2018/12/31 Workforce Business Services CA, LLC Certificate of Liability InsuranceacoR�� CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDiYYYY)
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12/13/2018
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 have ADDITIONAL INSURED provisions or 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 866 293 3600 ext. 623 FAX
AC No Ext : ( ) A/C NO);
PO Box 6090(AC_
ADDRESS:
Clearwater, FL 33758-6090
INSURERS AFFORDING COVERAGE
NAIC#
INSURER A: American Zurich Insurance Company
40142
INSURED
Workforce Business Services CA, LLC Labor Contractor, for co -employees of: Moore.
INSURER B :
Scott (partner) and Moore, Yvonne (partner) dba: Red Hawk Services; Red Hawk Fence
INSURER C :
INSURER D
& Environmental
1401 Manatee Ave. West Ste 600
INSURER E
Bradenton, FL 34205-6708
INSURER F :
COVERAGES CERTIFICATE NUMBER-- 18FL079858621 RF1/1Q1nM 11d1111AR1=0
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
I TYPEOF INSURANCE
ADDL
I
SUER
I
POLICY NUMBER
POLICY EFF
I MMIDDIYYYY
POLICY EXP
1MM1DDJYYYY1
LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
city of Men
fee
EACH OCCURRENCE
S
DAMAGE TO RENTED
PREMISES Ea occurrence
S
MED EXP (An one person)
$
City Clem
PERSONAL & ADV INJURY
S
GEN'L
AGGREGATE LIMIT APPLIES PER:
PRO- ❑
POLICY ❑ JECT LOC
GENERAL AGGREGATE
S
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DEC �/
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PRODUCTS - COMP.OP AGG
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OTHER:
AUTOMOBILE
LIABILITY
ANY AUTO
I
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
ReceiVE
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COMBINEDS INGLELIMIT
Ea accident
I S
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
I PROPERTYDAMAGE
Per accident
S
S
UMBRELLA LIAB
I OCCUR
EACH OCCURRENCE
S
AGGREGATE
S
EXCESS LIAB
CLAIMS -MADE
DIED RETENTION S
S
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
OF IC RWEMBEREXC UDED?ANYPROPRIETORIPARTNER�EXECUTIVE ❑
NIA
WC47-58-414-06
12/31/2018
I
12/31/2019
X 1 STATUTE I OERH
E.L. EACH ACCIDENT S 1,000,000
E.L. DISEASE - EA EMPLOYEE 5 1,000,000
(Mandatory in NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT S 1,000,000
DESCRIPTION OF OPERATIONS below
Location Coverage Period:
12/31/2018
12/31/2019
Client# 054134
DESCRIPTION OF OPERATIONS! LOCATIONS r VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is required)
Coverage is provided for Moore, Scott (partner) and Moore, Yvonne (partner) dba:
only those co -employees Red Hawk Services; Red Hawk Fence & Environmental
of, but not subcontractors 262 E 1 St Street
to: Perris, CA 92570
City of Menifee
29714 Haun Road
Menifee, CA 92586
liHlYIiCLLHI IVIV
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
V 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and loao are reaistered marks of ACORD 2 of 2 51092
Artex Risk Solutions, Inc. FL079
8840 E Chaparral Rd Suite 275
Scottsdale, AZ 85250
51092 1 AB 0.405 51092
CITY OF MENIFEE
29714 HAUN RD
MENIFEE, CA 92586-6540
1 of 2 51092