2013-211A - Laserfiche WebLink

Home Browse Search

OiM D /Y ATE (MM/DDYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 10/24/2013 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) . PRODUCER CONTACT NAME: Bouchard Insurance for WBS PHONE0. FA (866) 293-3600 ext. 623 INC, 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 : OAC Action Construction Corp INSURER c : 1401 Manatee Ave . West Ste 600 Bradenton , FL 34205-6708 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER : 12FLO79807625 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISESS Ea occurrence) $ CLAIMS-MADE F�] OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY F PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY ( Per person) $ ALL OWNED SCHEDULED BODILY INJURY ( Per accident) $ AUTOS AS NON-OWNED PROPERTY accident)DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X I WC STATU- OTH- AND EMPLOYERS' LIABILITY LIM TS ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N E. L. EACH ACCIDENT $ 1 , 0009000 A OFFICER/MEMBER EXCLUDED? NIA WC 90-OO-818-02 12/31 /2012 12/31 /2013 (Mandatory in NH ) E. L. DISEASE - EA EMPLOYE $ 1 , 000 , 000 If yes, describe under DESCRIPTION OF OPERATIONS below E. L. DISEASE - POLICY LIMIT $ 19000 , 000 Location Coverage Period : 12/31 /2012 12/31 /2013 Client# 052564 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101 , Additional Remarks Schedule, if more space Is required) OAC Action Construction Corp Coverage is provided for 12540 SW 130th St Suite 2-3 only those employees Miami , FL 33186 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 Historic Dodgetown Room Renovations SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 3901 26th Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Vero Beach , FL 32960 ACCORDANCE WITH THE POLICY PROVISIONS. i AUTHORIZED REPRESENTATIVE - - © 1988-2010 ACORD CORPORATION . All rights reserved .