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HomeMy WebLinkAboutWorkforce Business Services CA LLC Labor Contractor for Mid Peninsula Roofing Inc 11.29.24CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER� T11/29/2024HIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OP. 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 palicy(ies) must have ADDITIONAL WSURED provisions or be If SUBROGATION IS WAIVED, subJect to the terms and conditions of the policy, certain policies may require an endorsement. A endorsed. this certiflcato dew not confer rights to the certificate holder in lieu of suchpp endorsement s . statement on PRODUCER NAME.: CT TOdd GeoYge PO Ox 6090 -(A_�Uo.-3600 ext. 623 Clearwater, FL 33758.6090 E -M __ INSURERS Q_ROI NLCLC QVjERAG E INSURED Workforce Business Services CA, LLC Labor Contractor, for co -employees of: Mid Peninsula Roofing Inc 1401 Manatee Ave, West Ste 600 Bradenton, FL 34206.6708 A E 11-115 16 -IQ CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED T ­­'­ 114WIVIU-N; THE INSURED NAMFL) 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS, COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [:] OCCUR GE 'L AGGREGATE LIMIT APPLIES PER: POLICY 0 JrR,01 LOC OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED. SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY BAUTOS ONLY UMBRELLALIAB OCCUR EXCESS LIAR 1-1 11, A I. � Y' N INIA1 I WC 90.00-875-14 El Location Coverage Period: COMBINE SINGLE LIMIT BODILY INJURY (Por person) $ BODILY IN—JURY (Por ocoldem-) PPpPFRTY —DAMAGE $ $ 12/31/2024 112/31/2025 112/31/2024 2/31/2026 Client# 053763 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks CSchedule, may be attached If more space Is required) Coverage is provided for Mid Peninsula Roofing Inc only those co -employees 1326 Marston Road of, but not subcontractors Burlingame, CA 94010 to: Town of Los Altos Hills SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 26379 Fremont Rd THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Los Altos Hills, CA 94022 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I J41K ©1988.2015 ACORD CORPORATION.Allreserved. ACORD 25 (2016103) The ACORD name and 1090 are registered marks of ACORD