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CERTIFICATE OF LIABILITY INSURANCE 1 Date 8/27/2015 Producer: Plymouth Insurance Agency 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. (727) 938-5562 Insurers Affording Coverage NAIC # Insured: South East Personnel Leasing, Inc. & Subsidiaries Insurer A. Lion Insurance Company 11075 2739 U S. Highway 19 N. Insurer B: Holiday, FL 34691 Insurer C: Insurer 0: Insurer E. Coverages the pohaes of Insurance listed below have been issued to the Insured named above for the policy penod indicated. Notwithstanding any requirement temi or condition of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the polices described herein is subject to all the terms, exdusions, and conditions of such policies. Aggregate limits shown may have been reduced by paid dams. INSR LTR ADOL INSRD Type of Insurance Policy Number Policy Effective Date (MM/DD/YY) Policy Expiration Date (MM/DD/YY) Limits GENERAL LIABILITY Each Occurrence s Commercial General Liability Damage to rented premises (EA Claims Made Occur occurrence) $ Med Exp $ — S Personal Adv Injury General aggregate limit applies per: Policy Project LOC General Aggregate $ 3 ❑ ❑ Products - Comp/Op Agg $ AUTOMOBILE LIABILITY Combined Single Umit (EA Accident) $ Any AutoNOM All Owned Autos Bodily Injury (Per Person) $ imiwi Scheduled Autos Hired Autos Non -Owned Autos Bodily Injury (ParAcddent) $ `xixx Property Damage ice. (Per Accident) 3 EXCESS/UMBRELLA LIABILITY Each Occurrence Occur ❑ Claims Made Aggregate Deductible A Workers Compensation and Employers' Liability WC 71949 01/01/2015 01/01/2016 X 1 WC Statu- 1 tory Limits l OTH- ER Any propnetor/partner/executive officer/member E.L. Each Accident St ,000.000 excluded/ NO E.L. Disease - Ea Employee 51 000.000 If Yes, descnbe under special provisions below E.L. Disease - Policy Limits 51 000 000 Other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 Descriptions of Operations/LocationsNehicles/Exclusions added by Endorsement/Special Provisions: Client ID• 81-67-368 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company" Kerns Construction and Property Management Corp. Coverage only applies to injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s;, while working in: FL. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other enbty 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. 2015036, 87H STREET & 91ST AVENUE , INDIAN RIVER COUNTY, FL (PROJECT NO. 1205) WAIVER OF SUBROGATION APPLIES IN FAVOR OF INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS, OWNER AND ENGINEER. ISSUE 08-27-15 (TD) Begin Date 12/10/2012 CERTIFICATE HOLDER CANCELLATION INDIAN RIVER CO. BOARD OF CO. COMMISSIONERS OFFICE OF MANAGEMENT & BUDGET. PURCHASING DIV Should any of the above described policies be cancelled before the expiration date thereof. the Issuing Insurer will endeavor to mail 30 days wntten notice to the certificate holder named to the lett but failure to do so shall impose no obligation or liability of any kind upon he insurer Its agents or representatives 1800 27TH STREE VERO BEACH, FL 32960 4",�er„..-. -