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<br />, 3/16/2006 15:07 <br /> <br />Lion Insurance Company <br /> <br />SUSAN-+SUPER SERVICE <br /> <br />1/1 <br /> <br /> CERTIFICATE OF LIABILITY INSURANCE Date <br />ACORD TM 3/1612006 <br />Producer: Lion Insurance CompBrlY This Certificate Is Issued as a matter of Information only and confers no rights <br /> 2739 U,S, Highway 19 N, upon the Certificate Holder. This Certificate does not amend, extend or alter <br /> Holiday, FL 34691 the coverage afforded by the policies below. <br /> Phone: 727-938-5562 Fax: 727-937-2138 <br /> Insurers Affording Coverage NAIC /I <br />Insured: South East Personnel Leasing, Inc, Insurer A: Lion Insurance Company 11075 <br /> 2739 US Highway 19 N. Insurer B: <br /> Holiday, FL 34691 Insurer C: <br /> Phone: (727)938-5562 Insurer 0: <br /> Insurer E: <br />Coverages <br />Ire poliCies of InSlxance listed below have been Issued to the Insured named above for the policy penod indicated NOlWllhstandlng any reqUirement, term or condition of any contract or o!her document Wllh respecllo wf1ich <br />this ceniflcate 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 <br />paid claims <br />INSR ADDL Type of Insurance Policy Number Policy Effeclive Policy Expiration Dale Limits <br />LTR INSRD Dale <br /> (MMIDDIYY) (MM/DDIYY) <br /> 2"ENERAL LIABILITY Each Dc currence $ <br /> _ :immercial General Liability Damage 10 rented poemises (EA <br /> _ Claims Made 0 Occur occurrence J $ <br /> - Med Exp $ <br /> I- Personal Adv Injury $ <br /> k;eneral aggregate limit applies per: <br /> b Policy o ProJect 0 General Aggregate $ <br /> LOC <br /> Products. CompJOp Agg $ <br /> ~UTOMOBILE LIABILITY Combined Single Limit <br /> - (EA AcMent) $ <br /> Any Auto <br /> - All Owned Autos Bodily InjUry <br /> - (Per Pe"on) $ <br /> Scheduled Aulos <br /> - Hired AUIOS Bodily InjUry <br /> - Non-Owned Autos (Per ACCIdent) $ <br /> ~ Property Damage <br /> (Per Acc"Jent) $ <br /> GARAGE LIABILITY Auto Only- Ea ACCident $ <br /> ::J Any Auto Other Thal1 EA Acc $ <br /> Autos Only' AGG $ <br /> EXCESS/UMBRELLA LIABILITY Each Occurrence <br /> I- Occur o Claims Made Aggregate <br /> I- Deductible <br /> I- Retention <br /> I- <br />A Workers Compensation and x I WC Slatu- I r OTH- <br /> Employers' Liability WC 71949 0110112006 0110112007 lory Lim~s ER <br /> Any proprietor/partner/executive officer/member E.L. Each Accident $1000000 <br /> excluded? E,L. Disease - Ea Employee $1000000 <br /> Ir Yes, describe under special provisions below, <br /> E,L. Disease - Policy Limits $1000000 <br /> othe 0901526 <br /> Super Service, Inc, COVERAGE APPLIES ONLY TO THOSE EMPLOYEES LEASED, NOT TO SUBCONTRACTORS, <br />o.scriptions of Op,rltionllLocationlNehiCleslExClulions added by Endor.lmlntfSplcial Provisions: AODONDAlE: 5/19/2001 <br />COVRAGE APPLIES ONLY IN THE STATE OF FlORIDA TO THOSE EMPLOYEES LEASED TO BUT NOT SUBCONTRACTORS OF Super Service, Inc' FAX: 913-790-0021 <br />& 352.754-9719/ISSUED 3/16106 (SB) <br /> Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 <br />CERTIFICATE HOLDER CANCELLATION <br /> CITY OF ZEPHRYHILLS Should arty of the above described policies be cancelled before the expiration date thereof, the iSSUing Insurer will <br /> 5335 9TH STREET endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to do so shall impose no <br /> obligation or liabltity of any kind upon the insurer, its agents or representatives <br /> ZEPHRYHILLS Fl 33542 ~ /'--- <br /> <br />ACORD 25 (1001/08) <br /> <br />ACORD CORPORATION 1988 <br />