HomeMy WebLinkAbout07-6872
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
6872
Permit Number:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
6872
FIRE SPRINKLER SYSTEM
FIRE SPRINKLER
MEDICAL
Address: 37914 DAUG TERY RD
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 03-26-21-0010-00100-0030
2,300.00
95.00
95.00
7/23/2007
SPRINKLER MONITORING
Phone:
lk~r~
n(W(07
(~
FIRE SPRINKLER ACCEPTANCE
FIRE LINE PRESSURE TEST
FIRE DEPT. FINAL
REINSPECTION FEES: Reinspection fees will comply with Florida statute 553.80 (2)(c) when extra inspection
trips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting
from faulty construction c) repairs or corrections not made when inspections called d) work not ready for
inspection when called e) permit not posted on job site f) plans not at job site g) work not accessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
The payment of inspection fees shall be made before any further permits will be issued to the person owning same
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing, consult with your lender or an attorney
before recording your notice of com encement."
CONTRACTOR NATURE PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
6872
Permit Number:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
6872
FIRE SPRINKLER SYSTEM
FIRE SPRINKLER
MEDICAL
Address: 37914 DAUGH RY
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 03-26-21-0010-00100-0030
2,300.00
95.00
Name: DAUGHTERY ROAD PROFESSIONAL CN I
Address: 6719 GALL BLVD STE 106
ZEPHYRHILLS, FL. 33542
Phone: 813973-2657
SPRINKLER MONITORING
FIRE PERMIT FEES
15,00
FIRE SPRINKLER ACCEPTANCE
FIRE LINE PRESSURE TEST
FIRE DEPT. FINAL
REINSPECTION FEES: Reinspection fees will comply with Florida statute 553.80 (2)( c) when extra inspection
trips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting
from faulty construction c) repairs or corrections not made when inspections called d) work not ready for
inspection when called e) permit not posted on job site f) plans not at job site g) work not accessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
The payment of inspection fees shall be made before any further permits will be issued to the person owning same
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing, consult with your lender or an attorney
before recording your notice of commencement. n
CONTRACTOR SIGNATURE PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
Fee Simple Titleholder Address 1
I :.'3/7 C{ ) '-\
1
813-780-0020
Date Received
Owner's Name
Owner's Address
Fee Simple Titleholder Name I
JOB ADDRESS
SUBDIVISION
WORK PROPOSED
PROPOSED USE
TYPE OF CONSTRUCTION
DESCRIPTION OF WORK
BUILDING SIZE
City of Zephyrhills Permit Application
Building Department
Fax-813-780-0021
Owner Phone Number
C1" Owner Phone Number I
Owner Phone Number I
LOT#
NEW CONSTR
INSTALL
SFR
I
B
D
D
PARCEL 10# I
(OBTAINED FROM PROPERTY TAX NOTICE)
SIGN D MOVE D DEMOLISH
B
D
D
19 p,z ,"'I:::'/~ /'}to",,- I ~">'L' ....... r
1 sa FOOTAGE 1
D
D
D
ADD/AL T
REPAIR
COMM
OTHER I
STEEL D
BLOCK
FRAME
OTHER I
HEIGHT I
VALUATION OF TOTAL CONSTRUCTION
D BUILDING
D ELECTRICAL
D PLUMBING
D MECHANICAL
D GAS
1$ Z :Y;,D
1$
1$
1$
D ROOFING
FINISHED FLOOR ELEVATIONS I
1
I
I
1
D
I
WRE.C
D
D
AMP SERVICE
PROGRESS ENERGY
VALUATION OF MECHANICAL INSTALLATION
SPECIALTY D OTHER
FLOOD ZONE AREA DYES DNO
COMPANY
REGISTERED ~ FEE CURRENT ~
License #
COMPANY
REGISTERED ~ FEE CURRENT ~
License #
COMPANY
REGISTERED ~ FEE CURRENT ~
License #
COMPANY
REGISTERED ~ FEE CURRENT ~
BUILDER
SIGNATURE
Address
ELECTRICIAN I
SIGNATURE .
Address I
PLUMBER I
SIGNATURE
Address I
MECHANICAL I
SIGNATURE .
Address
OTHER
SIGNATURE
License # I
I~I~T~
License # IEI',9a::>>o ~'f""- I
Address
RESIDENTIAL
COMMERCIAL
SIGN PERMIT
Attach (2) Plot Plans, (2) sets of Building Plans; (1) set of Energy Forms
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Sanitary Facilities & 1 dumpster
Attach (3) sets of Building Plans; (1) set of Energy Forms.
Minimum ten (10) working days after submittal date. ReqUired onsite, Construction Plans, Sanitary Facilities & 1 dumpster
All commercial requirements must meet compliance
Attach (2) sets of Engineered Plans
--'PROPERTY SURVEY required for all NEW construction
Directions:
Fill out application completely
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement is required, (AlC upgrades over $5000)
Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs Sewers Service Upgrades Ale
Driveways-Not over Counter if on public roadways"needs ROW
Fences (Plot/Survey/Footage)
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions"
which may be more restrictive than County regulations, The undersigned assumes responsibility for compliance with any
applicable deed restrictions,
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations, If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law, If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division--Licensing Section at 727-847-
8009, Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible, If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County,
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended, The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting, It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or final power release, If the project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance, Furthermore, if Pasco County Water/Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances,
CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500,00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law-Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs, If the applicant is someone
other than the "owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the "owner" prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated, I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction, I also
certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify what actions I must take to be in compliance, Such agencies include but are not limited to:
Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, WaterlWastewater Treatment.
Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses,
Army Corps of Engineers-Seawalls, Docks, Navigable Waterways,
Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks,
US Environmental Protection Agency-Asbestos abatement.
Federal Aviation Authority-Runways,
I understand that the following restrictions apply to the use of fill:
Use offill is not allowed in Flood Zone 'Y' unless expressly permitted,
If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida,
If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wall,
If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties, If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required,
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction, I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application, A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans, construction or violations of any codes, Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced, An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension, If work ceases for ninety (90) consecutive days, the job is considered abandoned,
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND 0 OBTAIN FIN NCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NO OF C ENT,
FLORIDA JURAT (FS 117.03)
OWNER OR AGENT
Subscribed and sworn to (or affirmed) before me thiS
by
Who is/are personally known to me or has/have produced
as identification.
Notary Public
~':>o ~____
:--J)~~
Notary Public
Commission No
Commission No
Name of Notary typed, printed or stamped
_ffn October 29, 2010
IllliiIIII fIllY '1In .Ins..__, In. 1lO()..38>7019
ZephyrhiUs Fire Rescue
6907 Dairy Road, Zephyrhills, FL 33542
Fire Chief
Keith Williams
Bus (813) 780-0041
Fax (813) 780-0044
July 20, 2007
I have reviewed and approved the plans for a fire alanu system located at 37900 - 37914
Daughtery Rd (3 units). I have attached the comments for the plan approval. If there are
any questions please contact my office at 813-780-0041.
Inspections Required
1. Acceptance test.
~ ~~
~ .~ q:-
.t;y ? ~
,-\Y >>.~
~~.....~
rS' ~.J'
J:)' ~ ~
~"r F ~
~~~
\-.~ .~
~-.;; .s;;
~.~
"<:) 0
.;$'
~
Fire Chief Robert Hartwig
ZEPHYRHILLS FIRE DEPARTMENT
6907 Dairy Road, Zephyrhills, FL 33542
Bus (813) 780-0041 Fax (813) 780-0044
Occupancy No.:
Plan No.: ~"'7_ ("/'~(/)
Business Name:
BusinessAddress:
Business Phone No,:
Business Fax No.:
Contact:
PLAN REVIEW FEES
~. Site Plan N/C
Building Plans .04 sf
Revision 06 sf
FIRE SERVICE U~RJ/~ /
~: ~, <-<~- -
- Billing Address: .-J.:-..2,(-____ u../,///JLfi~ j ~t:J
L~-r7-:- n-.:r.,?')-v;;'-
,
STANDPIPE SYSTEM
o Per Riser $25
SPRINKLER SYSTEMS
D 0 - 25 Heads $30
o 26 plus Heads $60
FIRE PUMP
o Per Pump $100
FIRE ALARM SYSTEM
IxI 0 - 25 Devices $30
026 plus Devices $60
SUPPRESSION SYSTEMS
~ Wet $35
Dry $35
C02 $35
Other $35
GREASENENTILATION
o Hood/Ducts $35
PLANS TOTAL I
----
)2) I
Comments:
INSPECTION FEES
Annual N/C
1 st Re-inspection $25
2nd Re-inspection $50
3rd Re-inspection $125
4th Re-inspection $250
5th Re-Inspection $500
Construction $15
Commercial $25
SPRINKLER SYSTEMS
Hydro Undergrounds $45
Hydrostatic System $45
Wet Acceptance $30
Dry Acceptance $45
Hydrant Flow $25
Hood / Booth $30
Grease Duct $15
FIRE ALARM SYSTEM
~system Acceptance $50
o Recall Acceptance $50
OTHER
Fire Wall/Smoke Wall $15
LP Gas $25
Natural Gas $25
Fuel Tanks $25
Tent $15
/. ~
INSPECTION TOTA~
GRAND TOTAL
}" /..;) -?'77 - /C' _~.)
Billing Phone No,:
Billing Fax No,:
Contact:
PERMIT FEE
SPRINKLER SYSTEMS
o Automatic $15
FIRE PUMP
o Fire Pump $15
. FIRE ALARM SYSTEM
/~ Detection $15
OTHER
~ LP Gas
Natural Gas
Fire Works
Fuel Tanks
$45
$45
$25
$45
FALSE ALARM FEE
1 st Alarm N/C
2nd Alarm N/C
3rd Alarm N/C
4th Alarm $25
5th Alarm $50
6th Alarm $75
7th Alarm $100
8th Alarm $150
9th Alarm $200
10th Alarm $250
Non Compliance $150
"Affidavit of Service/Repair"
FALSE ALARM I
TOTAL
GREASENENTILATION
D Hood/Ducts $15
D Kitchen Suppression $15
~
PERMIT TOTAL! /) I
. ./-.-t~
?j I
Date:
?f;~)/
, j/,///,-/ 4~~ ///,/'~ /-:;:;'1
/. /
Inspector:
FROM ":VARI CONSTRUCTION SERVICES
FAX NO. :8139915128 Jul. 16 2007 04:29PM P2
VARI Construction servIC~:, .~
23110 State Road 54
PMB #106
LUlz. Florida 33549
Office: 813-973-2657 Fax: 813-991-5128
To: City of Zephyr hills (Karen Miller)
From: Vari Construction Services
'Ibis is to infonn you of a suhcontractor that we will he using on the Zephyr hills
Professional Center ( Daughtery Rd. HTS, LLC will be installing the alarm system on
this job.
Should you have any questions, please don't hesitate to call me. 813-973-2657
Thank you
Xi-
FRDM :VARI CONSTRUCTION SERVICES
FAX NO. :8139915128
FaX t10 er Sheet
- -
..' .~\ '1' I
. ~ .-:r_" It
..~- ;!' r~ I~
VARIO ~--~"""'."'~~JDc.
231lD.........-54-~ .
lUB.. .... ,'~_ ."
~JlJ.IllI;''' 33Se
'-
."
.-' ... .
,.. 1MIIQ n u ..........-
lIE:
cc:
_ IT · II .6. ~ r.....' - Jl......-..: ~'
Mfl .rr1r~
'S):..
'!'o"
~
r-'I8!.
M1r:
.--
IllS':
Jul. 16 2007 04:29PM Pi
~ :.
.. '.
....., ..
:.,... . "-:"
~.... . ,. ... ....; ...-
~. .'. ~:.
~~
- - .
.. ....
ow:
-
~~ ...~ ...-
..~ ~
.7P/J GUL(
..~
........
-
. ;. 10..,
, =-,--
L - - ,; .....
, . c'
I I . . '
. -
-
..
. .
i !
.
- .
To: City of 2ephyrhills
From: Amanda
Phone:
941
7-17-07 7:59am p. 2 of 2
SUNZ Insurance Company
PO Box 1777
St Petersburg
727-497 -1247
www.sunzinsurance.com
Dlte (nmldcVyy)
7/17/2007
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 THE
COVERAGE AFFORDED BY THE POLICIES BELOW,
FL 33731
INSURER SUNZ Insurance Company
INSURER
Insured
TXRECO, Inc, d/b/a Pinnacle
Employee Leasing
Suite 121
115 West Olympia Ave
Punta Gorda
INSURER
INSURER
FL 33950
NSR
LTR
TYPE Of INSURANCE
POLICY NUMBER
LIMITS
S
S
S
S
S
S
S
GENERAL LIABILITY
COMMEROAl GENERAl UAB
!\1l' CLAIMS MADE o OCCUR
lOC
COMBINED SINGLE UMIT
s
BODilY INJURY
(Per person)
BODilY INJURY
(Per llCCidenl)
PROPERTY DAMAGE
(Per accidenl)
s
s
DEDUCTIBLE
RETENTION S
A WORKERS' COMPENSATION &
EMPlOYERS' LIABILITY
S
AUTO ONLY. EA ACODENT S
OTHER THAN EA AC S
AUTO ONLY: AGG S
EACH OCCURRENCE S
AGGREGATE S
S
S
S
WCPE0000000802
6/15/2007 6/15/2008
STATUTORY lIMIT
El EACH ACCIDENT
El DISEASE. EA EMPLOYEE
El DISEASE. POliCY UMIT
Cover~e provided for all leased employees but not subcontractors of: HTS, LLC.
Client Effective Date: 01101/2007
State of Florida Coverage Only
City of Zephyrhills
Fax 813-780-0021
Phone 813-780-0020
5335 8th st
Zephyrhills
FL 33542
SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEfORE THE
EXPIRA TlON DATE THEREOF, THE ISSUING COMPANY WLl ENDEAVOR TO MAil
~Q__~_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 COMPANY, ITS AGENTS OR REPRE.
SENT A TIVES, . 10 Days for Non-Paymenl of Premium
AUTHORIZED
REPRESENTATIVE
a..ctdW~
Douglas Ulak
To: City of 2ephyrhills
From: Amanda
Phone:
941
7-17-07 7:59am p. 1 of 2
[From :--- - - - ----- -----------------
! SUNZ Insurance Company
i PO Box 1777
! St Petersburg
i Phone: 727-497-1247
i Fax: 727-497-1280
FL 33731
~J1!l!!e
www.sunzinsurance.com
L..,....",.._~"',.."'_''''',......,_,...."..,,...-,........~..................,................."........,.._..,......=-__....-.~_.J
From:
Amanda
Phone 941-833-2065
Subject:
Certification of Insurance
TXRECO, Inc, d/b/a Pinnacle
City of ZephyrhilIs
Fax 813-780-0021
Phone 813-780-0020
5335 8th St
Zephyrhills
FL 33542
Date:
Delivery Via:
No. of Pages:
7/17/2007
FAX
18137800021
2
..'.........""''''.......-...--................-.......---...-.........-.............-.......................--...
,.._........'-_..._---,-~--,----,_.._---
Attached please find your requested Certificate of Liability Insurance issued by SUNZ Insurance
Company,
THIS MESSAGE IS IIlTENOEO FOR THE USE OF THE 1N0MOUAl. OR ENTlTIY TO WHICH II IS ADDRESSED AND MAY CONTAIN INFlJRMI\nON THAT IS PRM.EGEO, ClIlFDENTIIlL AND EXEIFT FROM DISCLOSURE UNDER
APPlCABlE lAW, IF THE READER OF TIlE MESSAGE IS NOT THE ~IlOEO RECIPIENT, OR THE EMPlOYEE OR AGENT RESPONSIllE FOR OEllVERIlG THE MESSAGE TO THE IIlTENDEO RECIPENT. YOU ARf HEREBY
NOnAEO THAT MY OISSEIlNATION. DISTRIBUTION OR CCPYING OF THIS C~ICATION IS STRICTlY PROHIIlIlID, F YOU HAVE RECEIVED THIS C~CAnON IN ERROR. PlEASE NOTIfY US _EOIATEl Y BY
TElEPIlDNE,ANQ RETURN THE ORIGiNAl MESSAGE TO USAT THE ABOVE AOORESS VIA REGULAR POSTAl. SERVICE,
-------.--..-..-..------.--.--.-..--,....,...............
