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Certificates of Insurance A DATE(MM/DDC'YYYYI CV_V�,TI VV=11 ,141TE F LIABILITY INSURANCEE DATE 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 INSURE,R(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the pollcy(ies)roust 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.. Margaret Schneider CLIFFCORD INSURANCE CENTER, INC PHONE (352)245-5455 AtlC No): taszraas-sass 9790 SE 160th Lane E-MAIL ADDRESS:marg a:aret@cliffordinsurnce.net INSURER(S)AFFORDING COVERAGE NAIL# Summerfield FL, 34491 INSURER A:Southern Owners Insurance Co. 10190 INSURED INSURERS: L he Carpenter Construction, Inc. INsuRER c:Burchfield INSURERDmonton St INSURERE: st FL 33040-7446 INsuRERF. COVERAGES CERTIFICATE NUMBER:22/23 REVISION NUi1 BER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD @NDICATED. NOTVUI'THSTANDINGANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT VWITHI RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. INrSR ADDL SUER POLICY EFF POLICY EXP LLTR TYPE CR INSURANCEINSpPOLICY NUMBER M1M/ODIYYYY JUM22a=YL LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,ppp DA"IAGE To RENTED 300,00�p A CLAIMS MADE 7C OCCUR PREMISES Ea eccrurcenice S X MED EXP(Any rove person) .$.-...... -rseaza5e 5/1E/2022 s,+16J?023 10,000 PERSONAL&ADN INJURY .,-S 1,000,000 GENiLAGrGREGATELIMITAPPLIESPER. GENIERALAGGREGATE 5..... 2,000,000 ... POLICY F PRO- [:]LOG 2,ppp,00p JECT PROOUCTS-CC�P�1PfC]PAGG 5 OTHER S AUTOMOBILE LIABILITY APPROVE')BY RISK MANAGEMENT Ea COMBINED SING IEDSINGLE.LIMIT $ ANYAUTC DY mw K BODILY INJURY(Per person) S ALL O"A'u'1+9ED SCHEDULED �.,-- _ "' AUTOS AIJT.S DATE. �1/ter 022 BODILY INJURY Ter accident) 5 NCN-OWNED ...._ _._ _....._ ...,. PROPERTY DAMAGE HIRED AUTOS AUTOS WV'AVE:R NA YES µr.M_... Per acadew S S UMBRELLA.LIAe OC.,C'UR EACH OCCURRENCE S EXCESS LIAR CLAIMhS MIADE, AGGREGATE:. S I''.. DED RETENTION S S WORKERS COMPENSATION PLR AND EMPLOYERS'EMPLOYERS'LIABILITY YIN ST"vTUTE E:R ANY'PERIME EIERE EXCLUDED? EXECUTIVE E,4 EACH ACCIDENT ..,5 O�FPICER/MEMBER EXCI-4DDEDP IL_�I N PA IMandatnry in NH) IE.L DI.....SEASE...EA EMPLOYEE S If yes describe tinder DESCRIPTION,OF OPERATIONS beVaw E_L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,'may be attached it more space is required) Qualifier; Gary P. Burchfield - License Ns; CBC1250924 - RC29027091 - IH/106449 Monroe County Building Department is included as additional insured with respect to the General Liability coverage, per forth 55373 (5-17) . CERTIFICATE HOLDER CANCELLATION (305)289�-2515 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County Building Department THE,EXPIRATION DATE THEREOF,NOTICE WILL SE DELIVERED IN 279'8 Overseas Highway ACCORDANCE WITH!THE POLICY PROVISIONS. Suite 300 Marathon, L 33050 AUTHORIZED REPRESENTATIVE L.i.nda Clifford/SS a'1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS02'5(201401) Agency Code 12-0307-00 Poky Number 112322-78842358 55373 (5-17) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following!: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Under SECTION II -WHO IS AN INSURED is in whole or in part, by"your work"for that Addi- amended. The following provision is added. tional Insured by or for you. Other insurance A person or organization is an Additional Insured, available to the Additional Insured will apply as only with respect to liability caused, in whole or in excess insurance and not contribute as primary part, by"your work"for that Additional Insured by or insurance to the insurance provided by this for you: endorsement. 