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ACORDCERTIFICATE OF LIABILITY INSURANCE 7/23i2o a PRODUCER (561) 746-4546 FAX: (561) 746-9599 Te este A 4u Agency, yr Inc,. 218 S. US Highway One Suite 300 Teguesta FL 33469 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION NLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, INSURERS AFFORDING COVERAGE NAIC # INSURED J.W. Cheatham, LLC 7396 Westport Place West Palm Beach FL 33413 INSURERANational Fire Insurance 20893C INSURERB:National Fire Insurance 20893C INSURERaValley Fore Insurance 20508C INSURER D: Trans ortation Ins, Col 120894C INSURER E: TED PREMISETORE E=rrrrence THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AN 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. AG, �anRrErz �IE-LIWI5 19HOWN MAY HAVE M REDUCED BY PAID CLAIMS. INSR JJJL ADD'LEFFECTIVE INSRn TYPE OF INSURANCE POLICY NUMBER DATE MWDDDATE PEXPIRATION MMWD LIMITS A X GENERAL LIABILITY R COMMERCIAL GENERAL LIABILITY CLAIMS MADE ® OCCUR 02083039906 3/1/2008 3/1/2009 EACH OCCURRENCE $ 1 r 000 r 000 TED PREMISETORE E=rrrrence $ 50 r 000 MED EXP (Any oneperson) $ 5 r 000 PERSONAL 8 ADV INJURY $ 1 r 000 r 000 GENERAL AGGREGATE $ 24001000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICYX E CF�j LOC PRODUCTS - COMP/OP A $ 2 r 000 r 000 B AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 02055533016 3/1/2008 3/1/2009 COMBINED SINGLE LIMIT (Ea accident) $ 1 r 000 r 000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANYAUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ D EXCESS/UMBRELLA LIABILITY x OCCUR 7 CLAIMS MADE DEDUCTIBLE RETENTION $10,000 02067525954 3/1/2008 3/1/2009 EACH OCCURRENCE $ 10 , 000 , 000 AGGREGATE $ 10 r 000 r 000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? IT yes, describe under SPECIAL PROVISIONS below wc2055533047 3/1/2008 3/1/2009 R WC STATU- LIMITS OTH- ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500 r 000 OTHER DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL 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: Ponerline Road from CR510 North to the Sebastian City Limits. County Project # 0217 CERTIFICATE HOLDER CANCELLATION ACORD 25 (2001/08) IuenO)a ,^, ^o� ^o_ a ACORD CORPORATION 1988 0*ro 1 e47 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE INDIAN RIVER COUNTY EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1800 27TH STREET 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT VERO BEACH, FL 32960 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 a-- ACORD 25 (2001/08) IuenO)a ,^, ^o� ^o_ a ACORD CORPORATION 1988 0*ro 1 e47