J. Raymond Construction - Sprouts Farmers Market

DATE (MM/DD/YYYY) 6/26/2017

CERTIFICATE OF LIABILITY INSURANCE

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).

Julie Kwack

CONTACT NAME:

PRODUCER

(407)660-8282 jkwack@bborlando.com

INSURED Brown & Brown of Florida, Inc. 2290 Lucien Way Suite 400 Maitland FL 32751 J. Raymond Construction Corp. 465 West Warren Avenue Longwood FL 32750

FAX (A/C, No):

PHONE (A/C, No, Ext): ADDRESS: E-MAIL

(407)660-2012

INSURER(S) AFFORDING COVERAGE Amerisure Insurance Company Amerisure Mutual Insurance Co Travelers Cas & Sur Co of Am. Travelers Prop Cas Co of Amer Certain Underwriters at Lloyd’s

NAIC #

19488 23396 25674

INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F :

CL1762211764

COVERAGES

CERTIFICATE NUMBER:

REVISION NUMBER:

TYPE OF INSURANCE 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. INSD ADDL WVD SUBR POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS

INSR LTR

X

1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000

LOC POLICY GEN'L AGGREGATE LIMIT APPLIES PER: X X Contractual Liability per GL Form X JECT PRO- OCCUR CLAIMS-MADE COMMERCIAL GENERAL LIABILITY

PREMISES (Ea occurrence) DAMAGE TO RENTED EACH OCCURRENCE MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ (Ea accident) $ $

A

GL20118151601

7/1/2017 7/1/2018

OTHER:

1,000,000

AUTOMOBILE LIABILITY ANY AUTO ALL OWNED

$ $ $ $ $ $ $ $ $ $ $

B X

SCHEDULED NON-OWNED AUTOS AUTOS

CA20013891502

7/1/2017 7/1/2018

AUTOS

HIRED AUTOS

(Per accident)

X

15,000,000 15,000,000

UMBRELLA LIAB EXCESS LIAB

EACH OCCURRENCE

CLAIMS-MADE OCCUR

C

AGGREGATE

X

7/1/2017 7/1/2018

ZUP-51M63343-17-NF

0

DED

$ RETENTION

X

PER STATUTE

OTH- ER

WORKERS COMPENSATION AND EMPLOYERS' LIABILITY

Y / N

1,000,000 1,000,000 1,000,000 $350,000 $350,000

ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED?

E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT

N

N / A

B

7/1/2017 7/1/2018

WC20221681302

D Leased or Rented Equipment Legal Liability up to RC

QT-660-5G037350-TIL-17

7/1/2017 7/1/2018 Any One Item

Max Limit

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

FOR INFORMATION ONLY

CERTIFICATE HOLDER

CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

J. Raymond Construction FOR INFORMATION ONLY 465 West Warren Avenue Longwood, FL 32750

AUTHORIZED REPRESENTATIVE

T D'Avanzo, CPCU, CPA

© 1988-2014 ACORD CORPORATION. All rights reserved.

ACORD 25 (2014/01)

The ACORD name and logo are registered marks of ACORD

INS025 (201401)