COI Expires 01/01/2019CERTIFICATE OF LIABILITY INSURANCE 12/11/2017
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,
g y extend or alter the coverage afforded by the:policies below.
Holiday, FL 34691
727 938-5562 Insurers Affording Coverage NAIC #
Insurer A: Lion Insurance Company 11075
Insured: South East Personnel Leasing, Inc.& Subsidiaries
Insurer B:
2739 U.S. Highway 19 N.
I Insurer C:
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
iocument 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
Dolicies. Aggregate limits shown may have been reduced by paid claims.
INSR
LTR
ADDL
INSRD
Type of Insurance
Policy Number
Policy Effective
Date
(MM/DD/YY)
Policy Expiration
Date
(MM/DD/YY)
Limits
GENERAL LIABILITY
Each Occurrence
$
Commercial General Liability
Claims Made Occur
Damagg;,to rented premises (EA
occurrence)''. , .
$
Mad Exp .
Personal Adv Injury
General aggregate limit applies per:
Policy ❑ Project ❑ LOC
General Aggregate
Products - Comp/Op Agg
AUTOMOBILE LIABILITY
Combined Single Limit
(EA Accident)
S
Any Auto
Bodily li)jyry
All Owned Autos
(Per Person)
Scheduled Autos
Hired Autos
-
--
Rgdily Iniury -
(Per Accident)
Non -Owned Autos
Property'Damage
(Per Accident)
EXCESS/UMBRELLA LIABILITY
Each occurrence
Aggregate
Occur ❑ Claims Made
Deductible
A
Workers Compensation and
Employers' Liability
Any proprietor/partner/executive officer/member
excluded? NO
If Yes, describe under special provisions below.
WC 71949
01/01/2018
01/01/2019
X
WC Statu-
I tou Limits
OTH-
ER
E.L. Each Accident1,000,t
o00" 1,
E.L. Disease - Ea Em to ee
E.L. Disease - Policy Limits Pl,000,c
Other _ Lion Insurance Company is A.M. Best Company rated A (Excellent). AMB # 12616
Descriptions of Operations/Locations/Vehicles/Exclusions 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 employees) , 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 faxin a requEst t (727) 937-2138 or by calling (727) 938-5562.
Project Name: APPR ED iSK EMEW
ISSUE 03-01-17 (KR) BYE v' a • Y�
WAIVE /A7 ES
C r B in Date 9 19 201
C/O MONROE COUNTY RISK MANAGEMENT
1100 SIMONTON STREET, ROOM 2-231
Should any of the above described policies be canceliea oerore me exprreuun gars a e.a ".o
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.