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From : Brittany Caraballo At: Bouchard ImS,:rance Faxi To: Indian River Count; <br /> Dabs : + 012012008 ' 1 :01 MI Pape: 2 of 3 <br /> ACORRR.D_ CERTIFICATE OF LIABILITY INSURANCE OP 10 a DATE (MMfDDMYYI <br /> PR DUCER DERRI -2 10 / 20 /08 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Bouchard - Kissina¢nee HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 222 Church Street ALTER TME COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Kissimmee FL 34741 <br /> Phone : 407 -847 - 2841 Fax : 407 - 846 -2841 _ INSURERS AFFORDING COVERAGE __ MAIC # <br /> INSURED I INS_RER A <br /> isidgalLaloy.rs znr co 10701 <br /> INS_RER E WON % ald Inausanea Coapany <br /> Derrico Construction Corp . INb_RE:RC Mafttiald Insutanea Company 1 <br /> PO Box 361177 fr .-,ER o i-- <br /> Melbourne FL 32936 - 1177 �asttsald xnswaxa co p.ny <br /> INS _REP E <br /> COVERAGES <br /> THc =OLICIES C,F I NSDPA'%CE sTED B=LOVA I-AVE SEES ISSUED TC TH= IN=UREO NAIA=D ABOVE F(pR T-E POLI ' PERIOL NCI : AT =O NOTwir-STANDIN3 <br /> APlT P.EOU REMEN-, TERM OR CONDITIC;1 OF NIS CONN-ACT OR OTHER COCUF/ENT ttPA-H RESPECTTJ WHICH THIS ;:ERTIFICA E I/A'T BE .SSUEr. OR <br /> MF" PER_A!N ! HE NSURANCE AFFORJEC =Y THE POL CIES DESCPIFEL) HEREIN iS SUHJE�wT TO AL - rHE TERMS, E'(CLUSIONSAir) CONDITIONS JF SUCH <br /> PCLICIES. AGGREGATE L :MriS Sr"/N MA' HtkvE TEEN RECUCED 83 FA D CLAIMS <br /> LTR INSR TPE OF INSURANCE POLICY NUMBER DATE (4m)DD�ppm (VCAPIKA MM/DD � j LIMITS <br /> GENERAL IIABILRY <br /> f—i I EACH Ck:O.IP;FIY_E 11000000 <br /> D X I X� cOG'MERGAL "oENERALLIABILm TRA4527267 09 / 06 / 08um <br /> 09 / 06 / 09 FF . ' NML, <br /> I 'ES (Ea n:E1 $ 150000 <br /> �- CLA MS AL%.DF IX OCCIJR I —_ __- _,--- ._ <br /> _ - - __- -_ <br /> J I i WD EXP (Any one parson ; - 10000 <br /> X1 Broad Form PD � sUnAL s AD'✓ NJ_RY S1000000 <br /> X-�! Contractual i --- --- — <br /> I iENLkG >PFG' c — I GiNERALASG:Ei4� 12000000— <br /> I11- ATE LPJIT oPp_i E.. PE: I PROCVCTS - COMPJOP AGG 12000000 <br /> I- _ I _-EcR,y f—_I F— --- <br /> F;��ICY IX r — <br /> ntr .mvaEe EU+Du I I I <br /> C' IE <br /> IiNEC SI \GLI _INIT $ 1000000 <br /> C IWAUTO I TRA4527267 09 / 06 / 08 09 / 06 / 09 (Ee aJUCEIIq <br /> . L JN?L'D AJIOS I — <br /> BC DL 'r III J•JR" I 1 <br /> S,HF)I-LEDAU"JS I i j (Per rear } <br /> HIRED A_TO ! r — <br /> i <br /> F -- 1 BCD LY INJUF " <br /> I NOP:- CVVNEG AUTOS ! I ;Per eslyarq 4 <br /> � - <br /> ---- ---- --- - --------- - I PROPERT'r DArdAGE-- I I I (Par a .Wy I) <br /> . 1 <br /> 1 <br /> LIaB�LITY ALRO A\L" - EA ACCIDENT 1 <br /> AW, 4Ji'J I EA 4Ce; { <br /> OTHFR T-AN <br /> I AJTG J •.I " cG _ 1 <br /> EXC <br /> 01 " ESSrt1A19RaLA LJ91LR1' EACH 'JC.'LIR:ENCE $ 5000D00 <br /> B X OCCUR 771, cLAzL'SMADE TRA4S27267 09 / 06 / 08 09 / 06 / 09 AGGREGATE $ 5000000 <br /> I I ----- — ------ I g---- <br /> I DEL>`'CTIPI-F -- - - - <br /> X RETE'.?ION $ 10000 I I I T r� <br /> 1% ORKERS COMPENSATION AND X T��:H <br /> M ER <br /> A EMPLOYERS' LIABILITY NF1vP.^< PRIETOR+PAkR7T .ERrE +FCLJrVE 83034631 06 / 03 / 0806 / 03 / 09 , EL . Cc ,IDe.T 1500000 <br /> OFF : =EFiMEMBEP. E >;.LU7EC - I E L I5EASE _E4 EIh LOYE=1 500000 <br /> d .,es , dzs.rGa Ln7er I I — <br /> SPECIA - PROdSilrj I br.)cr E L CI =EASE - PCL CY _IW7 <br /> 1500000 <br /> OTHER <br /> I i I <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES 1 EXCLUSIONS ACDED BY ENDORSEMEf�SPECIAL PRJVISIOvS <br /> + 10 Day notice of cancellation in the event of non -payment of premium . <br /> Certificate Holder is an Additional Insured with respects to General <br /> Liability subject to the terms , condition & exclusions of the policy , <br /> CERTIFICATE HOLDER CANCELLATION <br /> IN'DIANR SHOVED AIJY JF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEF.•RE THE EYPIRATION <br /> DATE THEREOF THE ;SSUWG INSURER WILL ENDEAVOR TO MAIL 30 * _ DAYS WRITTEN <br /> Indian River County NOTICE TOTIwECERTIFICATE HOLDER 14AMEDTOTHE LEFT, BUT FAILURETODOSOSHALL <br /> Fax : 772 - 7710 - 5140 <br /> 1800 27th Street IMPOSE NC OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, TS AGENTS CR <br /> Vero Beach FL 32960 REPRESENTATIVES. <br /> AUTHWRESa <br /> ACORD 25 (2001 /08} OACORD CORPORATION 1988 <br />