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VV IIV I al 41 5 / 11 / 2010 13 : 23 Lion Insurance LION INSURANCE COMPANY -* TIMOTHY ROSE 1 / 1 CERTIFICATE OF LIABILITY INSURANCE 5/11/2010 Producer: Lion Insurance Company This Certificate Is Issued as a matter of Information only and confers no rights 2739 U . S . Highway 1 9 N . upon the Certificate Holder, This Certificate does not amend, extend or alter IV the coverage afforded by the policies below. Holiday , FL 34691 Insurers Affording Coverage NAIC # Insured : South East Personnel Leasing , Inc . Insurer A: Lion Insurance Company 11075 2739 U . S - Highway 19 N . Insurer B : Holiday , FL 34691 Insurer c : Insurer D : Insurer E : Coverages The poli cies o f insurance It sted below have been i ssu ad to the i nsured named above for the policy period in ¢aced Nowthis tan di ng any requirement, term or cond ioon of any contract or other document with respect to which this certificate maybe Issued or may pertain , the insurance afforded by the policies described herein Is subject to all the terms , exclusions, and conditions of such poi cies . Aggregate limits shown may have be on reduced by paid claims INSR ADDL Policy Effective Policy Expiration Date LTR INSRD Type of Insurance Policy Number Date Limits ( MM/DD/YY) ( MM/DD/YY) GENERAL LIABILITY Each Occurrence Commercial General Liability Damage to rented premises (EA Claims Made ® Occur occurrence) Med Exp eneral aggregate limit applies per : Personal Adv Injury Policy ❑ Project ❑ LOC General Aggregate Products - Corl Agg AUTOMOBILE LIABILITY Combined Single Limit Any Auto (EA Accident) All Owned Autos Bodily Injury Scheduled Autos (Per Person) Hired Autos Bodily Injury Non OwnBd Autos (Per Accident) Property Damage (Per Accident) EXCESS/UMBRELLA LIABILITY Each occurrence Occur ❑ Claims Made Aggregate Deductible I VI A Workers Compensation and WC 71949 01 /012010 01 /012011 X WC Statu- OTH- Employers' Liability I tory Limits I ER Any proprietor/partner/executive officer/member E . L . Each Accident $ 1 ,000,000 excluded? E . L . Disease - Ea Employee $ 1 .000 ,000 If Yes, describe under special provisions below, E. L . Disease - Policy Limits $ 1 ,000P000 Other Lion Insurance Company is A. M . Best Company rated A- ( Excellent) . AM B # 12616 Descriptions of Operatlons/Locations/Vehicles/Exclusions added by Endorsement/Special Provisions: Client ID : 31-665-108 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc . that are leased to the following "Client Company" : Timothy Rose Contracting, Inc . Coverage only applies to injuries incurred by South East Personnel Leasing, Inc . active employee(s) while working in Florida . Coverage does not apply to statutory employee(s ) or independent contractors) 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 : BID NO , 2010024, NORTH WTP RAW WATER TRANSMISSION SYSTEM , VERO BEACH , FL FAX: 772- 564-7888 & 772-770-5140 / ISSUE 05- 11 - 10 ( SD) Begin Date : 2 /4/2009 CERTIFICATE HOLDER CANCELLATION INDIAN RIVER COUNTY Should arty of the above described policies be cancelled before the expiration date thereof. the issuing insurer will PURCHASING DIVISION 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 Wind upon the insurer, its agents or representatives 1800 27TH ST . VERO BEACH, FL 32960 MAY - 11 - 2010 13 : 04 From : ID : TIM ROSE Page : 001 R =93 % Ilk (. q . .i y y II r Z -i i •.,,4 t ,� . 9 .. �Sti� ° .. . �. . � � 3,.. r - a w 3� � v � , a. _ III, IV ZI _.� _ � . m.t..,. r � Ax .r �.L .$ rlik