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'-'IL-011....OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />6/23/2015
<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 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
<br />Lassiter -Ware Insurance of Tampa Bay
<br />1300 N. Westshore Blvd
<br />Suite 110
<br />Tampa FL 33607
<br />CONTACT Debra Linkous
<br />NAME:
<br />PHOjJo,Frtic (800)845-8437 iac,No):(Bea)883-6680
<br />E-MAIL
<br />ADDRESS: DebraL@lassiter-ware.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIL #
<br />INsuRERA:HDI-Gerling America Insurance
<br />41343
<br />INSURED
<br />Johnson -Davis, Inc.
<br />604 Hillbrath Drive
<br />Lantana FL 33462
<br />INSURER B :Endurance American Specialty
<br />41718
<br />INSURER C :Bridgefield Casualty
<br />10335
<br />INSURER 0:XL Specialty Insurance Co
<br />37885
<br />INSURER E :
<br />$ 100,000
<br />INSURER F:
<br />•
<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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSR
<br />SUER
<br />wvn
<br />POLICY NUMBER
<br />POLICY EFF
<br />(MMIDD/YYYY)
<br />POLICY EXP
<br />(MM/DO/YYYY)
<br />LIMITS
<br />A
<br />GENERAL
<br />X
<br />LIABILITY
<br />COMMERCIAL GENERAL LIABILITY
<br />X
<br />Y
<br />EGGCC000173515
<br />Blanket Additional Insd
<br />incl Prod/Compl Ops and
<br />Primary & Non-Contrib.
<br />Contractual Liability
<br />3/1/2015
<br />3/1/2016
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence)
<br />$ 100,000
<br />CLAIMS -MADE
<br />X
<br />OCCUR
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONALBADVINJURY
<br />$ 2,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />7 POLICY n PEO- n LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2 , 000 ,000
<br />$
<br />A
<br />AUTOMOBILE
<br />X
<br />X
<br />UABILITY
<br />ANY AUTO
<br />ALL OWNED
<br />AUTOS
<br />HIRED AUTOS
<br />x
<br />_„
<br />-
<br />SCHEDULED
<br />AUTOS
<br />NON -OWNED
<br />AUTOS
<br />x
<br />y
<br />EAGCC000173515
<br />Additional Insd
<br />3/1/2015
<br />3/1/2016
<br />COMBINED SINGLE OMIT
<br />(Ea accident)
<br />$ 2,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />PIP -Basic
<br />$ 10,000
<br />A
<br />x
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />EXAGC000173515
<br />Follow Form
<br />3/1/2015
<br />3/1/2016
<br />EACH OCCURRENCE
<br />$ 3,000,000
<br />AGGREGATE
<br />$ 3,000,000
<br />DED X
<br />RETENTON$ 10,000
<br />$
<br />C
<br />WORKERS COMPENSATIONWC
<br />AND EMPLOYERS' LIABILITY
<br />•ANY PROPRIETOR/PARTNER/EXECUTIVE0196-38538
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />Y f N
<br />N
<br />N / A
<br />Blanket Waiver of Subrog
<br />3/1/2015
<br />3/1/2016
<br />X
<br />STATU- OTH-
<br />TORY LIMITS ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />B
<br />D
<br />Excess Lia (follow form)
<br />Installation Floater
<br />ELD10006501300
<br />UM00034349tdp,15A
<br />3/1/2015
<br />3/1/2015
<br />3/1/2016
<br />3/1/2016
<br />$1,000,0000/Si.000,000 Excess of $3M
<br />S200,000 Blkt All Jobs
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
<br />Pollution Liability - $1,000,000 Policy #7930030920000, Eff 3/1/15-16 Homeland Insurance Company of NY
<br />Project: Indian River County Bid No. 2015011, 45th Street Canal Enclsourer at 43rd Ave (Project No.
<br />1427); Indian River County and Indian River Farms Water Control District are an additional insured as
<br />respects to General Liability and Business Auto Policies. Coverage includes completed operations, and is
<br />on a primary and non-contributory basis. Waiver of Subrogation in favor of the additional insured as
<br />respect General and Auto Liability and Workers Compensation. Umbrella is to follow form to the
<br />underlying liability policies. Cancellation: Thirty (30) day's notice except for Ten (10) day's notice
<br />ERTIFICATE HOLDER
<br />Indian River County
<br />1801 27th Street
<br />Vero Beach, FL 32960-3388
<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 />Doug Childers/DEBRAL�
<br />lam'
<br />5)
<br />INS025 (201005).01
<br />© 1988-2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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