Certificates of Insurance
A4I~4Itlrlt@ CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYY)
01125100
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
USI Florida - Lakeland HOLDER. THIS CERTIFICATE OOES NOT AMEND, EXTEND OR
P. O. Drawer 1398 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
402 S. Kentucky Ave., 4th Fl. COMPANIES AFFORDING COVERAGE
Lakeland FL 33802.1398
COMPANY
A Ohio Casualty Ins Co
INSURED COMPANY CONSTPt Ir,Tlm! M~NM:;EMENT
Tom Ryan, Inc. B United National
and ~an Construction Services COMPANY MAR ~ 8 ZUUU
P.O. x 555 C Zurich 0/,,"\/"",
Big Pine Key FL 33043
COMPANY TIME: r.::::T: '" I
0 RECEIVED BY: ( ,,1 '1
COVERAGES
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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE (MM/DDIYY) DATE (MM/DDIYY)
B GENERAL LIABILITY BINDER 01/22/00 01/22/01 GENERAL AGGREGATE $ 1,000,000
-
X COMMERCIAL GENERAL LIABILITY PRODUCTS. COMP/OP AGG $ 1,000,000
~:J CLAIMS MADE 0 OCCUR PERSONAL & ADV INJURY $ 1,000,000
I-- OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (Anyone fire) $ 50,000
MED EXP (Anyone person) $ 1,000
A ~OMOBILE LIABILITY BAW52221956 01/22/00 01/22/01 1,000,000
COMBINED SINGLE LIMIT $
~ ANY AUTO
ALL OWNED AUTOS BODILY INJURY
~ $
~ SCHEDULED AUTOS (Per person)
X HIRED AUTOS BODILY INJURY
I-- ..' ny. :u'Q1 ~ $
X NON.OWNED AUTOS , (Per accident)
~
$1,000 COMP/OOLL DEDUCT :!
PROPERTY DAMAGE $
~AGE LIABILITY co -1 ~oD AUTO ONLY - EA ACCIDENT $
ANY AUTO r.~"TF~' -' OTHER THAN AUTO ONLY:
~
Lyrr EACH ACCIDENT $
~t,,:,.,.!\'[?: j>i" ,;~ , ,)
..--- AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
=1 UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM $ I
WORKERS COMPENSA nON AND I T~~y~II~W~ I 10FW'
EMPLOYERS' LIABILITY
1 / __1__/_- EL EACH ACCIDENT $
-- -- --
THE PROPRIETORI RINCL EL DISEASE . POLICY LIMIT $
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE $
OTHER
A Inland Marine BM052221956 01/22/00 01/22/01 Scheduled
A Auto Phys Damage BAW52221956 01/22/00 01/22/01 Scheduled
C Bui Iders Risk BR 97001300 10/18/99 10/18/00 168 , 500
8ESCRIPTION OF OPERATIONS/LQCATIONSlVEHICLES/SPECIAL ITEMS
ertificate holder, Its employees and directors are listed as additional
insured as respects ~eneral liability and auto liability.
Insured locat ion: 6 rd St, Marathon, FL
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Monroe County Board of County Com . . MONROE counTY EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
~~!J ,,,.. : ..... "~FMENT ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
TIME: MAR 3 0 ~ BUT FAILURE TO MAI~SHALLJMf'Q~~ N_O OBLIGATION OR LIABILITY
OF ANY KIND UPON 1. OMPANY, ITS AGENTS OR R~SENTATIVES. i
AUTHORIZED RE~~~~7", \ '" I.....:}
RECEIVED BY: \ 1\)) " \ 'ell
'~
ACORD 25-S (1195) ,~ 0,
@ ACORD CORPORATION 1988
Certificate of Insurance
This certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This certificate is not an insurance policy and does not amend, extend,
or alter the coverage by the policies listed below.
Named Insured(s):
Staff Leasing, LP, by Staff Acquisition, Inc., The General Partner, and
The Affiliated Limited Partnerships of Which Staff Acquisition, Inc. is
The General Partner and their Successor Corporations
600 301 Boulevard West, Suite 202
Bradenton, Florida 34205
C'NA
.RISK MANACEMENT
~,,' ;~, r: r \ \lED 'i,";;:;;:;;:;;;::'~~
The policy(ies) of insurance listed below have been issued to the insured named.il!!d~i"Uet"tht'1ioliCY period indicated. The insurance afforded by the policy(ies) described herein is
subject to all the terms, exclusions and conditions of such policy(ies).
OEe 2, 2, 1999
~
Insurer Affording Coverage
Continental Casualty Company
Coverages:
Type of Insurance
Certificate Exp. Date
D Continuous
D Extended
* ~ Policy Term
Policy Number
Limits
Workers'
Compensation
1-1-2001
we 189165165
we 189165182
Employer's Liability
Bodily Injury By Accident
$1,000,000
Each Accident
Bodily Injury By Disease
$1,000,000
Policy Limit
1.'.. .
Bodily Injury By Disease
$1,000,000
Each Person
Other:
w1
Employees Leased To:
Effective Date: 1/1/00
11360
Ryan Construction Service
The above referenced workers' compensation policy(les) provide(s) statutory benefits only to the employees of the Named Insured(s) on such policy(ies), not to the employees of any other employer.
*If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the
certificate expiration date. However, you will not be notified annually of the continuation of coverage.
Notice of Cancellation: (Not applicable unless a number of days are entered below)
Before the stated expiration date the company will not cancel or reduce the insurance afforded under the above policy(ies) until at least
30 days notice of such cancellation has been mailed to:
Certificate Holder:
MONROE COUNTY
5100 COLLEGE RD
KEY WEST, FL 33040-4319
11111111111111111111111111111111111111111111111111111111111111
# ail--
-
Martin Oosterbaan
Authorized Representative
Office: S1. Louis, MO 12/15/99
Phone: (877) 427-5567 Date Issued