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