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# 5/25/2010 10:44 Lion Insurance LION INSURANCE COMPANY4.GGR 4/5 Date CERTIFICATE OF LIABILITY INSURANCE 1 5/242010 Producer: Lion Insurance Company This Certificate is Issued as a matter of information only and confers no rights 2739 U.S. Highway 19 N. upon the Certificate Holder. This Certificate does not amend, extend or alter 9 y the coverage afforded by the polides below. Holiday, FL 34691 Insurers Affording Coverage NAIC # Insured: South East Personnel Leasing, Inc. Insurer A: Lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurer B: Holiday, FL 34691 Insurer c: Insurer D: Insurer E: Coverages The policies of insurance 1sted below have been issued to the insured named above fa to poficy penal rrhdcated. Nol .thstard'ing arty r equiremer4 term or condii on of any contract or other document wren respect to which this certificate may be issued or may pertain. the insurance afforded by the pofaes described herein is subject to al the torahs. exc sighs, and conditions of such pof cies. Aggregate Writs shown may have been reduced by paid claims. IISR A Policy Effective Policy Expiration Date Limits LIR iNSRD Type of Insurance Policy Number Date (MM/DD/YY) (MM/DD/YY) GENERAL LIABILITY Each Occurrence s Commercial General Liability Damage to rented premises (EA Claims Made 0 Occur occurrence) 5 Med bp 5 Personal Adv Injury 5 General aggregate limit applies per: General Aggregate 5 7 Policy ❑ Project ❑ LOC Products - Comp/Op Agg 5 AUTOMOBILE LIABILITY Combined Single Limit (EA Accident) 5 Any Auto ▪ Al Owned Autos BodiN MO/ (Per Person) 5 Scheduled Autos ▪ Hired Autos Bodes Injury Non-Owned Autos (Per Acaderi) 5 Property Damage (Per Accident) EXCESS/UMBRELLA LIABILITY Each Occurrence Occur ❑ Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/012010 01/01/2011 x I WC Li 1 ] ER F Employers' Liability Any proprietodpartnerlexecutive officerdnember E.L. Each Aceiderg 51.000.000 excluded? E.L. Disease - Ea Employee S1.000.000 If Yes, describe under special provisions below. E.L. Disease - Policy Limits 51,000,000 Other Lion Insurance Company is A.M. Best C _ an parry rated A- (Excellent). AMA # 12616 Descriptions of Operations /LocationsNehicies/Exc1usions added by Endorsement /Special Provisions: Client ID: 80 - 398 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. that are leased to the following "Client Company ": GGR Roofing, 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: 863 -551 -1459 / ISSUE 05 -24-10 (SD) Begin Date: /12/2010 CERTIFICATE HOLDER CANCELLATION CITY OF ZEPHYRHI L LS Shouid any of the above described polaes be canceled before the erptretion date thereof. the issuing insurer will BUILDING DEPARTMENT endeavor to mail 30 days writer notice to the certificate holder re Si the e letur fa , but to do so shat impose no obigauon or loony of any kind upon the insurer. Os agents or represenutives. 5335 8TH STREET ZEPHYRHILLS, FL 33542 /�r