2011-005 - Laserfiche WebLink

Home Browse Search

1 / 17 / 2011 09 : 25 Lion Insurance LION INSURANCE COMPANY -► Timothy Rose Contracting , Inc . 1 / 1 Date CERTIFICATE OF LIABILITY INSURANCE 1 / 17/2011 Producer: Lion Insurance Company This Certificate is Issued as a matter of Information only and confers no rights 2739 U . S . Highway 19 N . upon the Certificate Holder. This Certificate does not amend, extend or alter Holiday , FL 34691 the coverage afforded by the policies below. ( 727 ) 938 -5562 Insurers Affording Coverage NAIC +� Insured : South E= ast Personnel Leasing , Inc . Insurer A : Lan Insurance Company 11075 2739 U . S . Highway 19 N . Insurer B : Holiday , FL 34691 Insurer C : Insurer D : Insurer E : Coverages epolicies o insurance listed below have b aonissued to the insured named above for fine policy pen o indicated NotwThsten ing anN requi rem ent, term or cond ibono a my contractor other documentwt respect to which this certificate maybe issued or may pertain , the insurance afforded by the policies descnbed herein is subject to all the terms , exclusions , and conditions of such policies Aggregate limits shown may have been reduced by paid claims INSR ADDL Policy Effective Policy Expiration Date Limits LTR INSRD Type of Insurance Policy Number Date ( MM/DD/YY) ( MM/DD/YY) GENERAL LIABILITY Each Occurrence Commercial General Liability Damage to rented premises (EA Claims Made ❑ Occur occurrence ) Med Exp General aggregate limit applies per : Personal Adv Injury Policy ❑ Project ❑ LOC General Aggregate Products - Comp/Op Agg AUTOMOBILE LIABILITY Combined Single Limit (EA Accident) Any Auto Bodity Injury AN Owned Autos (Per Person) Scheduled Autos Hired Autos Bodily Injury Non-Owned Autos (Per Accident) Property Damage (Per Accident) EXCESS/UMBRELLA LIABILITY Each occurrence Occur ❑ Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01 /01 /2011 01 /01 /2012 x WC Statu- OTH- Employers' Llabiily I tory Limits I ER Any proprietor/partner/executiveoMearlmember E . L . Each Accident $ 1 ,0001000 excluded? E . L . Disease - Ea Employee 31 .000000 If Yes, describe under special provisions below. E . L . Disease - Policy Limits $ 1 ,00C ,000 Fother Lion Insurance Company is A. M . Best Company rated A- ( Excellent). AMB # 12616 Descriptions of Operations/LocationsIVehicies/Exclusions added by Endorsement/Special Provisions : Client ID : 31 .615 -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 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 : BARRIER ISLAND REUSE WATER SYSTEM , IMPROVEMENTS & SR 510 REUSE WATER SYSTEM IMPROVEMENTS, INDIAN RIVER COU FAX: 772- 564-7888 & 772- 770-5140 / ISSUE 01 - 17- 11 ( SD) Bectin Date : 2 ,/4/2009 CERTIFICATE HOLDER CANCELLATION INDIAN RIVER COUNTY DEPARTMENT OF UTILITY SERVI Should arty of the above described policies be canceled before the expiration date thereof , the issuing insurer volt endeavor to mail 30 days mitten notice to the cemhcate holder named to the left, but fatlure to do so shall impose no PURCHASING DIVISION obligation or liability of arty kind upon the insurer . Its agents or representatives 1601 27TH ST . VERO BEACH, FL 32960