HomeMy WebLinkAboutSOUTH EAST PERSONNEL LEASING INC & SUBSIDIARIES - INSURANCE CERTIFICATE-- - — --.1
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CERTIFICATE OF LIABILITY INSURANCE
Date
12/15/2015
Producer: Plymouth Insurance Agency
wa
2739 U.S. Highway 19 N.
I g y
This Certificate is issued as a matter of information only and confers no
rights upon the Certificate Holder. This Certificate does not amend,
extend or alter ;he coverage afforded by the policies below.
Holiday, FL 34691
727 938-5562
insurers Affording Coverage
NAIL #
Insured: South East Personnel Leasing, Inc.& Subsidiaries
2739 U.S. Highway 19 N.
Holiday,FL 34691
Insurer A: Lion Insurance Company
11075
Insurer B:
Insurer �:
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.
I INSR
LTR
ADDL
INSRD
Type of Insurance
Policy Number
Policy Effective
Date
Policy Expiration
Date
Limits
(MM/DD/YY)
(MM/DD/YY)
GENERAL LIABILITY
Each occurrence
$
Commercial General Liability
Claims Made Occur
Damage to rented premises (EA
occurrence)
$
Mad Exp
$
Personal Adv Injury
$
I
General aggregate limit applies per:
Policy ❑Project ❑ LOC
General Aggregate
$
Products - Comp/Op Agg
$
AUTOMOBILE LIABILITY
Combined Single Limit
Any Auto
All Owned Autos
Scheduled Autos
(EA Accident)
$
Bodily Injury
(Per Person)
$
0:4:y 'n,,:r,
Hired Autos -ddlmp`
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
01/01/2016
01/01/2017
Itory
WC Statu-
OTH-
Employers' Liability
Limits
ER
E.L. Each Accident
$f,o00,000
Any proprietor/partner/executive officer/member
E.L. Disease - Ea Em to ee
$f,000,000
excluded? NO
E.L. Disease -Policy Limits
$1,000,000
If Yes, describe under special provisions below.
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: 92-68-288
Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company":
Kancor Companies, LLC
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:
ISSUE 06-04-15 (EP)
Begin Date 3 10 2014
CERTIFICATE HOLDER CANCELLATION
CITY OF FORT COLLINS
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
P.0 BOX 580
FORT COLLINS, CO 80522
a ants or representatives.
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