COI EXPIRES 01/01/2019Date
CERTIFICATE OF LIABILITY INSURANCE
1/5 /2018
Producer: Plymouth Insurance Agency
This Certificate is issued as a matter of information only and confers no
2739 U.S. Highway 19 N.
1
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
11075
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.
INSR
ADDL
Policy Effective
Policy Expiration
Limits
LTR
INSRD
Type of Insurance
Policy Number
Date
Date
(MM /DD/YY)
(MM /DD/YY)
GENERAL LIABILITY
Each Occurrence
Commercial General Liability
Damage to rented premises (EA
Claims Made ❑ Occur
occurrence)
$
Mad Exp
Personal Adv Injury
General aggregate limit applies per:
Policy 1:1 Project ❑ LOC
General Aggregate
Products - Comp /Op Agg
AUTOMOBILE LIABILITY
Combined Single Limit
(EA Accident)
Any Auto
Bodily Injury
All Owned Autos
(Per Person)
Scheduled Autos
Bodily Injury
Hired Autos
Non -Owned Autos
(Per Accident)
Property Damage
(Per Accident)
EXCESS /UMBRELLA LIABILITY
Each Occurrence
Aggregate
Occur ❑ Claims Made
Deductible
A
Workers Compensation and
WC 71949
01/01/2018
01/01/2019
X
I WC Statu-
OTH-
Employers' Liability
tory Limits
ER
E.L. Each Accident
$1,000,000
Any proprietor /partner /executive officer /member
E.L. Disease - Ea Employee
$1,000.000
excluded? NO
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 /Locations/Vehicles /Exclusions added by Endorsement/Special Provisions: Client ID: 92 -70 -285
Coverage only applies to active employees) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company':
S.B. Painting and Grounds Maintenance, 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: I
APPR D R
ROGER SUAREZ LICENSE NUMBER SP4286 AS QUALIFIER. ISSUE 01 -05 -18 (RK) NT
' BY
WAIVER /A Y S
Begin Date 9/28/2017
CERTIFICATE HOLDER CANCELLATION
MONROE COUNTY BOARD OF COUNTY 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
do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives.
500 WHITEHEAD STREET
KEY WEST, FL 33040