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if 6/2/2009 11:50 L ion Insurance Lion Insurance Company -►CITY OF ZEPHYRHILLS 1/1 <br /> Date <br /> CERTIFICATE OF LIABILITY INSURANCE 1 6/2/2009 <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 /> 727 - 938 - 5562 Insurers Affording Coverage NAIC • <br /> Insured: South East Personnel Leasing, Inc. Insurer A: Lion Insurance Company 11075 <br /> 2739 U.S. Highway 19 N. Insurers: <br /> Holiday, FL 34691 Insurer C: <br /> Insurer 0: <br /> Insurer E: <br /> Coverages <br /> The policies of insurance listed below have been issued to the insured named above for the polity period indicated. Notwithstanding any requirement, term or condition of arty contract or other document with respect to which <br /> this certificate may be issued or may pertain. the insurance afforded by the policies descnbed herein is subject to all the terms, exclusions, and conditions of such policies. Aggregate limits shown may have been reduced by <br /> pad claims. <br /> INSR ADDL Policy Effective Policy Expiration Date Limits <br /> LTR INSRD Type of Insurance Policy Number Date <br /> (MM/DD/YY) ( MM/DD/YY) <br /> GENERAL LIABILITY Each Occurrence $ <br /> Commercial General Liability <br /> Damage to rented premises (EA <br /> Claims Made Occur occurrence) $ <br /> Med Exp $ <br /> Personal Adv Injury $ <br /> General aggregate limit applies per: — <br /> General Aggregate $ <br /> D Polity 0 Project a LOC <br /> Products - Comp /Op Agg $ <br /> AUTOMOBILE LIABILITY Combined Single Limit <br /> (EA Accident) $ <br /> Any Auto Bodily Injury <br /> NMI <br /> All Owned Autos <br /> (Per Person) $ <br /> Scheduled Autos <br /> r— Bodi y Injury <br /> Hired Autos <br /> Non -Owned Autos (Per Accident) $ <br /> Property Damage <br /> (Per Accident) $ <br /> EXCESS /UMBRELLA LIABILITY Each Occurrence <br /> R <br /> Occur a Claims Made Aggregate <br /> Deductible <br /> ■ <br /> A Workers Compensation and WC 71949 01/01/2009 01/01/2010 X I Cory Limits I I ER <br /> Employers' Liability <br /> Any proprietor/partner/executive officer /member E.L. Each Accident $1.000900 <br /> excluded? <br /> E.L. Disease - Ea Employee $1.000,000 <br /> If Yes, describe under special provisions below. <br /> E.L. Disease - Policy Limits $1000 000 <br /> Other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 <br /> Descriptions of Operations /LocationsNehicleslExclusions added by Endorsement /Special Provisions: Client ID: 29. 44-021 <br /> Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. that are leased to and working for the following "Client Company": <br /> West Coast Aluminum and Screen Inc. <br /> Coverage only applies to injuries incurred by South East Personnel Leasing, Inc. active employee(s) , while working in Florida. <br /> Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. <br /> 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. <br /> FAX: 352 -556 -2584 & 813 - 780 -0021 / ISSUE 06 -02 -09 (TD) <br /> Begin Date 9/17/2007 <br /> CERTIFICATE HOLDER CANCELLATION <br /> CITY OF ZEPHYRHI LLS Should any of the above described policies be cancelled before the expiration date thereof, the issuing insurer will <br /> endeavor to mail 30 days written notice to the certificate holder named to the left. but failure to do so shall impose no <br /> obligation or liability of ary kind upon the insurer. its agents or representatives. <br /> 5335 8TH STREET <br /> ZEPHYRHILLS FL 33542 e.....4.1 <br />