|
. .
<br />DATE (MMIDD/YYYY)
<br />ACC.) -1Z.1)
<br />CERTIFICATE OF LIABILEry INSURANCE
<br />12113/2018
<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, t.he policy(les) musi have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and •6nditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate -does not conferrIghts to the certificate older In lieu of such endorsement(s).
<br />PRODUCER
<br />Bouchard Insurance for WBS
<br />PO Box 6090
<br />Clearwater, FL 33758-0090
<br />..... ..... ....
<br />INSURED
<br />Workforce Business Services, Inc. Alt. Emp: Guett'
<br />1401 fyIamaleo Ave. West Sle 600
<br />Brudenten, FL 34205.6708
<br />Brothers Construe
<br />LLC
<br />comfAb
<br />/ .- lVr-' --
<br />- -3xt. sa = FAx
<br />,. ...1i.VQ,:.v„..Fdcl)(B66) 293 600 e
<br />;.... ... ..... _............_ . ...
<br />E-MAIL
<br />...i.M1Q9g.§.§........._..„ ... ....... . .........................________
<br />INSURER(S1 202 92!L_. .. .. _.....1_439)(...........
<br />irisuaeyin: American Zurich Insurance Cornpany........_.................._,...____..401_42_...,...,..........
<br />11:4s! -!...911.i....... _.. .. .. ,..„...............„_..................
<br />, y.3!14f1.....0..; ...................._ ._
<br />114011133131 D
<br />INSURE11 E :,_ _ ..... ____, _ _____.. __.........................
<br />----,.......„...._..................._
<br />. INSCMEV1F : .... .. .. . . .
<br />9902691
<br />COVERAGES
<br />CERTIFICATE NUMBER: I8FL
<br />•
<br />...•,•,.
<br />F.VISION NUMBER:
<br />THIS
<br />INDICA
<br />CERTIFICATE
<br />EXCLUSIONS
<br />LTR
<br />10 TO GER -HP,' THAT THE POLICIES
<br />'t ED. NOTWITHSTANDING ANY REQUIREMENT.
<br />MAY BE ISSUED 011 MAY
<br />AND CONDITIONS OF SUCH
<br />TYPE OF INSURANCE
<br />01' INSURANCE
<br />PERTAIN,
<br />POLICIES.
<br />•
<br />LISTED 1,14.0W HAVE BEEN
<br />TERM OR COND1.1.10N 01ANY
<br />THE INSURANCE AFFORDED BY
<br />LIMITS SHOWN MAY HAVE BEEN REDUCED
<br />POLICY NUMBEI1 I
<br />ISSUED To
<br />CONTRAC'f
<br />INC POLICIES
<br />BY
<br />(IMM/DD/YYYYL
<br />THE INSURED
<br />OR OTHER
<br />DESCRIBED
<br />PAID CLAIMS.
<br />(MM/D0/YYY11
<br />I
<br />NAMED ABOVE FOH 1F1F,
<br />DOCUMENT WITH RESPECT
<br />HERON 1;3 SUBJECT TO
<br />LIMITS
<br />EACH OCCURRENCE
<br />DAMMTE TURYNTI.4.n
<br />PREMISES (E0 emu/yew:A
<br />MEG EXP (Any one (lemon)
<br />PERSONAL & ADV INJURY
<br />GENERAL AGGREGATE
<br />pnooucrs COMP/OP AC '
<br />COMBINED SIHGccf, AlT
<br />(Ea aeeidoon
<br />RODITY10.4.i13Y (For pereen)
<br />00DILY I11J1.11/(Per /acoiclon1)
<br />r'nopERTY RAMAGE
<br />(pp/ aceId711)
<br />EA0CCURRENCE
<br />VGREGATE .
<br />/
<br />POLICY PERIOD
<br />TO WHICH THIS
<br />ALL THE 'FERRIS.
<br />.
<br />0 -
<br />$ ---..- ....
<br />0 ... .,...................
<br />c-.•
<br />• ....... . ........______
<br />S _
<br />'
<br />4,
<br />0
<br />$
<br />S
<br />'
<br />8
<br />S
<br />----
<br />..........
<br />GE
<br />--
<br />COMMERCIAL GENERAL
<br />------,
<br />CLAIMSTAADE
<br />................___________....
<br />1. ACGREGATE umrr
<br />POLICY I 1
<br />OTHER:
<br />LIABILITY
<br />I,____I OCCUR
<br />_____.. .._
<br />APPLIES PER:
<br />'
<br />• I LOC
<br />AU OMOOILE LIABILITY
<br />ANY AUTO
<br />OWNE0
<br />Au TOS ONLY
<br />HIRED
<br />AUTOS ONLY
<br />SCHEDULED
<br />1 AUTOS
<br />., NON•OWNED
<br />I AUTOS ONLY
<br />1
<br />..........
<br />••
<br />•
<br />WORKERS
<br />AND
<br />,lNYPN2PitITOyf"ANTNERitiXECLNIVE
<br />miii-waimy
<br />II yes.
<br />DESC,',RIPTION
<br />i
<br />UMBRELLA LIAEI I
<br />! 1 00,-;iin
<br />.. .. .
<br />t - ,
<br />E-XCESS LIAO I I CLAIMSTOADE
<br />• ,
<br />DEO , 1 RETENTION I;
<br />---/__
<br />COMPENSATION
<br />ILITY
<br />EMPLOYERS' LIABY / N
<br />LERIMEAIERExac1DEDFN1
<br />In NH)
<br />desedoo onoor
<br />or opERA-rioNsb,,ino,
<br />N/
<br />00-818-08 12/31/2018
<br />/
<br />/
<br />'
<br />12/31/2c(9
<br />v I KR.., _E. 1 NTH -
<br />,,- _(_;-51ANT 1.
<br />Li ' tC -' A 'C"IUC NACH
<br />A T
<br />EL.. DISEASE • EA EMPLOYEE
<br />E.L. DISEASE • POLICY LIMIT
<br />S
<br />$
<br />1,000 000
<br />1,000,000
<br />$
<br />1.000,000
<br />DESCRIPTION
<br />covetaaa
<br />only
<br />of, ut
<br />ta:
<br />those
<br />It n01
<br />Location Coverage Period: 12/31/2018
<br />12/. 1/2019
<br />Olient# 050682
<br />OP OPERATIONS i LOCATIONS i VEI•11C1 ES (ACORD10L Additional Remark/3 Schedule, may be ellach(d 11 mere • nice is required)
<br />Guettler Brothers Construction LLC
<br />is provided tor
<br />.. „,,
<br />4401 White Way Da ry Road _...... IV.2L3
<br />co -employees p}„
<br />,
<br />subcOntrilCIOIS Fort Pierce, FL 34947 ) {J1
<br />„
<br />CERTIFICATE HOLDER
<br />Indian River County t3uilding Department
<br />1800 27t11 Street
<br />Vero 13each, FL 32960
<br />1
<br />CANCELLATION
<br />SHOULD ANY OF THE ABOVE 009033113ED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL FIE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />AC71101312E0 REPRESENTATIVE
<br />, 4., •
<br />ACORD 25 (2016/031
<br />1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name anci loao are reaistered marks of ACORD
<br />2 eI 2 10330
<br />
|