Loading...
HomeMy WebLinkAbout2017OP ID: TJ '4�oRo CERTIFICATE OF LIABILITY INSURANCE OATE(MMR) 1o1/lz/2017zo17 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Stuart Insurance, Inc. 3070 S W Mapp Palm City, FL 34990 Rick Halcomb, CIC, ARM CONTACT Tani Jacobson NAME,PHONE 772-266-4334 FAX A AIC No : 772'266'9369 E-MAIL ADDRESS: tjacobson@stuartin surance.net PRODUCER .TIMOR -1 TONE R IO INSUIUUI AFFORDING COVERAGE NAIC N INSURED Timothy Rose INSURER A: Westfield Insurance 24112 Contracting, Inc. 1360 Old Dixie Hwy SW, Ste 106 INSURER B: A Vero Beach, FL 32962 INSURER C: INSURER D: CMM6079889 INSURER E: 0610612017 INSURER F: MED EXP (Any one person) $ 5,00 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE kDOL WERE POLICY NUMBER P LICYEFFOLICY MMIDD/YYYY EXP MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEFx-1OCCUR CMM6079889 06106/2016 0610612017 PREMISES Ea o=mence $ 500,00 MED EXP (Any one person) $ 5,00 PERSONAL &ADV INJURY $ 1,000,00 X Contractual Liab X Incl XCU GENERAL AGGREGATE $ 2,000,00 GEML AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP ADD $ 2,000,09 ' LOC 17 PoLICY X JECT $ A AUTOMOBILE LIABILITY ANY AUTO CMM8079889 0610812016 06106/2017BODILY COMBINED SINGLE LIMIT S 1,099,90 (Ea accident) INJURY(Per person) $ ALL OWNED AUTOSBODILY INJURY (Per accitlant) $ SCHEDULEDAUTOS JX HIRED AUTOS PROPERTY DAMAGE (PERACCIDENT) $ $ NON -OWNED AUTOS PIP 10000 $ X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 3,000,00 AGGREGATE $ 3,000,00 A EXCESS LIAB CLAIMS -MADE CMM6079889 06/0612016 06/06/2017 DEDUCTIBLE $ $ RETENTION $ WOR COMPENSATION WC STATU- TH- PER AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUrIVE❑ OFFICERIMEMBER EXCLUDED? NIA EL EACH ACCIDENT $ E. L. DISEASE -EA EMPLOYE $ (Mandatory In NH) Vs describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMn 8 A Contractors Equip CMM6079889 06/0612016 0610612017 Rented 50,00 Equipment $1000 de DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) RE: Street Milling & Paving -City of Sebastian is additional insured with respect to general liability for ongoing and completed operations when required by written contract. CERTIFICATE HOLDER CANCELLATION CITSE-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Sebastian ACCORDANCE WITH THE POLICY PROVISIONS. 1225 Main Street AUTHORIZED REPRESENTATIVE Sebastian, FL 32958 `-LET lv— ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD OP ID: TJ ,a��zo CERTIFICATE OF LIABILITY INSURANCE DATE /1 212 0 17 1 01/12/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER Stuart Insurance, Inc. 3070 S W Mapp Palm City, FL 34990 Rick Halcomb, CIC, ARM CONTACT Tani Jacobson NAME: PNONE Ea.772-286.4334 A/� No:772-286-9389 E-MAIL tjatObson@StUartinauranCe.nBt PRODUCE PRODUCER .TIMOR -1 INSURER(S) AFFORDING COVERAGE NAIC0 INSURED Timothy Rose INSURER A: Westfield Insurance 24112 Contracting, Inc. 1360 Old Dixie Hwy SW, .Ste 106 INSURER B: A Vero Beach, FL 32962 INSURER C: INSURER D CMMS079889 INSU0.ER E 06/0612017 INSURER F MED EXP (Any one person) $ 5,00 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE kDDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY) POLICY EXP IMMIOD1YYV1(1 LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE FX OCCUR X CMMS079889 06106/2016 06/0612017 PRISES hoccunence $ 500,00 EM MED EXP (Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 X Contractual Liab X Incl XCU GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS -COMROP AGG $ 2,000,00 17 POLICY FX -1 PRO- LOC $ A AUTOMOBILE LIABILITY ANY AUTO CMM6079889 0610612016 06106/2017 COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident)BODILY INJURY (Per person) $ ALL OWNED AUTOSBODILY INIURV (Per accident)$ IX SCHEDULEDAUTOS HIRED AUTOS PROPERTY DAMAGE (PERACCIDENT)NON.OWNED $ AUTOS PIP 10000 $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 3,000,00 AGGREGATE $ 3,000,00 A EXCESS LIAR CLAIMS -MADE CMM6079889 06/0612016 06106/2017 DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOMPARTNERIEXECUTIVE❑ OFFICERIMEMBER EXCLUDED? N/A EL EACH ACCIDENT $ EL DISEASE -EA EMPLOYE $ (Mandatory In NH) If ves describe under DESCRIPTION OF OPERATIONS below EJ- DISEASE -POLICY UNIT $ A Contractors Equip CMM6079889 0610612016 06106/2017 Rented 50,00 Equipment $1000 de DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES Attach ACORD 101, Additional Remarks Schedule, if more space is required) R • Vo Barber Recon tructio Paving ell and - ity olSebastian is additional insured with respect to general liability F%ongoing and completed operations when required by written contract. CERTIFICATE HOLDER CANCELLATION CITSE-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Sebastian ACCORDANCE WITH THE POLICY PROVISIONS. 