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CERTIFICATE OF LIABILITY INSURANCE D81e <br /> Producer: Lion insurance Company 12/14/2010 <br /> 2739 U . S . Highway 19 N . This Certificate Is Issued as a matter of information only and confers no rights <br /> upon the Certificate Holder, This Certificate does not amend, extend or alter <br /> Holiday , FL 34691 the coverage afforded by the policies below. <br /> ( 727) 938 -5562 Insurers Affording Coverage <br /> Insured: South East Personnel Leasing , Inc . Insurer A: NAIC # <br /> Lion Insurance Company 11075 <br /> 2739 U . S . Highway 19 N . Insurer B : <br /> Holiday , FL 34691 Insurer C : <br /> Insurer D : <br /> Inaurer C: <br /> Coverages <br /> Me Policies Of insurance listed belowave en Issued to the insured name ova ror tne Policy Wnocl m icate . NotWthsten ing any requirement, <br /> term or con ikon o any contract or er ocumertwt respect to tc <br /> this certificate may be issued or may pertain , the insurance afforded by the policies described herein is subject to ah the terms , exclusions, and conditions <br /> of such Policies . Aggregate limits shown may have been reduced by <br /> paid claims • <br /> INSR ADDL Polis <br /> LTR INSRD Type of Insurance Policy Number Policy Policy Expiration Date <br /> Limits <br /> ENERAL LIABILITY ( MM/DD/YY) ( MM/DD/YY) <br /> Commercial General Liability Each occurrence <br /> Claims Made ❑ Occur Damage to rented premises (EA <br /> occurrence) <br /> Med Exp <br /> neral aggregate limit applies per : Personal Adv Injury <br /> Policy ❑ Project ❑ LOC General Aggregate <br /> Products - Comp/Op Agg <br /> UTOMOSILE LIABILITY Combined Single Limit <br /> Any Auto (EA Accident) <br /> All Owned Autos Bodily Injury <br /> cichet1iAd AI $QS (Per Person) <br /> Hired Autos Bodily Injury <br /> Non- Owned Autos (Per Accident) <br /> Property Damage <br /> (Per Accident) <br /> EXCESS/UMBRELLA LIABILITY Each occurrence <br /> Occur Claims Made Aggregate <br /> Deductible <br /> A Workers Compensation and WC 71949 01 /01 /2011 01 /01 /2012 X WC Statu- OTH- <br /> Employers' Liabillty tory Limits ER <br /> Any proprietor/partner/executive officer/member E . L . Each Accident $ 1 ,000 ,000 <br /> excluded? <br /> If Yes, describe under special provisions below. E . L . Disease - Ea Employee $ 16000 ,000 <br /> E . L . Disease - Policy Limits $ 1 ,000 ,000 <br /> Other Lion Insurance Company is A. M . Best Company rated A- ( Excellent) . AM B # 12616 <br /> Descriptions of Operations/Locations/Vehicies/Excluslons added by Endorsement/Speelal Provisions : Client ID : 31-65408 <br /> Coverage only applies to active employee(s) of South East Personnel Leasing, Inc . that are leased to the following "Client Company" <br /> : <br /> Timothy Rose Contracting, Inc . <br /> Coverage only applies to injuries incurred by South Cast Personnel Leasing, Inc , active employee(s) , while working in Florida . <br /> Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. <br /> 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 <br /> (727) 938- 5562 . <br /> Project Name : BID N0 . 2011012, QUAIL CREEK SUBDMSION, INDIAN RIVER COUNTY, FL <br /> FAX : 772- 561 - 7888 & 772J70-5140 / ISSUE 12ml4A0 ( TD) <br /> BeginDate , 2 /4/2009 <br /> CERTIFICATE HOLDERCANCELLATION <br /> INDIAN RIVER COUNTY BOARD OF COUNTY 5hould any or me above described policlas be cancelled berore the expiration date [hereof, the Issuing <br /> Insurer will <br /> COMMISSIONERS PURCHASING DIVISION endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to do <br /> so shall impose no <br /> obligation or liability of anryldnd upon the insurer, its agents or representatives . <br /> 1800 27TH STREET <br /> VERO BEACH, FL 32960 "may <br />