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<br />7/ 1/15/2008 09:08 LION INSURANCE COMPANY LYONS INSURANCE COMPANY-+T. Owens Construction Inc. 1/1 <br /> <br /> , Date <br />, ACORD CERTIFICATE OF LIABILITY INSURANCE <br /> TM 1/15/08 <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 FalC 727.937.2138 <br /> Insurers Affording Coverage NAIC # <br /> Insured: South East Personnel Leasing, Inc. Insurer A Lion Insurance Company 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 poliCies of Insurance listed below have been issued to the Insured named above for the poliCY penod indicated Notwithstanding any requirement, term or condition of ~y coriract or other document with <br />respect to mich this certificate may be issued or may pertain, the Insurance afforded by the policies described herem is subject to all the terms, excllslcns. am conditions of such policies Aggregate limits <br />shown may have been reduced by paid claIms <br /> INSR ADDL Type of Insurance Policy Number Policy Effective Policy Expiration Date Limits <br /> LTR INSRD Dale <br /> (MMIODIYY) (MM/DDIYY) <br /> ~ENERAL LIABILITY Each Occurrence <br /> Commercial General Liability Damage to rented premises (EA <br /> : tJ Claims Made 0 Occur occurrence) $ <br /> ~ Mod Exp $ <br /> i- Personal Adv Injury $ <br /> lGeneral aggregate limit applies per: <br /> t:J Policy o Project 0 General Aggregate $ <br /> LOC <br /> Products ~ ComplOp Agg <br /> !AUTOMOBILE LIABILITY CombIned Single limit <br /> ~ (EA ACCident) $ <br /> Any Auto <br /> i- Bodily InJury <br /> All Owned Autos <br /> ~ (Per Person) $ <br /> Scheduled Autos <br /> ~ Hired AulDS Bodily Injury <br /> ~ Non~O""ed Autos (Per ACCident) $ <br /> i- Property Damage <br /> (Per Accident) $ <br /> GARAGE LIABILITY Auto Only ~ Ea Accl dent <br /> r:l MY Auto Other Than EA Acc $ <br /> Autos Only AGG <br /> EXCESS/UMBRELLA LIABILITY Each Occurrence <br /> - Occur o Claims Made Aggregate <br /> - <br /> Deductible <br /> - Retention <br /> - <br /> A Workers Compensation and x I WC Statu- I 10TH- <br /> WC 71949 0110112008 01/0112009 tory Limits ER <br /> Employers' Liability <br /> Arry proprietor/partner/executive officerlmember E.L. Each Accident $1000000 <br /> excluded? E.L. Disease ~ Ea Employee $1000000 <br /> IrYes, describe under special provisions below. <br /> E.L. Disease ~ Policy Limits $1000000 <br /> Other 42.44~009 <br /> T. Owens Construction Inc. COVERAGE APPLIES ONLY TO THOSE EMPLOYEES LEASED, NOT TO SUBCONTRACTORS. <br /> Descriptions 01 Operatlons/LocationsNehicJes/Exclusions added by Endorsement/Special Provisions: ADD ON DATE: 12/31/07 <br /> COVERAGE APPLIES ONLY IN THE STATE OF FLORIDA TO THOSE EMPLOYEES LEASED TO BUT NOT SUBCONTRACTORS OF T. Owens Construction Inc. . REF <br /> PROJECT. KISHOKE PETER 5720 GALL BLVD. ZEPHYRHILLS FL 33542' FAX 352.796.6101 & 813-780-0021/ISSUE 01.15-08 (JOY) <br /> Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 <br /> CERTIFICATE HOLDER CANCELLATION <br /> CITY OF ZEPHYRHILLS BUILDING DEPT Should any of the above descnbed poliCies be cancelled before the explranon date thereof. the Issuing <br /> insurer will endeavor to mail 30 days wntten notice to the certificate holder named to the left, but failure to do <br /> ATTN. JACKIE 50 shall Impose no obligation or liability of any kind upon the insurer, Its agents or representatives <br /> 5335 8TH STREET ~~. <br /> ZEPHYRHILLS FL 33542 <br /> <br />ACORD 25 (1001108) <br /> <br />ACORD CORPORATION 1988 <br />