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CERTIFICATE OF LIABILITY INSURANCE (139)CERTIFICATE OF LIABILITY INSURANCE iiia�i2o�3 ProduCer: Lion Insurance Company This Certificate is issued as a matter of iiMormatlon only and confere no riglhts 2739 U.S. HIghWBy 19 N. upon the Certificate Holder. This Certificate dces not amend, extend or altvr Holiday, FL 34691 the coverage afforded by the policies below. (727) 938-5562 Insurers Affording Coverage NAIC •� Insured: South East Personnel Leasing, Inc. & Subsidiarie �nsurerA: LionInsuranceCompany iior.; 2739 U.S. Highway 19 N. �nsurere: HOliday, FL 34691 �nsurerc: Insurer D: Insurer E: Coverages poiues uuirance ste e ve nis to irsue nem a ve r poicypeno i ica . olwi ta inganyrequremert,0artnw �OOno arrycontracta r ocunertwi respec[tow� this cerUficate may be issued or may pertain, the ireuance alforded by the policies described herein is subject ro all the tertns, ezGuSiors, and conditiors of such poticies. Aggregate limits shown may ha�,e been reduceii by paitl claims. �ISR ADDL Policy Effective Policy Expiration Date LinlitS �rR 9JSRD Type of Insurance Policy Number �ate (MM/DD/YY) (MM/DDlYY) ENERAL LIABILITY Eacnoccurence Commercial General Liability Damage to reMed premises (EA Claims Made � Occur o�c�rrence> Med E� Personal Adv Injury eneral aggregate limit applies per: General A99re9ate Policy ❑ Project ❑ LOC Produds-Comp/OpA99 UTOMOBILE LIABILITY __.. r_ ,_ �__ _ Combinedsing�eumit ArryAuOO ��. . . . ._ . . (EAActltler� All Ownetl A�s Bodily Iryuy Sched�ed A�1os (Per Person) Hired Autos Bodily Iryuy NorrOwned Autos _ (Per Accidert) . . . . .. . . .. .. . Property Damage :...__.....'--._.�-,�.... � . . � (PerAceidert) EXCESS/UMBRELLA LIABILITY EachOccurence Ocar ❑ ClaimsMade Aggregate Deductible A Workers Compensation and WC 71949 01/01/2013 01/01/2014 x wC Sta�u- oTH- Employers' Liability to Limits ER Any proprietodpartneNexecutive officedmember E.L. Each Accident S�,000,a:o excluded? NO E.L. Disease - Ea Employee S�,000,a:o If Yes, describe under special provisions below. E.L. Disease - Policy Limits 3i.000,a'o omer Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 Descriptions of Operations/Locations/Vehicles/Exclusions added by Endorsement/Special Provisions: Client ID: 93-67-004 Coverage only applies to active employee(s) of South East Employee Leasing Services, Inc. that are leased to the following "Client Company": Florida Gas Contractor, Inc. Coverage only applies to injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s) , while working in Florida. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Gient Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937-2138 or by calling (727) 938-5562. Project Name: ISSUE 01-14-13 (JG) in Date: 12 26 7Al2 CERTIFICAiE HOLDER CANCELLATION CITY OF CLEARWATER Sho�d ary ofthe abo�e tlescribed poliaes be cancelled before the e�iration date thereof, the issurg insirerwnN endeawr to mail 30 tlays wntten ro6ce to the certificate Mkler remed ro the leR, but failue ro tlo so shall impos�a no ATTN: C ITY CLERK obGgation or liability of ary kine iyon the insirer, its agerrs or represeMatives. PO BOX 4748 CLEARWATER, FL 34618 �� CERTIFICATE OF LIABILITY INSURANCE Date I 1/21/2014 Producer: Lion Insurance Company 2739 U.S. Highway 19 N. Holiday, FL 34691 (727) 938 -5562 This Certificate is issued as a matter of information only and confers no rights upon the Certificate Holder. This Certificate does not amend, extend or alter the coverage afforded by the policies below. Insurers Affording Coverage NAIC # Insured: South East Personnel Leasing, Inc. & Subsidiaries 2739 U.S. Highway 19 N. Holiday, FL 34691 Insurer A: Lion Insurance Company 11075 Insurer B: Insurer C: Insurer D: Insurer E: Coverages 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. Aggregate limits shown may have been reduced by paid claims. INSR LTR ADDL INSRD Type of Insurance Policy Number Policy Effective Date (MM /DD/YY) Policy Expiration Date (MM /DD/YY) Limits GENERAL Commercial LIABILITY General Claims Made Liability Occur Ca 12 n ce I 24,' led 2013 Each Occurrence $ occurrence) to rented premises (EA occuence) $ Med Exp $ Personal Injury $ General aggregate 3 Policy limit applies per: Project ❑ LOC General Aggregate gate $ Products - Comp/Op A99 $ AUTOMOBILE ■1 LIABILITY Any Auto All Owned Autos Scheduled Autos Hired Autos Non -Owned Autos RECEIVE FEB o 3 y�� 07fIC�,AL RECORDS LEGISLATIVE SEWS 2014 g� AND AND DEPT Combined Single Limit (EA Accident) $ Bodily Injury (Per Person) $ Bodily Injury (Per Accident) $ Property Damage (Per Accident) $ EXCESS /UMBRELLA LIABILITY Occur ❑ Claims Made Deductible Each Occurrence Aggregate A Workers Compensation and Employers' Liability Any proprietor /partner /executive officer /member excluded? If Yes, describe under special provisions below. WC 71949 01/01/2013 01/01/2014 x I WC Statu- tory Limits I 10TH ER E.L. Each Accident $1,000,000 E.L. Disease - Ea Employee $1,000,000 E.L. Disease - Policy Limits $1,000,000 Other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 Descriptions of Operations /LocationsNehicles /Exclusions added by Endorsement/Special Provisions: Client ID: 93-67 -004 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. that are leased to the following "Client Company ": Florida Gas Contractor, Inc. Coverage only applies to injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s) , while working in FL. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937 -2138 or by calling (727) 938 -5562. Project Name: ISSUE 01 -14 -13 (JG) REISSUE 12 -17 -13 (EP) Begin Date 12/26/2012 CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER ATTN: CITY CLERK PO BOX 4748 CLEARWATER, FL 34618�� Should any of the above described policies be cancelled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. CERTIFICATE OF LIABILITY INSURANCE I Date 1/21/2014 Producer: Lion Insurance Company 2739 U.S. Highway 19 N. Holiday, FL 34691 (727) 938 -5562 This Certificate is issued as a matter of information only and confers no rights upon the Certificate Holder. This Certificate does not amend, extend or alter the coverage afforded by the policies below. Insurers Affording Coverage NAIC # Insured: South East Personnel Leasing, Inc. & Subsidiaries 2739 U.S. Highway 19 N. Holiday, FL 34691 Insurer A: Lion Insurance Company 11075 Insurer B: Insurer C: Insurer D: Insurer E: Coverages 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. Aggregate limits shown may have been reduced by paid claims. INSR LTR ADDL INSRD Type of Insurance Policy Number Policy Effective Date (MM /DD/YY) Policy Expiration Date (MM /DDNY) Limits GENERAL Commercial LIABILITY General Claims Made Liability Occur Ca 12 n ce I 24 led 2013 Each Occurrence $ Damage to rented premises (EA occurrence) $ Med Exp $ Personal Injury $ General aggregate limit applies per: D Policy [J Project ❑ LOC General ral Aggregate gate $ Products - Comp /Op Agg $ AUTOMOBILE .1.. ■ LIABILITY Any Auto All Owned Autos Scheduled Autos Hired Autos Non -Owned Autos C L ,,gg� ," a :Ci SLATiVE n A FEE3 a 2".1,4 iiiECOi -Zu::' SI CS Air D7'1 Combined Single Limit (EA Accident) $ Bodily Injury (Per Person) $ Bodily Injury (Per Accident) $ Property Damage (Per Accident) $ EXCESS /UMBRELLA LIABILITY ROccur a Claims Made Deductible Each Occurrence Aggregate A Workers Compensation and Employers' Liability Any proprietor /partner /executive officer /member excluded? If Yes, describe under special provisions below. WC 71949 01/01/2013 01/01/2014 x I WC Statu- I tory Limits I OTH- ER E.L. Each Accident $1,000,000 E.L. Disease - Ea Employee $1,000,000 E.L. Disease - Policy Limits $1,000,000 Other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 Descriptions of Operations /LocationsNehicles /Exclusions added by Endorsement/Special Provisions: Client ID: 43 -67 -009 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. that are leased to the following "Client Company ": Clark Hunt Construction, Inc. Coverage only applies to injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s) , while working in FL. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937 -2138 or by calling (727) 938 -5562. Project Name: ISSUE 03 -01 -13 (TD) Begin Date 2/20/2013 CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER 100 S. MYRTLE AVENUE CLEARWATER, FL 33756+rK^ Should any of the above described policies be cancelled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. �r