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Nov 10 11 03o3lp Employee Pro 9042780558 <br /> p . l <br /> ACORQ. CERTIFICATE OF LIABILITY INSURANCE CERTIFICATENO. / DATE <br /> AC _ 1 - 109C01 ES - 30 <. 56ti5 <br /> 11119 11 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> 5501 Lint Risk Services LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Dallas , <br /> T]( 75240 FREEWAY , SUITE 1200 HOLDER, THIS CERTIFICATE DOES NOT AMEND , EXTEND OR <br /> Dall <br /> ( 800 ) 728 - 0623 ( 972 ) 404 - 0380 <br /> Fax : ( 972 ) 404 - 0380 INSURERS AFFORDING COVERAGE <br /> INSURED: PPS 1 / C / f : INSURER A: rS2certy - <br /> 'T =:dOTHY ROSE CONTRU4CTL'dG , INC . INSURER B: <br /> 1 ? 6C 5Ta CLC DLXIE EWY SUI "? 106 <br /> VERO 3EAC3 , FL 3290`7_ <br /> INSURER C <br /> ( ? . Z ; 235 - 4334 Fax - INSURER D. <br /> INSURER E. <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br /> ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br /> NTR SR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONLIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE s <br /> COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any One Fre) $ <br /> CLAIMS MADE F1 OCCUR MED EXP ;Any one person) E <br /> PERSONAL & ADV INJURY $ <br /> GENERAL AGGREGATE S <br /> GENI AGGREGATE LIMIT APPLIES PER* PRODUCTS - COMPIOPAGG 5 <br /> 17 POLICY PRO- LOC <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMff <br /> ANY AUTO (Ea accident) S <br /> ALL OWNED AUTOS —� <br /> BODILY INJURY E <br /> SCHEDULED AUTOS (Per person) <br /> z <br /> HIRED AUTOS <br /> BODILY INURY $ <br /> NON-O WN ED AUTOS (Per accident) <br /> PROPERTY DAMAGE S <br /> (Per accident) <br /> TANYGELAUABILITY AUTO ONLY - EA ACCIDENT TO <br /> OTHER THAN EA ACC E <br /> AUTO ONLY' AGG S <br /> EXCESS LIABILITY EACH OCCURRENCE E <br /> OCCUR El CLAIMS MADE AGGREGATE $ <br /> S <br /> DEDUCTIBLE S R - <br /> RETENTION S S <br /> WORKERS COMPENSATION AND DPEOG 120990060 03 / 23 / 2. 011 01 / 01 / 2012 X W <br /> EMPLOYERS' LIABILITY C,YIIM STA7U- O7H• <br /> E. L . I FP <br /> EACH ACCIDENT S 1C00000 <br /> A E_ L. DISEASE - EA EMPLOYEE $ -. 000000 <br /> E.L. DISEASE - POLICY LMIT S 1000600 <br /> OTHER <br /> LIMITS IS <br /> LIMITS 5 <br /> la This certificate remains in effect , provided the clien - ' s account is in good standin with <br /> PPS . <br /> overage is not provided for any employee for which the client is not repporCiaqq wages c <br /> PPS . <br /> pplies to 100 % of the employees of PPS leased to TIMOTHY ROSE CONTRACTING , TNC . , effective <br /> 3 / 23 / 2011 . 2 . Project Information : . Tans - FL Greenway Trail . 3 . _ nsured is afforded Workers <br /> ompensation & Employers liability as a cc - employer under the policy for employees leased _ <br />ron. PPS . <br /> CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION <br /> SHOUILD ANY OF I HE ABOVE DFE5CRIEI=U IJOLIL;IES 131: CANCELLED HiEFORe THE EXPIRATION <br /> DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> 180C 2 % ' F 3T L^G 6 <br /> IND :-7\N RIVSBL:DC 3COUN " Y PURC -�.S T- NG IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, <br /> ITS AGENTS OR <br /> REPRESENTATIVES. <br /> V� P.O FL 32960 <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25-S (7197 ) © ACORD CORPORATION 1988 <br /> - . _ <br /> :. 'll, .. . . y <br /> ,,11 , L - <br />