1225 Main Street AUTHORIZED REPRESENTATIVE Sebastian, FL 32958 ACORD 25 (2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OP ID: MK .4111 �/20 CERTIFICATE OF LIABILITY INSURANCE OATS/1112016 07/11/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone: 772-286-4334 Stuart Insurance, Inc. 3070 S W Map p Fax: 772-286-9389 Palm City, FL 34990 Rick Halcomb, CIC, ARM CONTACT Tani Jacobson PHONN E ; 772-286-4334 ui Not: 772-286-9389 E-h1AIL A: tjacobson@stuartinsurance.net DOREsa PRODUCER .TIMOR -1 CUSTOMER, INSURER(S) AFFORDING COVERAGE NAIC 0 INSURED Timothy Rose Contracting, Inc. 1360 Old Dixie Hwy SW, Ste 106 Vero Beach, FL 32962 INSURER A: Westfield Insurance 24112 INSURER B: INSURER C INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILSR TYPE OF INSURANCE Sembler & Sembler, Inc ACCORDANCE WITH THE POLICY PROVISIONS. POLICY NUMBER POLICY YIYEYYY MMIDOYEXP LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 A X COMMERCIALGENERALUABILITY CIAIMSMADE I (OCCUR CMM6079889 06/0612016 06/0612017 PREMISES Eaoccurrence S 500,00 MED EXP (Any one person) $ 5,00 PERSONAL &ADV INJURY $ 1,000,00 X Contractual Liab X Incl XCU GENERAL AGGREGATE $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $ 2,000,00 POLICY X PRO- LOC S A AUTOMOBILE LIABILITY ANV AUTO CMM6079889 06108/2016 08/0812017BODILY COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident) INJURY(Per person) $ ALLOWNEDAUTOS BODILY INJURY(Par accident) $ SCHEDULED AUTOS JX HIREDAUTOS PROPERTY DAMAGE (Per accident) $ $ NON -OWNED AUTOS PIP 10000 $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,00 AGGREGATE $ 3,000,00 A EXCESS LIAR CLAIMS -MADE CMM6079889 0610612016 0610612017 DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION I WC STATU- I PTH. AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIF.XECUTIVEEL EACH ACCIDEM $ OFFICERRAEMBER EXCLUDED? F NIA EL DISEASE - EA EMPLOYE $ (Mandatory In Ni . describe under DCRIPTION OF OPERATIONS below Nine I I E.L DISEASE -PODGY DMR $ A Contractors EquipCMM6079889 06106/2016 0610612017 Rented 50,00 Equipment $1000 de DESCRIP1`1g0N OF OPERATIONS /LOCATIONS Sitep I VEHICLES (Attach ACORD 101, Additional Remarks Schedule. If more space Is required) GradinPlorda RE: SebastiannProperty e1527S te 6a1528fIndian River Drive, Sebastain, FL 32958 CERTIFICATE HOLDER CANCELLATION SEMBS-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sembler & Sembler, Inc ACCORDANCE WITH THE POLICY PROVISIONS. 6945 49th Street AUTHORIZED REPRESENTATIVE Vero Beach, FL 32967 N� @ 1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD OP ID: TJ '4�Ro CERTIFICATE OF LIABILITY INSURANCE COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD DATE 6 16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone: 772-286-4334 Stuart Insurance, Inc. Fax: 772-286-9389 3070 S W Mapp Palm City, FL 34990 Rick Halcomb, CIC, ARM NAME: Tani Jacobson PHONE 772-2gfi-4334 FAx AIC No : 772-286-9389 au E-MAIL tjacobson@stuartinsurance.net PRODUCER . TIMOR -1 INSURERS AFFORDING COVERAGE NAIC # INSURED Timothy Rose Contracting, Inc. 1360 Old Dixie Hwy SW, Ste 106 Vero Beach, FL 32962 INSURER A : Westfeld Insurance 24112 INSURER B : INSURER C INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE DOL SUBR POLICY NUMBER MMIDDYIYYYY MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO KERrED-- PREMISES Ea occurrence $ 500,00 A X COMMERCIAL GENERAL LIABILITY CMM6079889 06/0612016 06106/2017 CLAIMS -MADE a OCCUR MED EXP (Any one person) $ 5,00 PERSONAL& ADV INJURY $ 1,000,00 X Contractual Liab X I Incl XCU GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 $ PRO -LOC POLICY X JECT A AUTOMOBILE LIABILITY X ANY AUTO CMM6079889 06/0612016 06/06/2017 COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident) BODILY INJURY (Per penton) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS X HIRED AUTOS PROPERTY DAMAGE (Per accident) $ $ X NON -OWNED AUTOS $ X PIP 10000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,00 AGGREGATE $ 3,000,00 A EXCESS LIAB CLAIMS -MADE CMM6079889 06/0612016 06/06/2017 DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION WC STATU- OTH- ITORY LIMITS I ER AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE [:] OFFICER/MEMBER EXCLUDED? NIA E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) ifes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Contractors Equip CMM6079889 06106/2016 06/06/2017 Rented 50,00 Equipment $1000 de DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Grading of Land/Site Prep - State of Florida RE: Sebastian Property: 1527 & 1528 Indian River Drive, Sebastian, FL 32958 CERTIFICATE HOLDER CANCELLATION ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Charlie Sembler ACCORDANCE WITH THE POLICY PROVISIONS. 6945 49th Street AUTHORIZED REPRESENTATIVE Vero Beach, FL 32967 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD