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HomeMy WebLinkAbout2014OP ID: TJ '`' % " CERTIFICATE OF LIABILITY INSURANCE DAT1110611YYYY) %. 11106H 3 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 pollcy(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 tleu of such endorsement(s). PRODUCER Phone: 772 - 286 -4334 Stuart Insurance, Inc. 3070 S W Mapp Fax: 772 - 286 -9389 Palm City, FL , CIC, Rick Halcomb, CIC, ARM CONTACT NAME: Rick Halcomb (AIC* N .772 - 286-4334 FAX Arc NO: ?72- 286 -9389 E-MAIL rhalcomb stuartinsurance.net CUSTOMER ID s: TIMOR -1 INSURERS AFFORDING COVERAGE NAIC 1 INSURED Timothy Rose Contracting, Inc. 1360 Old Dixie Hwy SW Vero Beach, FL 32962 INSURER A: Westfield Insurance 24112 INSURER B: A ENSURER C: X INSURER D: CMMS079889 06/06/13 INSURER E: PREMISES Ee occurrence S 100,00 INSURER F : $ 5,D0 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. LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYY MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXX ] OCCUR X CMMS079889 06/06/13 06/06114 PREMISES Ee occurrence S 100,00 MED EXP (Any one person) $ 5,D0 X Contractual Liab PERSONAL 8 ADV INJURY S 1,000,00 X Incl XCU GENERAL AGGREGATE S 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS- COMPIOP AGG S 2,000,00 POLICY X PRO- LOC $ A AUTOMOBILE LIABILITY ANY AUTO CMMS079889 06/06/13 06/06114 COMBINED SINGLE LIMIT (Ea cccidenI) $ 1,000,00 X BODILY INJURY (Per person) S ALL OWNED AUTOS BODILY INJURY (Per accident) $ X SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) S X NON -OWNED AUTOS S f UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 3,000,00 AGGREGATE $ 3,000,00 A EXCESS LIAR CLAIMS -MADE CMM6079889 06106/13 06/06/14 DEDUCTIBLE S S RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETORJPARTNERIEXECUTIVE N OFFICERMEMBER EXCLUDED? El NIA WCSTATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If es, describe under DESCRIPTION OF OPERATIONS bet aw E.L. DISEASE -POLICY LIMIT S A Contractors Equip CMM6079889 06106/13 06/06/14 Rented 50,00 Equipment $1000 dad DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Presidential Streets — Roadway r. Drainage Improvements. City of Sebastian is additional insured with respect to general liability. CITSE -1 City of Sebastian 1225 Main Street Sebastian, FL 32958 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988 -2009 ACORD CORPORATION. All rights reserved. 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