CERTIFICATE OF LIABILITY INSURANCE (472)Ire-___ --
Date
'.,. CERTIFICATE OF LIABILITY INSURANCE 112/11/2013
,Rre`ucer: Lion InsU.ance Company
Insurance
2739 U.S. Highway 19 N.
g y
Holiday, FL 34691
. (727) (727) 938 -5562 -__
This Certificate is issued as a matter of information only and confers no
y
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
'.¢TR
'••
I .ADDL
INSRD
Type of Insurance
I
Policy Number
Policy Effective
Date
(MM /DDNY)
Policy Expiration
Date
(MM /DD/YY)
Limits
Each Occurrence
$
�` •:;•'
•
‘,..r. N
��
-t
R
"
. ;°
I.
_..
GENERAL
LIABILITY
Commercial General Liability
Damage to rented premises (EA
occurrence)
$
Claims Made
Occur
General
Med Exp
$
Personal Adv Injury
$
aggregate limit applies per:
Policy ❑ Project ❑ LOC
General Aggregate
$
Products - Comp /Op Agg
$
Combined Single Limit
(EA Accident)
$
.AUTOMOBILE
`•
•, ' '
* ..
=NI
LIABILITY
Any Auto
All Owned Autos
Scheduled Autos
iiiiduAdtus —
Non -Owned Autos
Bodily Injury
(Per Person)
(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? No
If Yes,. describe under special provisions below.
WC 71949
01/01/2014
01/01/2015
x
I 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 I
Descriptions of Operations /LocationsNehicles /Exclusions added by Endorsement/Special Provisions: Client ID: 14-80-052
Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company ":
I Force Electric, Inc.
Covei-age only applies to injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s) , while working in FL.
eovirage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity.
%)i >waf 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.
!. #rc ect Name:
i ISSUE02 -07 -12 (TD)Reissued 12/10/12 (SH) / Reissued 12/9/13 (SH)
Begin Date 7/4/2002
- CERTIFIC7\TE HOLDER CANCELLATION
` CITY OF CLEARWATER
100 S. MYRTLE AVENUE
CLEARWATER, FL 33758r�•
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.
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