1. If required in a written contract or agreement; or 2. The following condition is added. 2. If required by an oral contract or agreement only Other Additional Insured Coverage Issued By if a Certificate of Insurance was issued prior to Us the Ioss indicating that the person or organiza- If this policy provides coverage for the same tion was an Additional Insured. loss to any Additional Insured specifically shown B. SECTION III - LIMITS OF INSURANCE is as an Additional Insured in another endorsement amended. The following provision is added, to this policy, our maximum firnit of insurance The limits of liability for the Additional Insured are under this endorsement and any other endorse- those specified in the written contract or agreement ment shall not exceed the limit of insurance in between the insured and the owner, lessee or con- the written contract or agreement between the tractor or those specified in the Certificate of insur- insured and the owner, lessee or contractor, or ance, if an oral contract or agreement, not to exceed the limits provided in this policy, whichever is the limits provided in this policy. These limits are less. Our maximum limit of insurance arising inclusive of and not in addition to the limits of out of an "occurrence", shall not exceed the limit insurance shown in the Declarations. of insurance shown in the Declarations, regard- C. SECTION IV- COMMERCIAL GENERAL less of the number of insureds or Additional LIABILITY CONDITIONS is amended. Insureds, 1. The following condition is added to 4. Other Insurance, All other policy terms and conditions apply. This insurance is primary for the Additional Insured, but only with respect to liability caused, 55373 (5-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 11 of 1 GARYBUR-01 REGANIL CERTIFICATE OF LIABILITY" INSURANCE DATE IMMG7DIYYYYI 7t7/2022 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 INSU'R R(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poilcy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain(policies may rewire an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER. No'MTEAcr Linda Regan Insurance Office of America PHONE FAX 13361 Overseas Highway IAIC,N r,Eztp:(305)537-2782 (AaC,Not. Marathon,FL 3305 EAra�O :Linda.Regan ioausa.com .._ INsURr� DING COVERAGE NAIL q. INSURER A:Progressive Express Insurance CU.tTI an/ 10193 INSURED INSURER 0: Gary Burchfield dba Gary the Carpenter INSURER c: _.. 800 Simonton Street INSURER D Key West,FL 33040-3168 INSURER E INSURER F:, _ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THUS 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 CONDITNON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO W'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 TYPE OF INSURANCE ADDL SUOR. ...POLICY E,FF POLICY EXP LIMITS LTIRPOLICY NUMBER COMMERCIAL GENERAL LIABILITY EACH OCCUiRRENCE S CLAIMS-MADE [:]OCCUR.. DAMAGE TO RENTED 1aEa _ac urr n ej. S _.._..._ PIEDEXP An aCe:.P..frson S ... PERSONAL&ADV INJURY S.. GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE S POLICY IA per, � ] LOC .. F-1 C, PRODUCTS-COMPAGR AOO S ............BOTHERS .,._........ A AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT 100,000.. _LEa accident➢ S ANY AUTO X 08370079-3 11//912021 1111'...9J2022 E ODLY INJURY(Per,pers©n s OWNED SCHEDULED AUTOS ONLY AUTOS BOt7iLY VN,JURY(Per accident S ,( IMIIR�E¢1 X NON-+J"dWNFD PROPERTY DAMAGE. AUT S ONLY AVJTO ONLY {Per accuderuil S 5 UMBRELLA LIAO ...........m OCCUR EACM OCCURR'.ENCE 5.. EXCESS LIAR CLAIMS-MADE AGGREGATE 5 DEC) I RETENTION S 5 WORKERS COMPENSATION' PER. OTIt'- AND EMPLOYERS'LIA.OILITY YIN ''....STAT" T .w ANY PROPRVETORIPARTNE'RIEXECUTIVC ... �CyyFFiCERIMEMlf3'ERIEXGLLiDED? NIA E..N_.EACHACCIDENT s_-....-_.___ (Mandatary In NH) E.L.C3V5EA.SE-EA EMPV.OYE S If yes, describe uindler �----_ .. DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule„may be attached if more space is required) 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. AUTHORIZED REPRESENTATIVE Monroe County BOCC 1100 Simonton Street f ✓/ A221073 ACORD 25(2+016103) 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are reglistered marks of ACORD r ATE IMe1Fw9rDDaYYYYy.... CERTIFICAITE F LIABILITY INSURANCE, TE(MMJ DJYYY 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 ondorsed. 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 Ilou of such endorsernent(s). PRODUCER CONTACT Todd Gear e NAME. g Bouchard Insurance for WBS-TG PHONE P PO Box 6090, (A/C,No,Ext): (866)293-3600 ext 623 Fax E-MAIL ._ IArc,Nay. Clearwater, FL 33758-6090 ADDRESS;_ .....INSURERtSjAFFORDING COVERAGE 1AIC iS INSURER A: Zurich-American Insurance Company 16535 _ INSURED 9NSURER Workforce Business Services,Inc.Alt.Ernp Gary the Carpenter Construction Inc _ B: _ _ B ...,,,,, .... 1401 Manatee Ave.West Ste 600 INSURER C: Bradenton,FL 342 0 5-6 7 0$ INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NU,MBER:21FL079807619 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 ALI THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR 4 ....... __. ___. ,,, ..... POLICY INSR JADDL SUBRI POLICY NUMBER MM IDDIYYY TYPE OF INSURANCE 1 1 POLICY EFY MMM®. E)c LIMITS O1^fYYX COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE C7C':CIJR I DAMAGE TO RENTED ..._ 6 � R'f1E4iPI,,L°a QE'u a�r.ctirrcnc'EL ° .. ......... .._._ .... MF.D EXP(Any one person) 5 _ ",RS NAL 1S AD"INJURY GEN"I AaGHE GA r"E LI11%I APPLIES PER l .. CJFfBI-tuHLFGGf«C)AiL 1 S 1 r`RO- _ k°4JLUCY f.11EC;T f LGC PRODUCTS C;P7 IPIOP AGG S ... ... CYEHEIR IE'. (Ea accident). AUITOMOE31LE LIABILITY � tC7JMNEl7SINGLE-LIMpl �.. I .. � ''...ANY AUTO E3f;LALY INJURY(Per person) �5 .. _ ... G fr'PV?C'1 Sw IRE[Jt1LEPC i l3(UD Y INJURY(Peraccidentj S _ AuISMS ON[Y AUFOS� � { . AU ros 01,ILY AU'OS aNF( 6 (F'er a adontp S I S UMBRELLA LIAB C?CC3tJR EACH OCCURRENCE EXCESS LIAB _._. CLAIM,`.)P,1ADJ P AGGREGATE C DEIC7 RETENTIONS _., �.. ....... S WORKERS COMPENSATION I F'EP Oulu AND EMPLOYE,RS'LIABILITY h'/N X SffiTtJTE _ IR,. ANYP O Iry I,ICHrPAP1NERIFXECUTIVE Ei EACHACCIOENT � 1,000,000 REXCLtJDEDT NJA� WC90-00-818-11 12/31/2021 12/31/2022 _._.. ,.. . (MUandatoryInNil) I�_.E.DI,T,EASF.-�EAF.MPLOYC S 1,)00,000 it yes,desr_'nbe under ........_. _ GES:CRIIPTION OF 0PERA110NS beNmv E_L.DISFASF-POLICY L.IMOT S 1,000,000 Location Coverage Period: 12/31/2021 12/31/2022 Client# 002806 l � DESCRIPTION OF OPERATION'S P LOCATIONS 1 VEHi'CLES (ACORD 101,Additional Remarks Schedule,may be attached if rnore space is required) Coverage is provided for Gary the Carpenter Construction Inc only those co-employees 800 Simonton St of,but not subcontractors Key West.FL 33040 to; CERTIFICATE HOLDER CANCELLATION Monroe County BL7CC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1100 Simonton Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Key West, FL 33040 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Q 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD