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CERTIFICATE OF LIABILITY INSURANCE (363)A o® CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 3/31/2014 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 TriGen Insurance Solutions, Inc. 315 SE Mizner Blvd, Suite 200 Boca Raton FL 33432 CONTACT NAME: Tamika Lynch PHONE INC. /C o.Ext): (877) 987-4436 (A/C, No): (954) 252 -4426 E -MAIL ADDRESS: certs @trigengroupinc.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Guarantee Insurance Company 11398 INSURED (904) 731 -9014 Convergence Employee Leasing, Inc. Convergence Employee Leasing II, Inc. Convergence Employee Leasing III, Inc. 3951 Baymeadows Road Jacksonville FL 32217 INSURERS: �' am ) ` '� v:. r ','' ,'� �r A S°m,•.• E $,,,) � INSURER C: INSURER D: $ INSURERE: $ INSURER F : COVERAGES CERTIFICATE NUMBER: Cert ID 2523 REVISION NUMBER: 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 INSD SUBR W VD POLICY NUMBER POLICY EFF (MM /DO/YYYY ) POLICY EXP /Y (MM /DDYYY) LIMITS COMMERCIAL GENERAL LIABILITY c, M,1 L' Fi°e�rEg 4 �' am ) ` '� v:. r ','' ,'� �r A S°m,•.• E $,,,) � , EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GE 'L AGGREGATE POLICY OTHER: LIMIT APPLIES JET PER: LOC PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON-OWNED AUTOS 1/ �) �r q �," j COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS UAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A WORKERS EMPLOYERS' 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 GPE0597000001 -113 10/17/2013 10/17 /2014 X STATUTE ERH 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 (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Coverage provided for all leased employees but not subcontractors of: Terry Painter dba Terry's Mobile Home Center Location coverage effective: 10/17/2013 CLIENT TERMED 2/21/14. THIS CLIENT COMPANY NO LONGER HAS COVERAGE THROUGH CONVERGENCE EMPLOYEE LEASING AS OF 2/21/14. THIS CERTIFICATE SUPERCEDES ANY PREVIOUSLY ISSUED CERTIFICATE. Terry Painter IS COVERED. CANCELLATION City of Clearwater 100 South Myrtle PO Box 4748 Clearwater FL 33756 I 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 C ACORD 25 (2013/04) © 1988-2013 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD