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2013-116M
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CERTIFICATE OF LIABILITY INSURANCE Date <br /> Producer: Lion Insurance Company 10/7/2013 <br /> This Certificate is issued as a matter of information only and confers no <br /> 2739 U . S . Highway 19 N . rights upon the Certificate Holder, This Certificate does not amend, extend <br /> Holiday, FL 34691 or alter the coverage afforded by the policies below. <br /> (727) 938-5562 Insurers Affording Coverage <br /> Insured : South East Personnel Leasing , Inc . & Subsidiaries NAIL # <br /> Insurer A: Lion Insurance Company 11075 <br /> 2739 U . S . Highway 19 N . Insurer B : <br /> Holiday, FL 34691 Insurer C: <br /> Insurer D: <br /> Insurer E : <br /> overages <br /> he policies of insurance listed below have been issued to the insured named above for the policy period indicated. Notwithstanding any requirement, term <br />or condition of any contract or other document <br /> lith respect to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein is s <br /> mits shown may have been reduced by paid claims. ubject to all the terms, exclusions, and conditions of such policies. Aggregate <br /> NIS R ADDL <br /> -TR INSRD Type of Insurance Policy Effective Policy Expiration Date <br /> Policy Number Date Limits <br /> (MM'DD/YY) (MM/DD/YY) <br /> ENERAL LIABILITY <br /> Commercial General Liability Each Occurrence <br /> Claims Made ❑ Occur Damage to rented premises (EA <br /> occurrence) <br /> Med Exp <br /> eneral aggregate limit applies per: Personal Adv Injury <br /> Policy ❑ Project ❑ LOC General Aggregate <br /> UTOMOBILE LIABILITY Products - Comp/Op Agg <br /> Combined Single Limit <br /> Any Auto <br /> (E4 Accident) $ <br /> All Owned Autos Bodily Injury <br /> Scheduled Autos (Per Person) <br /> Hired Autos <br /> Non-Owned Autos Bodily Injury <br /> (Per Accident) <br /> Property Damage <br /> (Per Accident) <br /> EXCESS/UMBRELLA LIABILITY <br /> ❑OEach Occurrenceccur Claims Made <br /> Deductible Aggregate <br /> Workers Compensation and WC 71949 01 /01 /2013 <br /> Employers' Liability 01 /01 /2014 X WC Statu- OTH- <br /> Any proprietor/partner/executive officer/member tory Limits ER <br /> excluded? NO E. L. Each Accident $ 1 ,000,000 <br /> If Yes, describe under special provisions below. E . L. Disease - Ea Employee $ 1 ,000,Ooo <br /> E . L. Disease - Policy Limits $1 ,000,000 <br /> Other Lion Insurance Company is A. M . Best Company rated A- (Excellent), AMB # 12616 <br /> riptions of Operations/LocationsNehicles/Exclusions added by Endorsement(Special Provisions : <br /> )ge only applies to active employee(s) of South East Employee Leasing Services, Inc. that are leased to the following "Client Company" : Client <br /> ID: 84-60-034 <br /> Gifford Youth Activity Center, Inc. <br /> ge only applies to injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s), while working in FL, <br /> ge does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity, <br /> f 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. <br /> t Name: <br /> 09-25-12 (TD) / REISSUE 09-26- 12 (TD)Reissued 12/10/12 (SH) / REISSUE 10-7-13 (CDF) <br /> FICATE HOLDER Begin Date: 2/ 29/ 2012 <br /> INDIAN RIVER COUNTY CANCELLATION <br /> Should any of the above described policies be cancelled before the expiration date thereof, the issuing <br /> insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to <br /> 1800 7TH STREET <br /> do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. <br /> VERO BEACH, FL 32960 <br />
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