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ACO�RO� DATE(MMlDD/YYYY) CERTIFICATE OF L1�4�ILITY IiVSURARJCE 12/08/2016 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 PHONE Ex . �g66)293-3600 ext.623 ac No: P O.BOX BO9O E-MAIL Clearwater;FL 33758-6090 ADDRESS: INSURER S AFFORDING COVERAGE NAIC# iNsuReRn: American Zurich Insurance Com an 40142 INSURED � INSURER B. Workforce Business Services,Inc.Alt Emp:Roofsmith of Tampa Bay Inc 1401 Manatee Ave.West Ste 600 INSURER C: Bradenton,FL 34205-6708 INSURER D: INSURER E. INSURER F: COVERAG;ES CERTIFICATE NUMBER:15FL079874703 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 I 7ypE OF INSURANCE ADOL SUBR POLICY EFP POLICY EXP LIMITS LTR POLICY NUMBER MMIDD/YYYY MMlDDIYYYY I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CWMS-MADE �OCCUR PREM SES Ea occu ence $ I � MED EXP(My one person) $ I PERSONAL&ADV INJURY $ i GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY��E a �LOC PRODUCTS-COMP/OP AGG $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ � Ea accident I ANYAUTO BODILYINJURY(Perperson) $ � ALL'OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-0WNED PROPERTY DAMAGE $ HIRED AUTOS pUTOS Per accident � � $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1 EXCESS LIAB CLAIMS-MADE AGGREGATE $ , , DED RETENTION$ S � � WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNERfEXECUTIVE Y�N E.LEACHACCIDENT $ 'I,OOO,OOO A OFFICER/MEMBEREXCLUDED? � NIA WC 90-00-818-05 12/31/2015 12/31/2016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,�00,�� �I If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY L1MIT $ 1,000,000 ILocation Coverage Period: 12/31/2015 12/31/2016 Client# 054253 i ; DESCRIPTION OP OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Addltlonal Remarks Scheduie,may be attached if more space Is required) Covera9e is provided tor Roofsmith of Tampa Bay Inc � only those co-employees 6089 Johns Rd,Ste 98�10 of,but not subconVactors Tampa,FL 33634 to: 1 CERTIFICATE HOLDER CANCELLATION I � City of Zephyrhilis Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ; 5335 8th Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN i ; Zephyrhills,FL 33542 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ', i I ` II I I O 1988-2014 ACORD CORPORATION. All rights reserved. I ' ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD , �— I J