOT LOC PRODUCTS - COMP/OP AGG $ OTHER $ 1 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ I ALL OWNED AUTOS _ SCHEDULED AUTOS BODILY INJURY (Per accident ) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ 1 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DED RETENT ON $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WCPE00000184 02 10/1/2014 10/1/2015 J PER STATUTE OTH- ER y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A WCPE00000184 01 10/1/2013 10/1/2014 E.L. EACH ACCIDENT $ 1,000,000 stir (Mandatory In NH) If describe E.L. DISEASE - EA EMPLOYEE $ 1,000,000 yes, under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B C NWD Workers Compensation Excess Coverage This is for informational purposes and nothing shall create any right under such reinsurance. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage provided for all leased employees but not subcontractors of: Timothy Rose Contracting, Inc. ow Effective date: 10/1/2013 Re: 20th Ave & 16th Street Intersection Improvements (project 0225) CERTIFICATE HOLDER 62200099 Indian River CountySHOULD Board of Count Cmmissioners ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1800 27th Street ACCORDANCE WITH THE POLICY PROVISIONS. Vero Beach FL 32960 AUTHORIZED REPRESENTATIVE 1 e 1 Glen J Distefano .".J�/^�� r ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD .1111, 24827288 1 1 Master Essential HP dba Employee Professionals 1 Natalie Matthews 1 5/27/2015 12:28:22 PM (CDT) 1 Page 1 of 1