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AC R � CERTIFICATE DATE(MM/DD/YW� �= OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE 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 the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to tt certifcate holder in lieu of such endorsement(s). PRODUCER Alliance Insurance Solutions LLC PO Box 1777 CONTACT NAME: St Petersburg, FL 33731 PHONE N : �2�-as�-�2a� Fn ac No: 727-497-12F E-MAIL ADDRESS: INSURER S AFFORDING COVERAGE NAIC il iNSUReRa: SUNZ Insurance Com an 3q�6z INSURED Convergence Employee Leasing, Inc. Convergence Employee Leasing II, Inc INSURERB. 8777 San Jose Bivd #402C INSURER C Jacksonville FL 32217 INSURER D INSURER E : INSURER F . COVERAGES CERTIFICATE NUMBER: 10100105 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIC INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TH CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP - GENERAL LIABILITY MM/DD MM/DD LIMITS EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP (My one person) $ PERSONA� 8 ADV INJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PR � LOC PRODUCTS - COMP/pP AGG $ AUTOMOBILE LIABILITY S COMBINED SINGLE LIMIT ANY AUTO Ea accident $ ALL OWNED 8 SCHEDULED BODILY INJURY (Per person) $ AUTOS AUTOS BODILY INJURY (Per accident) $ HIREDAUTOS NON-OWNED AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR $ EXCESS LIAB EACH OCCURRENCE $ CLAIMS-MADE _ AGGREGATE $ DED RETENTION $ $ $ /� WORKERS COMPENSATION WCPEOOOOOO4ZO'I / WC S TU- O�tl- $ AND EMPLOYERS' LIABILITY 7/�/ZO1 O 7/I/ZO� � � TORY IMITS rt ANY PROPRIETOR/PARTNERlEXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑ N/ A �_ _ E.L. E ACCIDENT $ 'I OOC (Mandatory in NH) If yes, descnbe under ---- -- --" E.L. DISEASE - EA EMPLOYEE $ �� DESCRIPTION OF OPERATIONS below __ E.L. DISEASE - POIICY LIMIT $ 'I OOC DESCRIPTION OF OPERATIONS / LOCATIONS ! VEHICLES (Attaeh ACORD 101, Additional Remarks Sehedule, if more spaee is required) Coverage provided for all leased employees but not subcontractors of: Curt Brocklesby Location coverage effective: 7M/2010 CERTIFICATE HOLD R CANCELLATION 460 City of Zephyrhills SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOF THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. Fa� 813-780-0021 5335 8th St AUTHORIZED REPRESENTATIVE Zephyrhills FL 33542 �� , ,� / �� .G ,,7 _ � � c.. Glen J Distefano wnnnn �e i�n�r��e�� OO 1988-2010 ACORD CORPORATION. All rights resen r�.., wrnon ......... ....a �....., _�.. �.......�..�..a .«...�.. ..c wnnnn