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<br />ACORD CERTIFICATE OF LIABILITY INSURANCE T DATE (MMlDDIYYYYI <br />TJI SSTBFKNZ 11/08/2007 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Lighthouse-Programs, LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />301 E, Pine Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />Suite 350 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Orlando, FL 32801 <br /> INSURERS AFFORDING COVERAGE NAIC# <br />INSURED INSURER A: SUA Insurance Company <br />First Financial Employee Leasing, Inc. <br />3745 Tamiami Trail INSURER B: <br />Port Charlotte, FL 33952 INSURER C: <br /> INSURER D: <br /> INSURER E: <br /> <br />COVERAGES <br /> <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 />I~~ r:.~~~ TYPE a~ INSURANCE POLICY NUMBER ~~~:~J~ P~W,~~~~ UMITS <br /> ~ERAL UABIUTY EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY ~~~~~S Ea occurence\ $ <br /> "- o CLAIMS MADE D OCCUR <br /> MED EXP (Anyone person) $ <br /> "- <br /> PERSONAL & ArN INJURY $ <br /> "- <br /> GENERAL AGGREGATE $ <br /> f-- <br /> n'L AGGR,EA LIMIT APPLIES PER: PRODUCTS-COMP~PAGG $ <br /> POLICY ~fR;: n LOC <br /> ~TOMOBILE UABIUTY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> - ANY AUTO <br /> - ALL OWNED AUTOS BODILY INJURY <br /> (Per persOrt) $ <br /> - SCHEDULED AUTOS <br /> - HIRED AUTOS BODILY INJURY <br /> (Per accident) $ <br /> - NON-OWNED AUTOS <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> RRAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> ALrrO ONLY: AGG $ <br /> SESSlUMBRELJ.A UABILlTY EACH OCCURRENCE $ <br /> OCCUR D CLAIMS MADE AGGREGATE $ <br /> $ <br /> =~ DEDUCTIBLE $ <br /> RETENTION $ $ <br />A WORKERS COMPENSATION AND WSLTHPE 000066-02 12/31/2006 01/01/2008 X I T't&vS,~{J#C, I I~TRH- <br /> EMPLOYERS'LIABIUTY E,L. EACH ACCIDENT $ 1,000,000 <br /> ANY PROPRIETORIPARTNERlEXECUTIVE <br /> OFFICERIMEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $ 1,000,000 <br /> ~~~I:S~~~~~~S below E.L. DISEASE - POLICY LIMIT $ 1,000,000 <br /> OTHER <br />DESCRIPTION OF OPERATIONS' LOCATIONS 'VEHICLES' EXCLUSIONS ADDED BY ENDORSEMENT' SPECIAL PROVISIONS <br />Coverage is extended to the leased employees of alternate employer (Florida Operations Only) : Southland Construction <br />Services, Inc. client #2669 (Effective 1.01.2006) DISCLAIMER: The Certificate of Insurance does not constitute a <br />contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does <br />it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. <br />This certificate only applies to License Holder: Thomas LaMeau. <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCELLATION <br /> <br /> SHOULD AHY OF THE ABOVE DESCRIBED POLICIES BE CAHCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAlL 30 DAYS WRITTEN NOTICE TO <br /> THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO <br /> OBUGATION OR LIABILITY OF AHY KIND UPON THE INSURER, ITS AGENTS OR <br /> REPRESENTATIVES. <br />City of Zephyrhills Bldg Dept. <br />813/780-0021 AUTHORIZED REPRESENTATIVE ~~ <br />5335 8th Street <br />Zephyrhills, FL 33542 Page 1 of 1 <br /> <br />ACORD 25 (2001/08) <br /> <br />@ACORDCORPORATION 1988 <br />