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' ® YY) DATE (MM/DD/YY A4"Ro CERTIFICATE OF LIABILITY INSURANCE 08/22/2012 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 ) . CONTACT PRODUCER NAME: Bouchard Insurance for WBS PHONE , ( 866) 293- 3600 ext . 623 A/c No) : P . O . BOX 6090 E-MAIL Clearwater , FL 33758 -6090 ADDRESS : INSURERS AFFORDING COVERAGE NAIC # INSURER A : American Zurich Insurance Company 40142 INSURED INSURER B : Workforce Business Services , Inc . Alt . Emp : Mancils Tractor Services Inc INSURER C : 1401 Manatee Ave . West Ste 600 Bradenton , FL 34205-6708 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER : 11FL079807825 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 ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DDlYYYY GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO N COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN' L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ POLICY PRO LOC $ Ea accident)AUTOMOBILE LIABILITY SINGLE LIMIT ANY AUTO BODILY INJURY ( Per person) $ ALL OWNED SCHAUTOS EDULED BODILY INJURY (Per accident ) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIARCLAIMSMADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X WC STATUS OTH- li AND EMPLOYERS' LIABILITY T R MIT R ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N E L. EACH ACCIDENT $ 1 , 000 ,000 A OFFICER/MEMBER EXCLUDED? N / A WC 90-00-81 $-01 12/31 /2011 12/31 /2012 ( Mandatory in NH) E. L DISEASE - EA EMPLOYE $ 17000 , 000 If yes , describe under DESCRIPTION OF OPERATIONS below E . L DISEASE - POLICY LIMIT $ 11000 , 000 Qualifier: Don Mancil Jr Location Coverage Period : 12/31 /2011 12/31 /2012 Client# 051157 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101 , Additional Remarks Schedule, if more space is required) Mancils Tractor Services Inc Indian River County Bid # 2012047 Coverage is provided for 4551 SE Hampton Ct Solid Waste Disposal District (SWDD) Customer Convenience Center Pavement only those employees Stuart , FL 34997 Improvements leased to but not subcontractors of: Endorsements : 30 days written cancel notice ( 10 days for non payment of premium) CERTIFICATE HOLDER CANCELLATION Indian River County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1800 27th Street THE EXPIRATION DATE THEREOF , NOTICE WILL BE DELIVERED IN Vero Beach , FL 32960 ACCORDANCE WITH THE POLICY PROVISIONS. li AUTHORIZED REPRESENTATIVE /� AOOO n ^ AO A ^ nM A T1 ^ k1 A11 � . � LA � . . . . ... . .. J