Item C19
Date
CERTIFICATE OF LIABILITY INSURANCE
6/2/2015
Plymouth Insurance Agency
Producer:This Certificate is issued as a matter of information only and confers no
rights upon the Certificate Holder. This Certificate does not amend, extend
2739 U.S. Highway 19 N.
or alter the coverage afforded by the policies below.
Holiday, FL 34691
(727) 938-5562 Insurers Affording Coverage
NAIC #
Insurer A: Lion Insurance Company11075
Insured:South East Personnel Leasing, Inc. & Subsidiaries
Insurer B:
2739 U.S. Highway 19 N.
Insurer C:
Holiday, FL 34691
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.
Policy Effective Policy Expiration
INSR ADDL Limits
Type of InsurancePolicy Number
Date Date
LTRINSRD
(MM/DD/YY)(MM/DD/YY)
GENERAL LIABILITY
Each Occurrence$
Commercial General Liability
Damage to rented premises (EA
Claims MadeOccur
occurrence)
$
Med Exp$
Personal Adv Injury$
General aggregate limit applies per:
General Aggregate$
PolicyProjectLOC
Products - Comp/Op Agg$
Combined Single Limit
AUTOMOBILE LIABILITY
(EA Accident)$
Any Auto
Bodily Injury
All Owned Autos
(Per Person)$
Scheduled Autos
Bodily Injury
Hired Autos
(Per Accident)$
Non-Owned Autos
Property Damage
(Per Accident)
$
Each Occurrence
EXCESS/UMBRELLA LIABILITY
OccurClaims MadeAggregate
Deductible
AWC 7194901/01/201501/01/2016 WC Statu-OTH-
Workers Compensation and X
tory LimitsER
Employers' Liability
E.L. Each Accident$1,000,000
Any proprietor/partner/executive officer/member
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
Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616
Other
Descriptions of Operations/Locations/Vehicles/Exclusions added by Endorsement/Special Provisions:
Client ID:91-67-687
Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company":
A-1 Property Services Group, 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:
FAX: 305-289-2515./ YOSVANY F. MADRUGA, (LICENSE NUMBER CCC1328326) AS QUALIFIER / ISSUE 11-10-14 (EP) REISSUE 11-11-14 (MT) REISSUE 11-12-14 (MT)
REISSUE 01-22-15 (EP) / REISSUE 03-11-15 (TLD) / REISSUE 06-02-15 (TLD)
Begin Date10/20/2014
CERTIFICATE HOLDERCANCELLATION
MONROE COUNTY 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
do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives.
2798 OVERSEAS HWY. STE 300
MARATHON, FL 33050