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2009 SIDEWALK PROJECT - 09-0039-EN - CERTIFICATE OF LIABILITY INSURANCE (2)Date CERTIFICATE OF LIABILITY INSURANCE 112/10/2013 Producer: Lion Insurance Company 2739 U.S. Highway 19 N g y 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 I 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. 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 LIABILITY Commercial General Liability Each Occurrence $ Damage to rented premises (EA occurrence) $ Claims Made 11 Occur Med Exp $ Personal Adv Injury $ General aggregate limit applies per: 3 Policy ❑ Project ❑ LOC General Aggregate $ Products - Comp /Op Agg $ AUTOMOBILE � LIABILITY Any Auto All Owned Autos Scheduled Autos Hired Autos Non -Owned Autos �f t ....,� ../ - .. - - Combined Single Limit (EA Accident) $ Bodily Injury (Per Person) $ Bodily Injury (Per Accident) $ Property Damage (Per Accident) $ Occur IREXCESS /UMBRELLA Deductible LIABILITY Claims Made Each Occurrence Aggregate A Workers Compensation and Employers' Liability Any proprietor /partner /executive officer /member excluded? NO If Yes, describe under special provisions below. WC 71949 01/01/2014 01/01/2015 X1 WC Statu- tory Limits I 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: 08-65 -829 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company ": Kilgore Construction, LLC 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: 2009 SIDEWALK PROJECT NO. 09- 0039 -EN, 1700 N. BELCHER ROAD, CLEARWATER, FL FAX: 727 - 581 -5724 / ISSUE 12 -23 -09 (TD)Reissued 12/10/12 (SH) / Reissued 12/9/13 (SH) Begin Date 1/5/2009 CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER 111 P.O. BOX 4748 CLEARWATER, FL 33758j+ 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. .fosws. 92159 . ___ CERTIFICATE OF LIABILITY INSURANCE Date 12/10/2013 Producer: Lion Insurance Company 2739 U.S. Highway 19 N. g Y Holiday, FL 34691 1727) 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 I 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: Coverages I 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 l ADDL INSRD Type of Insurance Policy Number I Policy Effective Date (MM /DD/YY) Policy Expiration Date ( M /DD/YY) Limits GENERAL LIABILITY Each Occurrence IS Commercial General Liability Damage to rented premises (EA occurrence) $ Claims Made Occur Med Exp $ Personal Adv Injury $ General D aggregate limit applies per: Policy ❑ Project ❑ LOC General Aggregate $ Products - Comp /Op Agg $ AUTOMOBILE 1■, miml w LIABILITY Any Auto All Owned Autos Scheduled Autos Hired Autos Non -Owned Autos , .._ ,. , ,� , -- '; ; Combined Single Limit (EA Accident) $ Bodily Injury (Per Person) $ Bodily Injury (Per Accident) $ Property Damage (Per Accident) $ EXCESS /UMBRELLA LIABILITY Each Occurrence Occur ❑ Claims Made Deductible Aggregate A Workers Compensation and Employers' Liability Any proprietor /partner /executive officer /member excluded? NO If Yes, describe under special provisions below. WC 71949 01/01/2014 01/01/2015 X I we Statu- tory Limits OTH- I 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 /Locations/Vehicles /Exclusions added by Endorsement/Special Provisions: Client ID: 08 -65 -829 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company ": Kilgore Construction, LLC 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: 2009 SIDEWALK PROJECT NO. 09- 0039 -EN, 1700 N. BELCHER ROAD, CLEARWATER, FL FAX: 727 - 581 -5724 / ISSUE 12 -23 -09 (TD)Reissued 12/10/12 (SH) / Reissued 12/9/13 (SH) Begin Date 1/5/2009 CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER P.O. BOX 4748 CLEARWATER, FL 33758 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. //� ' Ar-1,. v