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�. Ile1% 11 � r 1, MlII �� ,. ; <br /> Ire <br /> ,eco CERTIFICATE OF LIABILITY INSURANCE D04/ 18/20 YYYY) <br /> 04/ 18/2012 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER( S ) , AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER , AND THE CERTIFICATE HOLDER, <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy( les ) must be endorsed . If SUBROGATION IS WAIVED <br />, subject to <br /> the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer <br /> rights to the <br /> certificate holder In lieu of such endorsement (s), <br /> PRODUCER CONTACT <br /> NAME . <br /> __. _ _ _._ . _. _ _ .. ._ TFAX_ <br /> — <br /> Bouchard Insurance - <br /> IAJG�. flEy. Fast/: 5800) 277- 1620 ext. 4800 No 727 797-0704 <br /> 101 Starcrest Drive E-MAIL - - -- L [A/C, ) : ( . . ) _ . . .. <br /> Clearwater, FL 33758 ADDRESS : <br /> INSURER(S) AFFORDING COVERAGE - NAIC N <br /> INSURER A : American Zurich Insurance Company 40142 <br /> INSURED <br /> INSURER 8 <br /> Workforce Business Services , Inc. Alt . Emp : Guettler Brothers Construction cuRER <br /> 1401 Manatee Ave . West Ste 600 INSURER RER C : _ <br /> Bradenton , FL 34205-6708 INSURER D : <br /> INSURER E : <br /> INSURER F : <br /> COVERAGES CERTIFICATE NUMBER : 11FL079807821 REVISION NUMBER : <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY <br /> PERIOD <br /> INDICATED . NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL <br /> THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR . — — A66C �lJBRj- --' - --'-- - --- -- - - --- — <br /> LTR TYPE OF INSURANCE POLICY EFF I POLICY EXP <br /> POLICY NUMBER MMIDDIYYYYI 1MM/DDrYYYYILIMITS <br /> GENERAL LIABILITY I ( EACH OCCURRENCE 5 <br /> I <br /> COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED <br /> CO ' <br /> -_ _ i PREMISES &a occurrenceL_ <br /> -'-- � S —.._ .. - '--._.._ .. <br /> CLAIMS-MADE OCCUR 1----- <br /> - - - - -- MED EXP (Any one person) S <br /> -- LIF RSONAL 8 ADV INJURY S <br /> I <br /> -- -- LOC ( i GENERAL AGGREGATE S <br /> GENT AGGREGATE LIMIT APPLIES PTS - CO <br /> ER , I PRODUCTS AGG S <br /> POLICY PRO- �__ - - I <br /> AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT <br /> i _(Ea acudentJBODILY INJURY ( Peir.--- __person) -S — - ---- -- --- -. ._... <br /> ANY AILITO <br /> - S <br /> LL OWN <br /> AUTO EO ' AUTOSULED I i BODILY INJURY (Per accident) -- -- -_ ._._--_-_ <br /> -- S <br /> ------- <br /> NtREDAUTOSNON-OWN <br /> AUTOS EO PROPERTY DAMAGE S <br /> S <br /> UMBRELLA UAB OCCUR I EACH OCCURRENCE _ S ` <br /> EXCESS LIAR CLAIMS-MACE AGGREGATE S <br /> -- --- <br /> Ile <br /> DED RETENTIONS $ <br /> WORKERS COMPENSATION WC STATU- OTN- <br /> AND EMPLOYERS' LIABILITY YIN X . TORY LIMITS ER , <br /> ANY PROPRIETOR;PARTNEWEXECUTIVE E L EACH ACCIDENT $ 1 . 000 , 000 <br /> A OFFICER,MEMBEREXCLUDED? NIA WC 90-00-818-01 12/31 /2011 12/31 /2012 1 - - - . -- - <br /> ? Mandatory in NHI <br /> yes describe under E L DISEASE - EA EMPLOYEE S 1 . 000 , 000 <br /> ntl � _ - . . . <br /> DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ 11000 , 000 <br /> Location Coverage Period : 12/31 /2011 12/31 /2012 Client# 050682 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101 , Additional Remarks Schedule, if more space is required ) <br /> Coverage is provided for Guettler Brothers Construction Also reference IRC Bid No . 2012032 <br /> only those employees 4401 White Way Dairy Rd 66th Avenue Roadway Improvements • Phase 2 (41h Street to 16th Street) <br /> teased to but not Ft Pierce , FL 34947 <br /> subcontractors of: <br /> CERTIFICATE HOLDER CANCELLATION <br /> Indian River County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 180027th Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Vero Beach , FL 32960 ACCORDANCE WITH THE POLICY PROVISIONS, <br /> AUTHORIZED REPRESENTATIVE <br /> © 1988-2010 ACORD CORPORATION . All rights reserved . <br /> ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />