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A`oRb® CERTIFICATE OF LIABILITY INSURANCE <br />INTR <br />TYPE OF INSURANCE <br />ti1�011"Y' <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: N the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Risk Transfer Programs, LLC <br />219 East Livingston Street <br />Orlando, FL 32801 <br />CONTACT <br />NAME: <br />-- --- --. _- <br />I N R. _ 866-481-9363 FAX No): <br />E-MAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE NAIC tl_ <br />_ <br />INSURER A :CasdePoint National Insurance Company 40134 <br />INSURED <br />Southeast Personnel Leasing, Inc (LCF) West Coast Storm, Inc. <br />_ <br />INSURER B <br />INSURER C: <br />2739 US Highway 19 North <br />Holiday, FL 34691 <br />-- --- <br />I='v�' <br />INSURER D: <br />INSURER E: <br />DAMAGE TO REN ED --- <br />PREMISES Ea occurrence $ <br />INSURER F: -- _ <br />�.vvcKAUCJ GtKIWIGAIt N1UM6E1R:PAKQ3OM7 RFVICI! ki h111YRGR- <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INTR <br />TYPE OF INSURANCE <br />IIINSR <br />VVVDR <br />POLICY NUMBER <br />MPMO POLICY EFF <br />M LILY EXP <br />LIMITS - <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE —1 OCCUR <br />I='v�' <br />�. <br />DAMAGE TO REN ED --- <br />PREMISES Ea occurrence $ <br />MED EXP (Any one person) $ <br />PERSONAL 8 ADV INJURY $ <br />_. <br />— <br />GENERAL AGGREGATE $ <br />GE AGGREGATE LIMIT APPLIES PER: <br />POLICY M PE 6 1-1 LOC <br />PRODUCTS - COMP/OP AGG $ <br />AUTOMOBILE LIABILITY <br />�-'^, `�.,', <br />COMBINED ntSINGLE LIMIT <br />accident) <br />o$ <br />BODILY INJURY (Per person) $ <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) $ <br />HIRED AUTOS AUTOS <br />PeNON-OWNED PROPERTY DAMAGE r acddenf� $_ <br />$ <br />UMBRELLA UAB <br />OCCUR <br />EACH OCCURRENCE $ <br />EXCESS LIA <br />CLAIMS -MADE <br />AGGREGATE $ <br />DED RETENTION $ <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? El <br />NIA <br />WSLTHPE90176901 <br />11/21/1011 <br />06/15/2012X <br />WC STATU- OTH- <br />TORY LIMITS I I ER <br />E.L. EACH ACCIDENT $ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000 <br />- <br />(Mandatory in NH) <br />If yes, describe under <br />1 <br />--_ <br />E.L. DISEASE - POLICY LIMIT $ 1,000,000 <br />DESCRIPTION OF OPERATIONS below <br />$ <br />DESCRIPTION OF OPERATIONS / LOCATIONS f VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />(California Operations Only) Coverage is extended to leased employees as approved and assigned by SouthEast Personnel Leasing, Inc. but not subcontractors or <br />nonleased employees of: West Coast Storm, Inc. <br />This certificate only applies to VARIOUS LOCATIONS IN SANTA ANA, CA. <br />Includes Waiver Of Subrogation in favor of CITY OF SANTA ANA PUBLIC WORKS AGENCY. <br />CITY OF SANTA ANA PUBLIC WORKS AGENCY <br />DESIGN ENGINEERING <br />P.O. BOX 1988 M-36 <br />SANTA ANA, CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORMED REPRESENTATIVE <br />rage i or U 11938-ZU11U ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010105) The ACORD name and loco are registered marks of ACORD <br />