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# 5/11/2010 13:23 Lion Insurance LION INSURANCE COMPANY -►TIMOTHY ROSE 1/1 CERTIFICATE OF LIABILITY INSURANCE 5/1112010 Producer: Lion Insurance Company 2739 U.S. Highway 19 N. Holiday, FL 34691 This Certificate Is Issued as a matter of Information only and confers no rights upon the Certificate Holder. This Certificate does not amend, extend or alter the coverage afforded by the policies below. Insurers Affording Coverage NAIC # Insured: South East Personnel Leasing, Inc. Insurer A: Lion Insurance Company 11075 Insurer B: 2739 U.S. Highway 19 N. Holiday, FL 34691 Insurer C: Insurer D: Insurer E: Coverages epoicieso insurance listed belowhave een:ue to the insured name re a oor policy period Indicated. Notwithstanding any requirement, term or condition oarycontractorother ocumerawathrespedtowhlch this certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions, and conditions of such policies. Aggregate limits shown may have been reduced by . paid claims. INSR LTR ADDL INSRD Type of Insurance Policy Number Policy Effective Date Policy Expiration Date Limits (MM/DD/YY) (MM/DD/YY) GENERAL LIABILITY Commercial General Liability Each Occurrence Damage to rented premises (EA occurrence) Claims Made ® Occur . Med Exp General aggregate limit applies per: Personal Adv Injury General Aggregate Policy ®Project ® _LOC Products - Comp/Op Agg AUTOMOBILE LIABILITY Combined Single Limit Any Auto (EA Accident) All Owned Autos Bodilylnjury Scheduled Autos (Per Person) BodilyInjury Hired Autos - Non -Owned Autos (Per Accident) -- Property Damage (Per Accident) EXCESS/UMBRELLA LIABILITY Each Occurrence Occur ❑ Claims Made - Aggregate Deductible A Workers Compensation and Employers' Llablllty WC 71949 01/01/2010 01/012011 X I WC Statin bory Limits oTFi ER E.L. Each Accident $1.000.000 Any propdetor/parbner/executive officerlmember excluded? E.L. Disease - Ea Employee $1.000.000 If Yes, describe under special provisions below. E.L. Disease - Policy Limits $1.000,000 Other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AM B # 12616 Descriptions of Operations/LocatlonsNehicles/Exclusions added by Endorsement/Special Provisions: Client ID: 31-65-108 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: 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 any of the above described policies be cancelled before the expiration date thereof, the issuing insurer will PURCHASING DIVISION endeavor to mai130 days written notice to the certificate holder named to the left, but failure to do so shall impose no obligation or liability of arty Idnd upon die insurer, its agents or representatives. 1800 27TH ST. VERO BEACH, FL 32960 F" NAY -11-2010 13:04 From: ID:TIM ROSE Page•001 R=93%