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Group 5Dale CERTIFICATE OF LIABILITY INSURANCE 9119/2013 Producer- Lion Insurance Company This Certificate is issued as a matter of information only and confers no rights. 2739 U.S. Highway 19 N. Holiday, FL 34691 upon the Certificate Holder. This Certificate does not amend, extend or alter the coverage afforded by the policies below. Insurers Affording Coverage NAIC # (727) 938 -5562 Insured: South East Personnel Leasing, Inc. & Subsidiarie Insurer A: Lion Insurance Company 11075 Insurer B: 2739 U.S. Highway 19 N. Holiday, FL 34691 Insurer C: Insurer D: Insurer E: Coverages The policies at insurance listed below have been issued to the insured named above forthe policy period indicated. Nosmthstandirg any mcluirement,torte orcondit €on of any contract or otherdoclu nl with respect to which this certiticate may be issued or may pertain, the insurance afforded by the policies described herein 15 subject to all the temis, exWusdw and conditions of such policies. Aggregate limits Shown may have been reduced by paid claims. - INSR LTR ADDL INSRC Type of Insurance Policy Number Policy Effective Date Policy Expiration Date Limits (MMIDDIYY) (MMIDD/YY) GENERAL LIABILITY Each occurrence Commercial General Liability Claims Made 11 Occur Carnage to rend premises (EA occurrence) Med E>p General aggregate limit applies per: Personal Adv Injury General Aggregate Policy ® Project ® LOC Products - ComprOp Agg AUTOMOBILE LIABILITY Combined single Limit - (EA Accident) Any Auto Bcdily Injury All Owned Autos (Per Person) Scheduled Autos Bcdily lnjury Hlred Autos Non -owned Autos (Per Accident) Property Damage (Per Accident) EXCESSIUMBRELLA LIABILITY EachOccunence Occur ® CTaims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2013 01;0112014 X I we stat.- DTH- Employers'Liability tol Limits ER E.L. Each Accident $1 ,600.000 Any pnoprietodpattner /executive officerlmember excluded? NO E.L. Disease - Ea Employee 51,000.000 If Yes, describe under-special provisions below. E.L. Disease - Policy Limits 51,000,000 Other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AM # 12616 Descriptions of Operations /LocationsNehicleslExclusions added by Endorsement/Special Provisions: Client ID: 83 -67 -091 Coverage eniy applies to active employee(s) of South East Employee Leasing Services, Inc. that are leased to the following "Client Company ": H & R Paving, Inc. Coverage only applies to injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s) , while working in: Ft. Coverage does not apply to statutory employees) or independent contractor(s) of the Client Company or any other entity. A list of the active employees) leased to the Cient Company can be obtained by faxing a request to (727) 937 -2138 or by calling (727) 938 -5562. Project Name: RFP #CP- 2013 -08 ROAD RESUPFACING ON SW 62ND STAND SW 57TH ST ISSUE 09 -19 -13 (TLD) Begin Date: 1.2/2312012 CERTIFICATE HOLDER CANCELLATION CITY OF SOUTH MIAMI Should anyofthe above described policies be cancelled before the expiration datethereof, the issuing insurerwi €I endeavor to mail 30 days mitten notice to the certficale holderromed to the lei, butfailureto do so shall impose no ATTN STEVEN KULI CK abligation ar IiabiGly of any kind upon the insurer, its agents or representatives. 6130 SUNSET DRIVE SOUTH MIAMI, FL 33143 Raid H &RPA -2 OP ID. GBG .14� L>F CERTIFICATE OF LIABILITY INSURANCE D0 911 9 /2 0 1 YY) 0 911 912 0 1 3 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy (ies) must be endorsed. 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). PRODUCER Phone: 305 -364 -7804 BROWN & BROWN OF FLORIDA INC Fax: 305 -714 4441 14900 NW 79th Court Suite #200 Miami Lakes, FL 33016 -5869 Eric Sheesley CAmONTACT NE: PRONE PAx Na Ext: Arc No): E-MAIL ADDRESS: GENERAL LIABILITY I �XCMMERCIAL GENERAL LIAB]LITY CLAIMS -MADE C OCCUR INSURER(S) AFFORDING COVERAGE I NAIC # INSURERA:WeSCO Insurance Co. 425411 pREMISESOEa occur erce INSURED H & R Paving Inc INSURER B:Great American Insurance Co. 116691 1955 NW 110th Ave Miami, FL 33172 -1911 INSURERC:The North River Ins. Company 121105 -INSURER a:WestehesterSurplus Lines Ins 110172 INSURER E: PERSONAL &ADV INJURY S 1,000,00 INSURER F : Contractual Llab. GENERAL AGGREGATE COVERAGES CERTIFICATE NUMBER: RFVISION NIfMRFR- THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR. TYPEOFINSURANCE AODL SUB POLICYNUMBER POLICY EFF MM1D0 POLICY EXP DD LIMITS A GENERAL LIABILITY I �XCMMERCIAL GENERAL LIAB]LITY CLAIMS -MADE C OCCUR I WPP109493500 0510112013 05/01/2014 EACH OCCURRENCE $ 1,040,00 pREMISESOEa occur erce $ 104,00 i MED EXP (Any one person) $ 5,00 XCU PERSONAL &ADV INJURY S 1,000,00 LX Contractual Llab. GENERAL AGGREGATE 2,000,44 LA GGREGATE LIMIT APPLIES PER: ! POLTCY X PRO LOC PRODUCTS - COMP /OP AGG 2,000,04 Emp Ben. $ 1,000,00 A AUTOMOBILE X LIABILITY ANY AUTO WPP109493500 05/0112013 05/01/2014 COMSINEp SINGLE LIMIT Ea accident $ 1 r 400,44 BODILY INJURY (Per person) ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY Peraccidenq' $ :HIRED AUTOS I X NON -OWNED AUTOS X PROPERTY DAMAGE Per accident S X UM1IBRELLA LIA13 OCCUR ' EACH OCCURRENCE', 5 5,000,00 AGGREGATE 5 5,000,00 B PEXCESS Uae C IAIMS -MADE TUU048352600 0510112013 05101/2014 ED [ X ! RETENTIONS 14,000 5 IOFRCERIMEMBEREXCLUDED? WORKERS COMPENSATION AND EMPLOYERS` LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE YIN 'NIA - WCSTATU- OTH- : TORY LIMITS I : ER E.L.EACHACCIDENT $ E.L. DISEASE - EA EMPLOYE 5 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E -L. D €SEASE - POLICY LIMIT $ C (Excess Umbrella 5227472844 0510112013" 05/01/2014 Limit 5,000,00 D ''Pollution G242755516001 I 0510112013 05/01/2014 Limit 1,000,00 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES lAttach ACORD 101, Additional Remarks Schedule, if mare space is required) RFP# CP- 2413 -48 Road Resurfacing on SW 62 Street & SW 57 Street City of South Miami 6130 Sunset Drive South Miami, FL 33143 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRES ENTATIV E a 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD