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CERTIFICATE OF LIABILITY INSURANCE (459)A CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 10/28/2013 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 Bouchard Insurance for WBS P.O.Box 6090 Clearwater, FL 33758 -6090 CONTACT NAME: PHONE (A/C. No. Eat): (866) 293 -3600 ext. 623 FAX (A /C, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC p INSURER A : American Zurich Insurance Company 40142 INSURED Workforce Business Services, Inc Alt. Emp: Coastal Contracting Services Inc 1401 Manatee Ave. West Ste 600 Bradenton, FL 34205 -6708 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 12FL079856601 R 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MMIDD/YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY t JJ °� , T °' S L �� ryy 1" EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (E CLAIMS -MADE OCCUR one $ GE PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 'L AGGREGATE POLICY LIMIT APPLIES PRO PER: LOC PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS r,,,`id`u r ,,,,, ado l;y�, ` ¢[�14��) j° /�� )° (EaacBcideDSINGLELIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY OFFICER/MEMBER EXCLUDED? PROPRIETOR/PARTNER/EXECUTIVE (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N - N /A WC 90- 00- 818 -02 12/31/2012 12/31/2013 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 Location Coverage Period: 10/20/2013 12/31/2013 Client# 054113 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Coverage is provided for Coastal Contracting Services Inc only those employees 4710 96th Street North leased to but not St Petersburg, FL 33708 subcontractors of: CERTIFICATE HOLDER City of Clearwater 100 S Myrtle Ave Clearwater, FL 33756 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD