Certificates of Insurance
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A'CORD CERTIFICATE OF LIABILITY INSURANCE Dale
TM 4/13/05
Producer: Lion Insurance Company 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.
Phone: 727-938-5562 Fax: 727-937-2138
Insurers Affording Coverage NAIC #
Insured: South East Personnel Leasing, Inc. Insurer A: Lion Insurance Company 11075
2739 U.S. Highway 19 N. Insurer B:
Holiday, FL 34691 Insurer C:
Phone: (727)938-5562 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 daims.
INSR ADDL Policy Number Policy Effective Policy Expiration Limits
LTR INSRD Type of Insurance Date Date
(MMIDDIYY) (MMIDDIYY)
~ENERAL LIABILITY Each Occurrence ~
I--
I- Commercial General Liability Damage to rented premises (EA
::J Cbims Made 0 Occur occurrence) ~
l-
I-- Med Exp ~
I- Personal Adv Injury ~
~eneral aggregate limit applies per: ~
tJ Policy o Project 0 General Aggregate
LOC
Products - CornplOp Agg ~
~UTOMOBILE LIABILITY Combined Single Limit
I- (EA Accident) ~
Any Auto Bodily Injury
I-
All Owned Autos ~
I- (Per Person)
Scheduled Autos 1'l;.~Ern
I- ...\PP~ rr '~y~O~ 'I
! ,~ '~'I,',~~V' Bodily Injury
Hired Autos
l- n "'{ _'n ,__. (Per Accident) ~
Non-Owned Autos ~n.
I- ~ .:-0 ~ Property Damage
[AT [ --".--.,-
". " (Per Accident) ~
-
-'1"-' ~"" .:~, -
GARAGE LIABILITY Auto Only - Ea Accident Is
R Any Auto Other Than EA Ace. 1$
Autos Only: AGG. Is
EXCESS/UMBRELLA LIABILITY Each Occurrence
- Occur o Claims Made Aggregate
-
Deductible
- Retention
-
A Workers Compensation and X I WC Statu- I I OTH-
WC 71949 01/01/2005 01/01/2006 tory Limits ER
Employers' Liability
Any proprietor/partner/executive officer/member E.L. Each Accident $1000000
excluded? E.L. Disease - Ea Employee $1000000
If Yes, describe under special provisions below.
E.L. Disease - Policy Limits $1000000
Other 3465161
Ameriseal of N.E. FL., Inc. COVERAGE APPLIES ONLY TO THOSE EMPLOYEES LEASED, NOT TO SUBCONTRACTORS.
Descriptions of Operations/Locations/vehicles/Exclusions added by Endorsement/5pecial Provisions: ADD ON DATE: 1/5/04
COVERAGE APPLIES ONLY IN THE STATE OF FLORIDA TO THOSE EMPLOYEES LEASED TO BUT NOT SUBCONTRACTORS OF Ameriseal of N.E. FL., Inc. . REF:
A.I.P. NO. 3-12-0037-2404 UP.I.N. NOS. PFL 0000166, PFL 0003229 PFC APPLICATION NOS. 8' FAX: 904-810-5999 & 305-261-4017 /ISSUE 4/13/05 (JJG)
CERTIFICATE HOLDER CANCELLATION
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS Should any of the above described policies be cancelled belore the expiration date thereol, the issuing
insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to
ATTN: BEVETTE MOORE-KEY WEST INT'L AIRPORT do so shall irrpose no obligation or liability of any kind upon the insurer, its agents or representatives.
3491 S ROOSVELET BLVD
KEY WEST FL 33040 A(/~
A_~e>.RD25(1()01/08)
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ACORD CORPORATION 1988
ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYVY)
TM 04/21/2005
PRODUCER (904)353-3181 FAX (904)353-5722 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Cecil W. Powell & Co. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Drawer 41490 HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
219 Newnan St.
Jacksonville, FL 32203-1490 INSURERS AFFORDING COVERAGE NAIC#
INSURED Ameriseal of Northeast Florida, Inc. INSURER A: Transportation Ins Co
POBox 4492 INSURER B:
St Augustine, FL 32085 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.
'~~: ~o,,~~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY 2075878686 12/31/2004 12/31/2005 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,000
I CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ 5,000
A PERSONAL & ADV INJURY $ 1,000,000
-
GENERAL AGGREGATE $ 2,000,000
I-- 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
11 POLICY [Xl ~f8T n LOC
AUTOMOBILE LIABILITY 2075879000 12/31/2004 12/31/2005 COMBINED SINGLE LIMIT
rx ANY AUTO (Ea accident) $ 1,000,000
f--
ALL OWNED AUTOS BODILY INJURY
f- $
SCHEDULED AUTOS (Per person)
A y
HIRED AUTOS BODILY INJURY
f- $
X NON-OWNED AUTOS (Per accident)
f--
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EAACC $
7''' AUTO ONLY: AGG $
^ "
EXCESS/UMBRELLA LIABILITY At-'i1)l'tU\ r\T '1.;11\ EACH OCCURRENCE $
~ OCCUR o CLAIMS MADE BY ~.. r, I J 1 AGGREGATE $
DATE 1 )_~1 -( h $
R DEDUCTIBLE _~_ YES $
RETENTION $ WAIVER N/A .-"-- $
WORKERS COMPENSATION AND I wc STATU- I IOJ~-
EMPLOYERS' LIABILITY
ANY PROPRIETORlPARTNERlEXECUTIVE EL. EACH ACCIDENT $
OFFICERlMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
SPECIAL PROVISIONS below EL. DISEASE - POLICY LIMIT $
OTHER
~ESCRlPTlON OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
IP No. 3-12-0037-2404; UPIN Nos. PFL 0000166, PFL 0003229, PFC Application Nos. 8
~ertificate holders are additional insured when required by written contract.
Monroe County Board of County Commissioners
attn: Bevette Moore - Key West Int'l Airport
3491 S Roosevelt Blvd
Key West, FL 33040
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
---1L DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES
AUTHORIZED REPRESENTATIVE
Fa e G. Coleman CIC
ACORD 25 (2001/08) FAX: (305)261-4017
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001108)
AC!JRQM CER1IFICATE OF LIABILITY INSURANCE ' I DATE'(MM/DDIYYYY)
01/27/2005
PRODUCER (904)353-3181 ' FAX (904)353-5722 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Cecil W. Powell & Co. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Drawer 41490 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
219 Newnan St.
Jacksonville, FL 32203-1490 INSURERS AFFORDING COVERAGE NAIC#
INSURED Ameriseal of Northeast Florida, Inc. INSURER A: Transportation Ins Co
POBox 4492 INSURER B:
St Augustine, FL 32085 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 DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL UABILITY 2075878686 12/31/2004 12/31/2005 EACH OCCURRENCE $ 1,000,OO(]
CX COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,00(]
I CLAIMS MADE m OCCUR MED EXP (Anyone person) $ 5,OO(]
A PERSONAL & ADV INJURY $ 1,000,00C
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
n POLICY [Xl ~f~T n LOC
AUTOMOBILE LIABILITY 2075879000 12/31/2004 12/31/2005 COMBINED SINGLE LIMIT
X ANY AUTO (Ea accident) $ l,OOO,OO(]
-
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
A X
HIRED AUTOS BODILY INJURY
- $
X NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY 2077253069 12/31/2004 12/31/2005 EACH OCCURRENCE $ 3,OOO,OO(]
~ OCCUR o CLAIMS MADE AGGREGATE $ 3,OOO,OO(]
A $
~ DEDUCTIBLE $
X RETENTION $ 10,00(] $
WORKERS COMPENSATION AND I WC STATU- I 10J~-
EMPLOYERS' UABIUTY
ANY PROPRIETORlPARTNERlEXECUTIVE E.L. EACH ACCIDENT $
OFFICERlMEMBER EXCLUDED? EL. DISEASE - EA EMPLOYEE $
If yes, describe under EL. DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
he Monroe County Board of County Commissioners, its employees and officials are additional insured as
~espects general liability and automobile liability when required by written contract.
~E: Seal Coat Ramps, Marking, T/W A-9 Rehabilitation & Environmental, Key West International Airport,
~onroe County FL, 33050, AlP # 3-12-0037-2404, UPIN #'s PFL0000166 & PFL0003229, PFC Application #8
10 days notice for nonpayment of premium
C
URS Corporation
Mr Andres Gutierres, PE, Project Manager
7650 Corporate Center Drive
Suite 400
Miami, FL 33126
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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
~g~
ACORD 25 (2001/08)
@ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001/08)