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ACC0R0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/20/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Advanced Risk Solutions CONTACT NAME: Jill Ney 12980 Metcalf, Suite 490 PHONE (A/C. No. Ext): 913.385.2455 FAX (A/C, No): 913,385.2605 Overland Park, KS 66213 E-MAIL ADDRESS: jneyeadvancedrisksolutions.com INSURER(S) AFFORDING COVERAGE NAIC # www.advancedrisksolutions.com INSURER A : Lumbermen's Underwriting Alliance 23108 INSURED SourcePointe LLC; SourcePointe of AL, LLC; L/C /F INSURER B : CAPSCO INDUSTRIES, INC. INSURER C: 2000 -B Southbridge Pkwy Suite 200 Birmingham AL 35029 INSURERD: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 8289064 REVISION NUMBER: THIS IS TO CERTIFY THAT THE 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 WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDlYYYY) (MMIDOVYYYI) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ — COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ - --- PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALLOWNED SCHEDULED _ AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED PROPERTY DAMAGE AUTOS (Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE DED RETENTION $ $ A WORKERS COMPENSATION 2975598 9/13/2010 6/1/2011 I TORY LIMITS WC STATU- O7H- AND EMPLOYERS' LIABILITY Y 1N ER ANY PROPRIETOR/PARTNER/EXECUTIVE 1 000000 OFFICER/MEMBER EXCLUDED? n E.L N / A . EACH ACCIDENT $ (Mandatory In NH) E . DISEASE - EA EMPLOYEE $ 1000000 If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY UMIT $ 1 000000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, W more space is required) Workers' Compensation coverage is provided by contract to all employees of SourcePointe of AL assigned to CAPSCO INDUSTRIES, INC.. Coverage does not apply to any employees not approved and assigned by SourcePointe of AL to CAPSCO INDUSTRIES, INC.. License Holder: Martin B Hoglievina #14044500012009. Covers all employees in the State of Florida. CERTIFICATE HOLDER CANCELLATION City of Zephyrhills SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 5335 8th Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Zephyrhills, FL 33542 AUTHORIZED REPRESENTATIVE "let--X.c,./. 714.-74P- Robert M Gagne © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CERT NO 0289069 John Walston 9 /20/2010 1:56:35 PM Page 1 of 1