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ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) 03/14/08 PRODUCER 1-727-797-4190 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher Risk Management Services, Inee ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2600 McCormick Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 300 Clearwater, FL 33759 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Zurich American Ins Co 16535 A-1 Contract Staffing Group INSURER B: 3829 Coconut Palm Dr. INSURER C: Tampa, FL 33619 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR r..~~~ Pg,k+~~~~~~,!;~\E Pg~!fFY/~'a:~~N ~ LTR POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED ]~"'., ~,,~,~'U~ PREMISES lEa occurence) $ CLAIMS MADE D OCCUR MEO EXP (Anyone person) $ "~-- PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ ~~'L AGGREnE LIMIT APnS PER: PRODUCTS - COMP/OP AGG $ POLICY P'~PT LOC _~TOMOBILE LIABILITY i COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) -- -- ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) --- ---- -- HIRED AUTOS BODILY INJURY (Per accident) $ NON~OWNED AUTOS -- I ~" ~- PROPERTY DAMAGE $ (Per accident) ~~RAGE LIABILITY ! AUTO ONL Y ~ EAACCIDENT i$ ANY AUTO ! OTHER THAN EAACC I $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY I EACH OCCURRENCE $ :=J OCCUR D CLAIMS MADE I --"- AGGREGATE $ " ~ $ ~~ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND WC343478605 01/01/08 01/01/09 X I T'6~~I~JNs I X I OJ~~ EMPLOYERS' LIABILITY $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT OFFICERlMEMBER EXCLUDED? i E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under $1,000,000 SPECIAL PROVISIONS below E.L. DISEASE ~ POLICY LIMIT OTHER I i DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Sean Patrick Enterprises Inc. dba Alliance Fire & Safety, Inc. dba Accutech Fire Sprinklers is an alternate employer. Coverage is for contracted employees of A-1 Contract Staffing not subcontracted labor. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Zephyrhi11s DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN - Contractor Licensing NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 5335 8th Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Zephyrhil1s, FL 33542 AUTHORIZED REPRESENTATIVE ~C~ USA ACORD 25 (2001/08) betraJ.k 8309747 @ACORDCORPORATION 1988