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Ins Cert/2 of 2/WC/Clean Sweep/F CrumACCORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 5/13/2015 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 AFFORDE' =''% r •LI BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSU- ■� REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. i, viz, f`k IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poltcy(ies) must be endorsed. If SUBROGATION IS ' D, •'ec 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 (3k such endorsement(s). PRODUCER Pettineo Insu *ance Agency, Inc 2430 E. Comme4cial Blvd. Ft. Lauderdale, FL 33308 CONTACT NAME: (PHONE 954- 493 -9424 MAIat): NZ ° E ADDRESS: (NC. No):954- 493 -8968 INSURER(8I AFFORDING COVERAGE NAICR INSURERA: FCB & I Fund INSURED Clean Sweep & Vac LLC 8255 Business Park Drive Port Saint Lucie, FL 34952 INSURER B INSURER C : INSURER D : INSURER E INSURER F BER: REVISION NUMBER: THIS IS TO CERTIFY THAT INDICATED. NOTWITHSTANDING CERTIFICATE MAY BE ISSUED EXCLUSIONS AND CONDITIONS THE POLICIES OF INSURANCE LISTED.BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. HMI LTR TYPE OF INSURANCE AGOL IMO BURR- WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP SMM/ODfY YY) LIMITS COMMERCIAL GENERAL LIABILITY I OCCUR EACH OCCURRENCE $ TED PREMISESO(Ea occurrence) S CLAIMS -MADE I MED EXP (My one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GE 'L AGGREGATE LIMIT APPLIES PER POLICY I—) JECT LOC OTHER: PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE _ — _ LIABILITY ANYAUTO ALL OWNED AUTOS HIRED AUTOS — - — __- SCHEDULED NON-OWNED AUTOS • COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA L1AB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED I I RETENTION $ A WORKERS COMPENSATLCN AND EMPLOYERS' LIABILL hY ANY PROPRIETOR/PAR R XECU7IVE YIN (Mandatory DCCLUDEp7 N (Mmdarory in NH) K s, describe under DESCRIPTION OF OPERA1hIONS below WA 106 -56691 5/12/155/12/18 / I STATUTE I I ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE$ 500,000 E.L. DISEASE - POLICY LIMIT S 500,000 DESCRIPTION OF OPERATION / LOCATIONS / VEHICLES ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City Of Okeechobee 55 SE 3rd Ave Okeechobee, FL 34974 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 ®1988 -2014 ACORD CORPORATION. All rights reserved. ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD ""' CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 01/08/2015 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 FrankCrum Insurance Agency, Inc. 100 South Missouri Avenue Clearwater, FL 33756 CONTACT NAME: PHONE (NC, No, Ext): 1-800- 277 -1620 x4800 IFAX (A/C, No): (727) 797 -0704 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Frank Winston Crum Insurance Co. 11600 INSURED FRANKCRUM L /C /F CLEAN SWEEP & VAC, LLC 100 SOUTH MISSOURI AVENUE CLEARWATER, FL 33756 INSURER B: INSURER C: INSURER D: INSURER E: $ INSURER F: DAMAGE TO RENTED PREMISES (Ea occurrence) CERTIFICATE NUMBER: 305302 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME 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 INSRD SUER MD POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP (MMIDD/YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY _ EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n PROJECT nLOC PRODUCTS- COMP /OP AGG $ -I $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED - ' a]� O �1 > .. - l MBI',,. a SI H an $ a $ ` • T' � acci, ent) $ PROPERTY DAMAGE {Per accident) $ $ UMBRELLA LIAB EXCESS LIAB iiiiiii„ OCCUR CLAIMS -MADE Cancellation date: 04/03/15 EACH OCURRENCE $ - AGGREGATE $ DED I 'RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory and If f yees, , describe under DESCRIPTION OF OPERATIONS below Y/N N/A WC201500000 01/01/2015 01/01/2016 X WC STATUTORY 0TH - LIMITS ER E.L. EACH ACCIDENT $1,000,000 I ( E.L. DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (At ach ACORD 101, Additional Remarks, Schedule, if more space is required) EFFECTIVE 06/11/2011, COVERAGE IS FOR 100% OF THE EMPLOYEES OF FRANKCRUM LEASED TO CLEAN SWEEP & VAC, LLC (CLIENT) FOR WHOM THE CLIENT IS REPORTING HOURS TO FRANKCRUM. COVERAGE IS NOT EXTENDED TO STATUTORY EMPLOYEES. CERTIFICATE HOLDER A CITY OF OKEECHOBEE 55 S.E. 3RD AVENUE OKEECHOBEE, FL 34974 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 ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD A v' CERTIFICATE OF LIABILITY INSURANCE ■---" -- DATE MWDD YYYY) 01/08/2015 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 FrankCrum Insurance Agency, Inc. 100 South Missouri Avenue Clearwater, FL 33756 CONTACT NAME PHONE INC. No, EXt} 1 -800- 277 -1620 x4800 !FAXING, N2L L727)797 -0704 E -MAIL ADDRESS INSURER(S) AFFORDING COVERAGE NAICa INSURER A Frank Winston Crum insurance Co. 11600 INSURED FRANKCRUM L /C /F CLEAN SWEEP & VAC, LLC 100 SOUTH MISSOURI AVENUE CLEARWATER, FL 33756 INSURER B INSURER C. INSURER 0. S INSURER E INSURER F CLAIMS -MADE COVERAGES RTIFICATE NUMBER: 305302 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME 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 SOUL INSRD SUBR WVD POLICY NUMBER POLICY EFF (MM/DOIYYYY) POLICY EXP (MMIDD$YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY I OCCUR 'ACM OCCURRENCE S DAMAGE TO RENTED PREMISES (Ea ORUIrPr,AP CLAIMS -MADE MEDEXPIAny one PersonI PERSONAL B ADV INJURY S S GENERAL AGGREGATE GEN'C AGGREGATE LIMIT APPLIES PER POLICY n PROJECT nLOC PRODUCTS- COMP/OP AI:.