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<br />f/ 1/111':'UlJl 1lJ:"U <br /> <br />L~\.II'1 .Ll'1'IJVl\(Al'''L \"'VllU Iln I <br /> <br />ACORD TM Dale <br />CERTIFICATE OF LIABILITY INSURANCE 7/11/07 <br />Producer: lion Insurance Company 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 # <br />Insured: South East Personnel Leasing, Inc, Insurer A: Lion Insurance Campa ny 11075 <br /> 2739 U,S, Highway 19 N, Insurer B: <br /> Holiday, FL 34691 Insurer C: <br /> Phone: (727)938-5562 Insurer D: <br /> Insurer E: <br />Coverages <br />The poticies 01 insurance listed below have baen isslled to Ihe insured named above for tha policy periOd indicated, Nolwithstanding any requiremenl, tenn or condition 01 any conlract or other docllment with <br />respect to which this certificate may be isslled or may pertain, 1I1e insurance afforded by Iha pollcias described herein is slIbject to all tl1a terms, axc"sims, am concltions of such policies. Aggregate limits <br />shown may have bean reduced by paid claims. <br />tNSR ADDL Type of Insurance Policy Number Policy Effective Policy Expiration Date Limits <br />LTR INSRD Date <br /> (MM/DDIYY) (MM/DDIYY) <br /> GENERAL LIABILITY Each Occurrence $ <br /> I- Commercial General Liability Damage to rentod promises (EA <br /> :: tJ Claims Made 0 Occur occurrence) $ <br /> - Med Exp $ <br /> - Personal Adv Injury $ <br /> General aggregate limit applies per: <br /> ] Policy D Project 0 General Aggregate $ <br /> LOC <br /> Products - ComplOp Agg $ <br /> II.UTOMOBILE LIABILITY Combined Single Limit <br /> - (EA Accident) $ <br /> Any Auto <br /> - All OWned Autos Bodily Injury <br /> - (Per Person) $ <br /> Sctleduled AlIlos <br /> - Hired Autos Bodily Injury <br /> - Non~Owned Autos (Per Accident) $ <br /> - Property D8Ina[le <br /> (Per Accident) <br /> GARAGE LIABILITY Aulo Only - Ea I\ccident $ <br /> ~ Any Auto Other Than EA Ace. $ <br /> Autos Only AGG $ <br /> EXCESS/UMBRELLA LIABILITY Eacl1 Occurrence <br /> I- Occur o Claims Made Aggregate <br /> I- Deductible <br /> I- Retenlion <br /> I- <br />A Workers Compensation and WC 71949 X I WC Statu- I 10TH- <br /> 01/0112007 01/0112008 tOI')' Limits ER <br /> Employers' Liability <br /> Any proprietor/partner/executive officer/member E,L. Each Accident $1000000 <br /> excluded? E ,L, Disease - Ea Empioyee $1000000 <br /> If Yes, describe under special provisions below, <br /> E,L. Disease - Policy Limits $1000000 <br /> Other 3040009 <br /> Chase General Contracting, Inc COVERAGE APPLIES ONLY TO THOSE EMPLOYEES LEASED, NOT TO SUBCONTRACTORS, <br />Descripflons of Operatlons/LocationsNehicles/Exclusions added by Endorsement/Special Provistons: ADD ON DATE: 2/20/06 <br />COVERAGE APPLIES ONLY IN THE STATE OF FLORIDA TO THOSE EMPLOYEES LEASED TO BUT NOT SUBCONTRACTORS OF Chase General Contracting, Inc' <br /> FAX: 727-787-01911 iSSUE 07-11-07 (JOY) <br /> Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 <br />CERTIFICAlE HOLDER CANCELLATtON <br /> CITY OF ZEPHYRHILLS Should any of the above described pOlicies be canceUed belore the e""lretlon date thereof, the issuing <br /> insurer Will endeavor 10 mail 30 deys wrttten notice to the cerlillcale hotder named 10 the leR, but failure to do <br /> so shall impose no obligation or tiability of any kind upon the inslIrer, its agenls or representatives, <br /> 5335 8TH STREET )tZ,~~, <br /> ZEPHYRHILLS FL 33542 <br /> <br />ACORD 25(1001108) <br /> <br />ACORD CORPORATION 1988 <br />