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CERTIFICATE OF LIABILITY INSURANCE 1 l nz /2 010 Producer: Lion Insurance Company This Certificate is issued as a matter of information only and confers no rights upon the Certificate bolder. This Certificate does not amend, extend or alter 2739 U.S. Highway 19 N. the coverage afforded by the polities below. Holiday, FL 34691 Insurers Affording Coverage NAIL # Insured: South East Personnel Leasing, Inc. Insurer A: Lon Insurance Company 11075 2739 U.S. Highway 19 N. Insurer 8: Holiday, FL 34691 Insurer C: Insurer D: Insurer E Coverages he ties 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 poi cies. Aggregate limits shown may have been reduced by paid claims. INSR ADDL Policy Effective Policy Expiration Date LTR INSRD Type of Insurance Policy Number Date Limits (MM /DD/YY) (MM/DD/YY) GENERAL LIABILITY Each Occurrence $ Commercial General Liability Damage to rented premises (EA Claims Made Occur occurrence) $ Med Exp $ Personal Adv Injury $ General aggregate limit applies per: — _ D Policy ❑ Project ❑ LOC General Aggregate $ Products - Comp /Op Agg $ AUTOMOBILE LIABILITY Combined Single Limit Any Auto (EA Accident) $ '., Bodily Injury All Owned Autos '■' (Per Person) $ Scheduled Autos - Hired Autos Bodily Injury Non -Owned Autos (Per Accident) $ Property Damage (Per Accident) $ EXCESS /UMBRELLA LIABILITY Each Occurrence I Occur ❑ Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2010 01/01/2011 x I WC Statu I 1OTH- Employers' Liability tory Limits ER Any proprietor/partner /executive officer /member E.L. Each Accident $1.000,000 excluded? E.L. Disease - Ea Employee 51.000.000 If Yes, describe under special provisions below. E.L. Disease - Policy Limits 51,000,000 Other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 Descriptions of Operations /LocationsNehicles /Exclusions added by Endorsement /Special Provisions: Client ID: 19-57-205 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. that are leased to the following "Client Company ": East Pasco Electric, Inc. Coverage only applies to injuries incurred by South East Personnel Leasing, Inc. active employee(s) , while working in Florida. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937 -2138 or by calling (727) 938 -5562. Project Name: FAX: 352 -521 -3845 & 813 -780 -0021 / ISSUE 01 -12 -10 (TD) Begin Date: 12/9/1999 CERTIFICATE HOLDER CANCELLATION CITY OF ZEPHRYHIL LS Should any of the above described policies be cancelled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to do so shat impose no obhgation or liability of any kind upon the insurer. its agents or representatives. 5335 8TH STREET ZEPHRYHILLS, FL 33540 / ; ,' _ J r � .