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Date CERTIFICATE OF LIABILITY INSURANCE I 1/28/2010 Producer: Lion Insurance Company This Certificate is issued as a matter of information only and milers no 2739 U.S. Highway 19 N. ts the Cefi. Tha or righ alter upon the coverage rti a cate fforded Holder by the policies is Certific belte ow. does not amend, extend Holiday, FL 34691 • Insurers Affording Coverage ' NAIC # I. ad: South East Personnel Leasing, Inc. Insurer A: Uon Insurance Company 11075 2739 U.S. Highway 19:N.. .. Insurer B: Holiday, FL 34691 Insurer C: Insurer D: Insurer E: Coverages ' fhe 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 vith 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 imits shown may have been reduced by paid daims. NSR ADDL Policy Effective Policy Expiration LTR INSRD Type of Insurance Policy Number Date Date Limits (MM /DD/YY) (MM /DD/YY) GENERAL LIABILITY Each Occurrence $ Commercial General Liability Damage to rented premises (EA Claims Made 0 Occur occurrence) $ 4 ' Med Exp $ Personal Adv Injury $ • General aggregate limit applies per: . _ . D Policy El Project CI LOC - General Aggregate $ Products - comp/Op Agg $ AUTOMOBILE LIABILITY r. Combined Single Limit Any Auto (EA Accident) $ All Owned Autos Bodily Injury NOM Scheduled Autos iiem (Per Person) $ 'Hired Autos Bodily Injury MINN Non -Owned Autos (Per Accident) $ Property Damage (Per Accident) $ EXCESS /UMBRELLA LIABILITY Each Occurrence Occur ❑ Claims. Made Aggregate _ • Deductible A Workers Compensation and WC 71949 01/01/2010 01/01/2011 x I WC Statu I I OTH- Employers' Liability tory Limits ER Any proprietor/partner /executive officer /member E.L. Each Accident $1 000,000 excluded? E.L. Disease - Ea Employee $1,000,000 If Yes, describe under special provisions below. E.L. Disease - Policy Limits $1,000,000 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: 30 - 27 - 284 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. that are leased to the following "Client Company ": Mike Currie 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: 727 - 846 -7195 / ISSUE 12 -09 -08 (SD) / REISSUE 12 -23 -08 (SD) / REISSUE 11 -16 -09 (SD) / RENEWAL 12 -17 -09 (SH) / REISSUE 01 -28 -10 (SD) Begin Date: 4/10/2006 CERTIFICATE HOLDER CANCELLATION CITY OF ZEPHYRHILLS 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 shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. 5335 8th STREET ZEPHYRHILLS, FL 33542 e