CERTIFICATE OF LIABILITY INSURANCE (478)_ RI J•WWWWW. samw
CERTIFICATE OF LIABILITY INSURANCE
Date
12/10/2013
Producer: Lion Insurance Company
2739 U.S. Highway 19 N.
g y
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:
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
Occur
Med Exp
$
Personal Adv Injury
$
General aggregate limit applies per:
3 Policy ❑ Project ❑ LOC
General Aggregate
$
Products - Comp /Op Agg
$
■
AUTOMOBILE
NNW
LIABILITY
Any Auto
All Owned Autos
Scheduled Autos
Hired Auiuo
Non -Owned Autos
Combined Single Limit
(EA Accident)
$
Bodily Injury
(Per Person)
$
Bodily Injury
(Per Accident)
$
Property Damage
(Per Accident)
$
EXCESS /UMBRELLA LIABILITY
1 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- I
tory Limits
1OTH-
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: 37 -19 -004
Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company ":
Anytime Plumbing of Central Florida, 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:
FAX: 813 - 792 -1165 / ISSUE 03 -05 -09 (TD) / REISSUE 12 -01 -09 (TD) / RENEWAL 12 -17 -09 (SH) / REISSUE 01 -29 -10 (TD) / REISSUE 10 -19 -10
(SD) / REISSUE 02 -02 -12 (TD)Reissued 12/10/12 (SH) / Reissued 12/9/13 (SH)
Begin Date 4/18/2005
CERTIFICATE HOLDER CANCELLATION
CITY OF CLEARWATER
100 SOUTH MYRTLE AVE
CLEARWWATER, FL 33756
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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