COI Expires 01/01/2018 CERTIFICATE OF LIABILITY INSURANCE 1 3/1/2017
Producer: Plymouth Insurance Agency This Certificate is issued as a matter of information only and confers no
2739 U.S. Highway 19 N. rights upon the Certificate Holder. This Certificate does not amend, extend
Holiday, FL 34691 or alter the coverage afforded by the policies below
(727) 938 - 5562 Insurers Affording Coverage NAIC #
Insured: South East Personnel Leasing, Inc. & Subsidiaries Insurer A: Lion Insurance Company 1107
2739 U.S. Highway 19 N. Insurer B :
Holiday, FL 34691 Insurer C .
Insurer D:
Insurer E:
Coverages
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. Aggregate
limits shown may have been reduced by paid claims.
INSR ADDL Policy Effective Policy Expiration
LTR INSRD Type of Insurance Policy Number Date Date Limits ;
(MM /DD/YY) (MM /DD/YY) f
GENERAL LIABILITY Each Occurrence $
Commercial General Liability Damage to rented premises (EA
Claims Made Occur occurrence) $
Med Exp $
•
Personal Adv Injury $
General aggregate limit applies per:
General Aggregate $
D Policy ❑ Project ❑ LOC
Products - Comp /Op Agg $
AUTOMOBILE LIABILITY Combined Single Limit
(EA Accident) $
Any Auto
▪ All Owned Autos Bodily Injury
(Per Person) $
Scheduled Autos
▪ Hired Autos Bodily Injury
▪ Non -Owned Autos (Per Accident) $
Property Damage
— (Per Accident) $
EXCESS /UMBRELLA LIABILITY Each Occurrence
R Occur ❑ Claims Made Aggregate
Deductible
A Workers Compensation and WC 71949 01/01/2017 01/01/2018 x I WC Statu- I 1OTH-
Employers' Liability tory Limits ER
Any proprietor /partner /executive officer /member E.L. Each Accident $1,000,00
excluded? NO
E.L. Disease - Ea Employee $1,000,000
If Yes, describe under special provisions below.
E.L. Disease - Policy Limits $1,000,000
Other Lion Insurance Company is A.M. Best Company rated A (Excellent). AMB # 12616
Descriptions of Operations /LocationsNehicleslExclusions added by Endorsement/Special Provisions: Client ID: 92 -70 -655
Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company ":
•
Sweetwater Environmental, Inc.
Coverage only applies to injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s), while working in: FL.
Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity.
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.
Project Name:
APP
ISSUE 03 - 01 - 17 (KR) ' GEMENT
' t` t 9
C
Begin Date 9/19/2016
CERTIFICATE HOLDER CANCELLATION
MONROE COUNTY BOARD OFCOUNTY COMMISSIONER Should any of the above described policies be cancelled before the expiration date thereof, the issuing
insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to
C/O MONROE COUNTY RISK MANAGEMENT do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives.
1100 SIMONTON STREET, ROOM 2 -231
KEY WEST, FL 33040 „l d