CERTIFICATE OF INSURANCE FOR EMPLOYEES LEASED TO CLARK SALES DISPLAY INCORPORATED
PUBLIC SERVICES DePARTMENT
Copy _. '_'_ File
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Certificate of Inaurance CONST.
This oertlflcatels Issued as a matt.. of Information only and oonfers no rights upon the Cerllflcate Hold..,oIher than those provided by this polley.
This oerllflcate does not amend. extend. or alter the coverage afforded by the pdldes descrfbed herein. U PMl i
Named Insured(s):
Gevity HR. Inc and its wholly owned subsidiaries including but not limited to
13evity HR, LPj 13evity HR II, lPj 13evily HR III, lPj13evity HR IV, LPj
Gevity HR V, L.P; Gevity HR VI, L.P: Gevity HR VII, L.P; Gevity HR VIII. L.P:
Gevlty HR IX, L.P; Gevlty H R X, L.P; Gevlty HR XI, L.L.C; Gevlly HR XII Corp.
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MARSH
600301 Boulevard Weat Inaurer Affording Coverage
Bradenton, Florida 34205
Am....CM Hom. Assurlne. Co.,
Coverages: M....b.r or Am",lcan Intematlonal Oroup,lnc.(A10)
This Is to certify lIlllt lIllI pollcy(les) of InsuranCl!l deserlbed hlll'tlln hllV8 been Issued IIll the Insul'8d named herein for thll polley period Indicated.
Notwithstanding any requll1lment, !arm Dr condition of any connot or other document with I8sp8GItO which the Certificate may be Issued or may pertain.
thelnwrancellfforded by the pollcy(les) desalbed herein Is wbJ8ct to all the terms, conditions and exclusions of wch pollcy(les),
(Aggregate) LImits shown may have been reduced by paid dalms.
Type of Insurance Certificate Exp. Polley Number LImits
Date
RMWC0330470 Employera Liability
Workers' 1-1-200& Bodily Injury By Accident
Com pensatlon RMWC0330.c&5 $2,000,000 Each Acx:ldent
Bodily Injury By Disease
$2,000,000 Polley Limit
Bodily Injury By Disease
$2,000,000 Eadl Person
Other:
Employeea Leased To: Effective Date : 01-JAN-2005
101Bl.Clark 9&1.. Di.play IDe
The above referenced worke",' lXlmpensaticln policy(iea) provicJe(e) sllltutory benefilil only to employeEllll of the Named Ineured(s) em such poliey(iee), not to
the employellll r:I any olher employer.
NotIce of CancellatIon: Should any of the policies desaibed herein be ~cell&d before the expiration dats thersof, 1he insurer
affording coverage will endEl8vc::r to mail 30 days written notice to the certificate holder named herein, but failure to mail such notice
ahalllmpoae no obligation or liability ct any kind upon the In8Urer affordng coverage, Its agents or represenfalvea,
Certificate Hold.r
City of Clearwater
PO Box 4748
Clearwater, FL 34618
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RECEIVED
Michael C, Weias
Authorized Repr....ntativ. of Mar9h USA Inc.
(8El6).443-8A8g 11-ATJ'Q-2005
AUG 1 7 2005
Phone
Date Issued
RISK MANAGEMENT