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<br />~ 1/27/2011 11:57
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<br />LIon Insurance
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<br />LION INSlRANCE COMPANY-iOCASTLE USA
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<br /> CERTIFICATE OF LIABILITY INSURANCE 1127/2011
<br />Producer: Lion Insurance Company This Certificate is issued as a matter of information only and confers no rights
<br /> 2739 U.S, Highway 19 f'j, upon the Certificate Holder. This Certificate does not amend, extend or alter
<br /> Holiday, FL 34691 the coverage afforded by the polices below.
<br /> (727) 938-5562 Insurers Affording Coverage NAIC #
<br />Insured: South East Personnel Leasing, Inc. 'Murer A: Lion InsunlOce ComP<' nr 11075
<br /> 2739 U.S. Highway 19 N, Insurer B:
<br /> Holiday, FL 34691 Insurer c:
<br /> Insurer D:
<br /> Insurer E:
<br />Coverages
<br />,r.e poa':fe5 Oi I!1St.:rcO!:'? ~st8a t~ow lla'o'Q .t?€!n :S~Gd to t!1il in;url}O narn9C' aOO'o"a for tre P')tcv p,:mCd Ir:o:c:::r.ea Not'fiUista1011g any reqUi:emtl'rt, rerm or (0:10-:1('..11 01 ~ L"'Qntact or ml1eroo:umGfIt 'N'I1l respect to wnch
<br />titS c-erMce!e m~ybe isst:td Cr;118'j Pf'l1a!n. t"/B InSl1arce aftcrded 'C/{trll3 D0JCH?S IjeScn09l.1 herem;5 subjec: t-J all the :erms, &xcluslons. anc cond:t1Gn; of sLiet"; pc_cles Aggregate limIts shown ma-y have been reduced tJ{
<br />PZIO cia!rn~
<br />rlSR AUCt. Policy Number Policy Effective Policy Expiration Dale Limits
<br />LT~ tiSRD Type of Insurance Date
<br /> (MMIDOIYY) (MM/OOIYY)
<br /> IGENERAL LIABILITY Edl:n OCClJrTfnCe >
<br /> I-
<br /> Commercial General Liability DamagB to rGnted pr~mi5tfS (EA
<br /> ~ tl Claims Made 0 Occur oc:urren(-e)
<br /> I- Mea E,"P .
<br /> ~ Personal Adv Injury ~
<br /> ~enerai aggregate "mit appfies per:
<br /> tJ P:!I':V 0 G<<16rai AI,..-g'~3te
<br /> D~""'t LOG
<br /> '''.;'''r
<br /> Product; .. Comp!Op Agg
<br /> ~UTOMOBILE LIABILITY Cc,<rb w:a S;n;f.~ :";~:I;t
<br /> ~ {EA ?_ccicrentj .
<br /> AryA..;t.::
<br /> ~ codiiyl;'\jt..ry
<br /> hi (t\\1iE<:l Autos
<br /> I- tPer?ets:m}
<br /> '3<:.~~r:;w~J ";Jt~J~
<br /> ~ Hired t\:..i~.'JS 2ooi_Vir.j:"':!'f
<br /> ~ r...:.n....O,...("!':?d Al,;tos (PBrA:::c,(!Gn:}
<br /> ~ Prcper.i Damey~
<br /> {Por AC':ldont) i
<br /> EXCESS/UMBRELLA LIABILITY ::;):hOcc,;",-;er1ce
<br /> =J ~ccr o Ci.]I'Tl':; MadS Aogrt?g,ato?
<br /> C~riuc::t.~o?
<br />A Workers Compensation and we 71949 0110112011 0110112012 X I we Statu. I 10TH-
<br /> Employers' LIability tory Limits ER
<br /> f>rr.J proprietor/partner/executive officerlmember EL Each Accident $1.0CO,(1J.)
<br /> excluded? E,L, Disease - Em Employee S1,o..."':0,OOO
<br /> If Yes, describe under special provisions below, EL Disease - Policy Lirrits $~,OOO.ooo
<br /> other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616
<br />Descriptions of OperatlonslLocationsNehiclos/Excluslons added by EndorsemenUSpeclal Provisions: Client 10: 80-65-182
<br />Coverage only applies to active employee(s) of South East Personnel leasing, Inc. that are leased to the folloY\ing "Client Company":
<br /> Castle USA Corporation
<br />Coverage only applies to injuries inclJ'red by South East Persomel Leasing, Inc. active employee(s) , while working in Rorida.
<br />Coverage does not apply to statutory empioyee(s) or independent contractor(s) of the Client Company or any other entity.
<br />A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937-2138 or by calling (727) 938-5562.
<br />Project Name: FABRIC CANOPY STRUCTURE AT GOVERNMHJT CENTER, SUNNY ISLES BEACH, FL
<br />FAX: 305-513-8342 & 305-303-9191 I ISSUE 01-27-11 (SO)
<br /> """In Dote: 1I17/201l
<br />CER7IFICATE HOLDER CANCELLATION
<br /> CITYOF SUNNY ISLES BEACH Shol),j a':1{ljf ~EI 3tCye ce..-;:nbedpo],ces be c.erC5!'eo t:!;'t10!ettv: eiplretlOrl Cate th6'r~(Jf, t1e 15SlIr y In'::iUr~ w<tl
<br /> to'1dBa't'crtc mail.30 dayS 'r'mt:efl nctl:e to ttie CB:1i~cate I1c!::iernerr.e-:1 ~ tt;$' !eft. b:....tfa,urero do so shah lm-'ose 1'0
<br /> c.c+gat,c-1 cr !l3r.~~ of ary :<Ir-,d upcn ~le- msu-e-.-, '.!; .?t9€nts t;"" .t?{..;~~ntat~~s
<br /> lB070 COLLINS AVENUE ~ /---
<br /> SUNNY ISLES BEACH, FL 33160
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