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# 6/24/2010 09:58 L ion Insurance LION INSURANCE COMPANY - ■FUTURISTIC CONST 1/1 Date CERTIFICATE OF LIABILITY INSURANCE 1 6/24/2010 Producer: Lion Insurance Company This Certificate Is issued as a matter of Information only and confers no rights upon the Certificate Holder. 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 NAIC # Insured' Insurer A: Lion Insurance Company 11075 South East Personnel Leasing, Inc. 2739 U.S. Highway 19 N. Insurer B: Holiday, FL 34691 Insurer C: 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 condit on 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 poh cies. Aggregate limits shown may have been reduced by paid claims INSR ADDL Policy Effective Policy Expiration Dat 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 El Occur occurrence, $ Med Exp $ Personal Adv Injury $ General aggregate limit applies per: General Aggregate $ D Policy ❑ Project ❑ LOC Products - ComplOp Agg $ AUTOMOBILE LIABILITY Combined Single Lirnit Any Auto (EA Accident) $ All Owned Autos All Injury Scheduled Autos (Per Person) $ 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 1 1OTH- Employers' Liabllky 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: 22 19 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. that are leased to the following "Client Company": Futuristic Construction, 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: EDWARD JONES INVESTMENTS 6949 GALL BLVD, ZEPHRYHILLS, FL FAX: 863 -993 -1356 / ISSUE 06 -24 -10 (SD) Begin Date: 4/14/2003 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 shall impose no BUILDING DEPARTMENT obligation or liability of any kind upon the insurer, its agents or representatives 5335 8TH STREET ZEPHYRHILLS, FL 33542 ��_4190 F