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