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<br />7/ 1/27/2011 11:57 <br /> <br />Lion Insurance <br /> <br />LION INSURANCE COMPANY~CASTLE USA <br /> <br />1/1 <br /> <br /> DOle <br /> CERTIFICATE OF UABIUTY INSURANCE 1/2712011 <br />Producer: Lion Insurance Company This CerUflcalllls l$SUed as a matller of Information only and confers no rights <br /> 2739 U.S. Highway 19 N. upon the Certificate Holder. This Certificate does not amend, extend or alter <br /> Holiday. FL 34691 the coverage afforded by the polldes below. <br /> (727) 938-5562 Insurers Affording Coverage NAIC# <br />Insured: South East Personnel Leasing, Inc. In"uter A: Lion Insurance Company 11075 <br /> 2739 U,S. Highway 19 N, Insurer B: <br /> Holiday, FL 34691 Insurer c: <br /> Insurer D: <br /> Insurer E: <br />Coverages <br />TIle poioesof msurance isted bEllow haW! boon ISSlleo to me ,nsureo nameoa"""" for tt'e p<)Jicypenodindico:ed Now",stalong anyreqUlremelt. term Of cendll Of! 0 arrv COnJiact Cf otller OOClRTlern W1:n respGctlo wrlcn <br />Ihls cel1lnca:e may be issued or may pell.,n, t'1O mSLlar~e a1TCflJed b/ tile p:)Ioes descnbed herem '5 subject to al tne :erms. exclusions. an<! condition. 01 suc~ pel Cles, Aggregate kmlts snown may hfMl been reduCed b/ <br />paid claIms <br />iNSR AOl.X. Type of Insurance Policy Number Policy Effectlve poucy Expiration Date Limits <br />LTR iNSRO Date <br /> (MMIDDIYY) (MMIDDIYY) <br /> g.eNERAL LIABILITY EaCh OcclJ'Tence <br /> ~ prCial General Liability Oamog9 to r9Ot.d prom..., (EA <br /> I- Claims Made 0 Occur occulTence) <br /> I- Mad E>P <br /> ~ Personal Adv Injury <br /> ~eneral aggregale imit appies per: <br /> t:I Pelicy Dpro).ct 0 General A99'egate <br /> LOC <br /> ProduCIS - ComplOp Agg ~ <br /> ~UTOMOBILE LIABILITY Combined Smgle Umit <br /> I- (EA Accident) j$ <br /> Ary 1>,,10 <br /> I- M CWlea Autos SodlIyInJur,' <br /> ~ (Per Pers,",) <br /> SChe:du~J Autos <br /> ~ Hired Autos 8odllyiOJur,' <br /> ~ Non-OMlgd Alt'tcs {Per Acci~r'{) <br /> I- Property Damag. <br /> (Per ACClder~) <br /> EXCESS/UMBRELLA LIABILITY Each Occurrence <br /> R~c~ o Clalmo Mad. AQ;g~g<3te <br /> O<lductib!e <br />A Wor1lers Compensation and WC 71949 0110112011 0110112012 X I WC Statu- I 10TH- <br /> Employers' L1abllty I """ Limits ER <br /> AA'/ proprietorlpartl'l.../execulive oflicerlmember E.L. Each Accident $1.0CO.OOO <br /> excluded? E.L. Disease - E. Employee S 1,000.000 <br /> If Yes. describe under special provisions below. EL Dise..... - Policy Lirrit$ $1.000,000 <br /> Other Lion Insurance Company is A.M. Best ComDany rated A- (Excellent). AMB # 12616 <br />Descriptions of OperatlonslLocatlonsNehlcleslExcluslons added by EndorsamenUSpeclal Provisions: Cflent !D: 80-65.182 <br />Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. that are leased to the following "Client Company": <br /> Castle USA Corporation <br />Coverage only applies to injuries inclrred by South East Persomel Leasing, Inc. active employee(s) , while working in Rorida. <br />Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. <br />A list of the actlve employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937-2138 or by calling (727) 938-5562. <br />Project Name: FABRIC CANOPY STRUCTURE AT GOVERNMENT CENTER, SUNNY ISLES BEACH, FL <br />FAX: 305-513-8342 & 305-303-9191/ISSUE 01-27-11 (SO) <br /> """In D<>te: 1/1712011 <br />CERTIFICATE HOLDER CANCELLATION <br /> CITY OF SUNNY ISLES BEACH Should a:l{ottn~ above. dCS;r.1be'dpo,lldes be cenceVoo before'tI1e exp~ratloo d5t$ t1&f60f. tnf:l' ISSUIng Insurer Will <br /> endeaiOftc 1081130 dayS v.TJIIen nol,:e!o !I1eceltIlcate holder named lllhe Ie~. but ta/ure Ie de so shall imoose no <br /> ob~gatiC1n or ij.eblity ol arykiod upcn the ins\rli'r. it. a9~nts or repl'esl;jlntstivtis. <br /> 18070 COLLINS AVENUE a.4 /___ <br /> SUNNY ISLES BEACH. FL 33160 <br />