-: $ AUTOMOBILE - - -- ,_ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS - SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Es accident) BODILY IN.;t/RY (Per person) 5 BODILY INJURY Per ncritlenll PROPERTY DAMAGE Per accident) UMBRELLA LIAB EXCESS LIAO OCCUR t:I. AIMS- 1Ai'OE EACH OE:URRENCE ., AGGREGATE S DEO I 'RETENTION§ A 'WORKERS COMPENSA ,ION AND EMPLOYERS' LIABILITY V/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFf ICES/MEMBER EXCLUDED, I I (Mandatory in NH) If yes describe pride DESCRIPTION OF OPERATIONS below N/A WC201500000 01/01/2015 01/01/2016 -T7- X IWC STATUTORY O'H- LIMITS FR E L EACH ACCIDENT b1,00J IiCf, E I.. DISEASE EA EMPLOYEE 11 . 00(1.000 F l DISEASE -POI !CY I 'MIT $1 OP C SAl DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks, Schedule, if more space is required) EFFECTIVE 06/11/2011, COVERAGE IS FOR 100% OF THE EMPLOYEES OF FRANKCRUM LEASED TO CLEAN SWEEP & VAC, LLC (CLIENT) FOR WHOM THE CLIENT IS REPORTING HOURS TO FRANKCRUM. COVERAGE IS NOT EXTENDED TO STATUTORY EMPLOYEES- CANCELLATION CITY OF 3RD AVENUE O S.E- HO AVENUE OKEECHOBEE,FL34974 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 REP ESENTATIVE ACORD 25 (2010705) The ACORD name and logo are registered marks of ACORD ©1988 -2010 ACORD CORPORATION. All rights reserved. ACOROe CERTIFICATE OF LIABILITY INSURANCE "� DATE (MM °D YVYY) 11/21/2013 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 FRANKCRUM INSURANCE AGENCY, INC. 100 S. MISSOURI AVE. CLEARWATER FL 33756 CONTACT NAME: E (AICNN , Eat): 1-800-277 -1620 x4800 (FAX No)_ 727-797-0704 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: FRANK VVINSTON CRUM INSURANCE CO. 11600 INSURED FrankCrum 1- 800 - 277 -1620 100 S MISSOURI AVENUE CLEARWATER FL 33756 INSURER B: INSURER C: INSURER D: INSURER E: $ INSURER F: DAMAGE TO RENTED PREMISES (Ea occurrence) ERTIFICATE NUMBER: 227028 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. INSa LTR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MWDD/YYYY) LIMITS GENERAL UABIUTY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (My one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY I1PROJECT I --ILOC PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ _AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per sodden!) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTIONS $ A WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC201400000 1/1/2014 1/1/2015 X TORY LIMITS O S ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) EFFECTIVE 06/11/2011, COVERAGE IS FOR 100% OF THE EMPLOYEES OF FRANKCRUM LEASED TO CLEAN SWEEP & VAC, LLC (CLIENT) FOR WHOM THE CLIENT IS REPORTING HOURS TO FRANKCRUM. COVERAGE IS NOT EXTENDED TO STATUTORY EMPLOYEES. CERTIFICATE HOLDER CANCELLATION CITY OF OKEECHOBEE 55 S.E. 3RD AVENUE OKEECHOBEE, FL 34974 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) The ACORD name and logo are registered marks of ACORD ©1988 -2010 ACORD CORPORATION. All rights reserved. ACp m CERTIFICATE OF LIABILITY INSURANCE DATE (MWDDNYYY) 6/26r2013 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 FRANKCRUM INSURANCE AGENCY, INC. 100 S. MISSOURI AVE. CLEARWATER FL 33756 CONTACT NAME: PHONE ,N FAX X4800 FAX 727- 797 -0704 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: FRANK WINSTON CRUM INSURANCE CO. 11600 INSURED FrankCrum 1- 800 - 277 -1620 100 S MISSOURI AVENUE CLEARWATER FL 33756 INSURER B: INSURER C: INSURER D: INSURER E: $ INSURER F: DAMAGE TO RENTED PREMISES (Ea occurrence) • REVISION NUMBER: yv• 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 SUER WVD POLICY NUMBER POLICY EFF (MM /OD/YYYY) POLICY EXP (MM /DO/YYYY) UMTS GENERAL UABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ ICI MS -MADE OCCUR MED EXP (Any one person) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ -1 POLICY r 1PROJECT - LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ OED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N/A WC201300000 1/1/2013 1/1/2014 X TORY LIMITS ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) EFFECTIVE 06/11/2011, COVERAGE IS FOR 100% OF THE EMPLOYEES OF FRANKCRUM LEASED TO CLEAN SWEEP & VAC, LLC (CLIENT) FOR WHOM THE CLIENT IS REPORTING HOURS TO FRANKCRUM. COVERAGE IS NOT EXTENDED TO STATUTORY EMPLOYEES. CANCELLATION CITY OF OKEECHOBEE 55 S.E. 3RD AVENUE OKEECHOBEE, FL 34974 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 .7-7-„....—---..--. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ©1988 -2010 ACORD CORPORATION. All rights reserved.