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AieOOR& CERTIFICATE OF LIABILITY INSURANCE D10/22/2014) <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,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: <br /> Bouchard Insurance for WBS acN; <br /> Exti: 866)293-3600 ext.623 FAX No): <br /> P.O.Box 6090 E-MAIL <br /> Clearwater,FL 33758-6090 ADDRESS: <br /> INSURER(S) AFFORDING COVERAGE NAIC# <br /> INSURER A: American Zurich Insurance Company 40142 <br /> INSURED INSURER B: <br /> Workforce Business Services,Inc.Alt.Emp:Mancils Tractor Services Inc INSURER C: <br /> 1401 Manatee Ave.West Ste 600 <br /> Bradenton,FL 34205-6708 INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:13FLO79807825 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 PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> ILTR TYPE OF INSURANCE I S SBR POLICY NUMBER POLICY EFF MMIDD EXP LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY AAI O E T <br /> ED <br /> PREMISES Ea occurrence $ <br /> CLAIMS-MADE 7 OCCUR MED EXP Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ <br /> POLICY 7 PRO LOC $ <br /> AUTOMOBILE LIABILITY LE I I <br /> Ea accident $ <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED <br /> AUTOOr <br /> AUTOS BODILY INJURY(Per accident) $ <br /> NON-OWNED PR <br /> PER DAMAGE $ <br /> HIREDAUTOS AUTOS <br /> UMBRELLA LIABOCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB HCLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ $ <br /> WORKERS COMPENSATION X WC LIMITJ <br /> OTH- <br /> AND EMPLOYERS'LIABILITY Y/N <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 <br /> A OFFICER/MEMBEREXCLUDED? ❑ NIA WC 90-00-818-03 12/31/2013 12/31/2014 <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> Qualifier:Don Mancil Jr <br /> Location Coverage Period: 12/31/2013 12/31/2014 Client# 051157 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) <br /> Coverage is provided for <br /> Manciis Tractor Services Inc <br /> 4551 SE Hampton Ct <br /> only those employees Stuart,FL 34997 <br /> leased to but not <br /> subcontractors of: <br /> Endorsements:30 days written cancel notice(10 days for non payment of <br /> premium) <br /> CERTIFICATE HOLDER CANCELLATION <br /> Indian River County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 1801 27th 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 />