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COI Expires 12/31/2018AC"1; " CERTIFICATE OF LIABILITY INSURANCE. DDIY Y"' 01/03/2018 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 have ADDITIONAL INSURED provisions or 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 CONTACT NAME. Bouchard Insurance for WBS PHONE- /Arc. Nq.Ext);_t866) 293-3600 ext. 623 --- -_ LAICcNoj_-. -__ _-. `.-___- P,O.Box 6090 E-MAIL -------- Clearwater, FL 33768-6090 _ --` INSURER(S) AFFORDING COVERAGE - NAIC # INSURER A: American Zurich InSuranCe Company _. -F ! 40142 _ INSURED INSURER B : Workforce Business Services, Inc. Alt. Emp: Discount Rock & Sand Inc " --- -' ------ "`- "--' -' """'-"' - ._______..__ .__.._..__..__..._________ __i..._-____ 1401 Manatee Ave. West Ste600 INSURER C Bradenton, FL 34205-6708 INSURER D : _ INSURERS: - INSURER F : COVERAGES CERTIFICATE NUMBER:17FLO79866489 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 ADDLiSUBR IWVD T POLICY EFF ;POLICY EXP - POLICY NUMBER ! M11MIDDIYYY i MMIDDrMY I --LIMITS I j COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE i$ CLAIMS-NIADE j OCCUR _ IS EST -LEa qec urr I rPR-EE--M-encej-�5 -___ -- ' I" MEO EXP (Any one person) $ __-...-_._.._-._.... PERSONAL & ADV INJURY I S ! - i GENERAL AGGREGATE 1 S- _ ,fit __----------------- AGGREGATE LIMIT APPLIES PER: ,GENT_ f POLICY j J17. r---! ___ CT LOC f ; PRODUCTS-COMP;OPAGG S I OTHER: j AUTOMOBILE LIABILITY I i COMBINED ISINGLE LIMIT I S ANY AUTO I BODILY INJURY (Per person) ! S ..__y OWNED I - ' SCHEDULED I i ~-------�- --- -� -- -- BODILY INJURY (Per accident) S _' AUTOS ONLY i— AUTOS I— }HIRED NON -OWNED I I ' I I PROPERTY DAMAGE i AUTOS ONLY AUTOS ONLY I i1Per accident ' iS j UMBRELLA LIAB I j OCCUR --- I i EACH OCCURRENCE_ S - j EXCESS LIAB CLAIMS -MADE AGGREGATE _S - - --------- ------ — DEU ' RETENTIONS -..... _..............- ; S WORKER9 COMPENSATIONOTH- f I ! ! X PER i i STATUTE ER AND EMPLOYERS' LIABILITY IANYPROPRIETOR;PARTNEIZEXECUTIVE YIN A iOFFICERlMEMBEREXCLUDED? ❑ N!A --- ------ I E L EACH ACCIDENT S 1,000,000 WC 90 00-818 07 i 12/31/2017 12/31l2018 �'------- ----- — --- - _.__...._....__-._._.. (Mandatory in NH) I I ! E.L. DISEASE - EA EMPLOYEE, $ 1,000,000 If yes describe under , DESCRIPTION OF OPERATIONS belcnr ! i f E.L. DISEASE -POLICY LIMIT S 1,000,000 Location Coverage Period: 112/31/2017 ` 12/31/2018 Client# 054212 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 161, Additional Remarks Schedule, may be attached if more space is required) Coverage is provided for Discount Rock & Sand Inc CGC 1523252 only those co -employees 10500 Aviation Boulevard of, but not subcontractors Marathon, FL 33050 Additionally Insured: to; Monroe Conty Board of County Commissioners OV B NAG8MENT 500 Whitehead Street SAY Project Name: Habitat for Humanity Building Demolition Key West, Florida 33040 WAIVER /A YES CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe Conty Board of County Commissioners THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 500 Whitehead Street ACCORDANCE WITH THE POLICY PROVISIONS. Key West. Florida 33040 AUTHORIZED REPRESENTATIVE Cc- 5 _ ...- ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD