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ACORDm CERTIFICATE OF LIABILITY INSURANCE 10/ 28/2 8 PRODUCER ( 561 ) 746 - 4546 FAX : ( 561 ) 746 - 9599 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Tequesta Agency , Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 218 S . US Highway One ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Suite 300 Teguesta FL 33469 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: National Fire Insurance 20893C J . W . Cheatham , LLC INSURERB: National Fire Insurance 20893C 7396 Westport Place INSURERaValley Fore Insurance 20508C INSURER D: Trans ortation Ins , Co . 20894C West Palm Beach FL 33413 INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANIY 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 , AGI MM kTE LIMITS SHOWN MAY HAVE N REDUCED BY PAID CLAIMS- INS& ADD'L POLICY TYPE OF INSURANCE POLICY NUMBER DATE (MWDDTIVE POLICY MWDD YYI TION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 r 000 r 000 NCOM MERCIAL GENERAL LIABILITY DAMAGE TO RENTED 50 000 PREMISES Ea occurrence $ r A X CLAIMS MADE a OCCUR 02083039906 3 / 1 / 2008 3 / 1 / 2009 MED EXP An one person ) $ 5 r 000 PERSONAL & ADV INJURY $ 1 r 000 r 000 GENERAL AGGREGATE $ 2 r 000 r 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - MP/OP AGG $ 2 r 000 , 000 POLICY X JECTT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 r 000 r 000 X ANY AUTO (Ea accident) B ALL OWNED AUTOS 02055533016 3 / 1 / 2008 3 / 1 / 2009 BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EAAC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 10 r 000 r 000 X1 OCCUR 7 CLAIMS MADE AGGREGATE $ 10 , OOO , 000 S D DEDUCTIBLE 02067525954 3 / 1 / 2008 3 / 1 / 2009 $ hX RETENTION $ 10 , 000 C WORKERS COMPENSATION ANDX WTO Y LATU- OTH- EMPLOYERS' LIABILITY ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500 r 000 OFFICER/MEMBER EXCLUDED? WC2055533047 3 / 1 / 2008 3 / 1 / 2009 E.L. DISEASE - EA EMPLOYEE $ 500 , 000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - -POLICY LIMIT $ 500 r 000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The Certificate Holder is an additional insured per form G140331A atttached to the General Liability Policy . Form G140331A is attached for reference . Job Desc : 17th Lane SW from 27th Ave . to East Approx . 900 ' 20th Ave . from 21st S SW to 17th Lane SW 17th Lane SW from Falcon Trace project entrance to 20th Ave . Project No . ' s 0803 , 0837 6 0838 *Except 10 Days cancellation notice for nonpayment of premium . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE INDIAN RIVER COUNTY EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL . W" MNL 1801 27TH STREET * 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT VERO BEACH , FL 32960 - 3388 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Mark Kasten / DEBBIE ACORD 25 (2001 /08) a ACORD CORPORATION 1988 eucn9S m+ no% no.. Dene t nr