www.eCertsOnline.com
~ 2002 Insurance Visions, inc,
JUL-17-2007 TUE 10:24 AM FEDERATED MAIL AND FAX
FAX NO. 5074558883
P. 02/02
~[~~~~~~~'
PRODUCER
,...........~ ,.,,, . . . . ...~."f'.....',,,
FEDERATED MUTUAL INSURANCE COMPANY
Home Office: P.O. Box 328
Owatonna. MN 55060
Phone: '-888-333-4949
bATE IUMIDDIYYI
07/17/07
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONL V AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BV THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
COMPANY FEDERATED MUTUAL INSURANCE COMPANV OR
A FEDERATED SERVICE INSURANCE COMPANY
INSURED
HTS LLC
2020 LAND 0 LAKES BLVD STE '0
& 11
LUTZ FL 33549
320-649.7
COMPANY
B
COMPANY
C,
U.L;~t.tj~*tC~i.f.liJ~w.; ""
TI1IS IS TO CERTIFY THAT THE POLICIES OF INSURAI\ICE LISTED BELOW HAVE BI:EN ISSUED TO THE INSURED NAMED AIIOVE FOR THE POLICY PERIOD
'NDICArED, IIIOTWITHSTANDING ANY REQUIREMENT, TEAM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIT'"' RESPECT TO WHICH THIS
CERTIFICATE MAY De ISSUED OR MAY PERtAIN, THe INSURANCE AFFORDED BY THE POLICIES DESCFlIBED HEREIN IS SUBJECT TO All. THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUC,", POLICIES. LIMITS SHOWN MAY HAve BEEN ReDUCED BV PAID CLAIMS.
CO
LTIl
TYPE OF lMSURANCE
POUcY NUUIISl
POUCY EfFI!CTJVEi POUCY EiXPlRA TlON
DATE IUM/DDJYV, DATE IUM/PDml
UMrrs
GENEIlAa. UABIUTV
COMMERCIAL GENERAL LIAIiILI'l'Y
A CLAIMS MAO~ 00 OCCUR
OWNER'S'& CON'l'RACTOR'6 PROT
9296693
04/12107
04112/08
ClENERA~ AGGREGATE
PRODUCTS. COMI"IOP AGG
P~R&ONAL & AOV INJURY
EACH OCCURRENCE
FIRE OAMI'.GE IAny ana flr.,
MEO El(p IAn~ ..,. porIOn)
2 000 000
2 000 000
'.000.000
. 1 000 000
100,000
A
AUTOMOHILI! UABIUTV
ANY AUTO
ALL OWNED AlITOS
SCHEDULEO Al1TOS
HIRED AlITOS
NON-OWNED AUTOS
CDMIIINED SINGLE LIMIT
e 1,000,000
9296693
04/12107
04112108
ROCIL Y INJURY
IPlr P'/IIDnl
1I00lL Y INJURY
(Pill' DCDklamJ
GARAGE UAIlILITV
ANY AlITO
PFlOPEA'TY DAMAGE
.EXCESS LIAIIILITY
UMSRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS CCMPB/SAnON AND
EMIILoYERS' UAIILITV
AUTO ONLY - ~ ACCIDENT .
O'l'HER THAN AUTO ONLY:
EACH ACCIDENT
AGGREG^TE
EACH OCCURRENCE
AGGREGATE
WC STATU.
THE PROf'RIETORI
PARTNERSlEl(ECUTIVE
OFFICERS AR',
OlliS!
'NeL
EXCL
EL EACH ACCIDENT
EL DISEASE. POLICY LIMIT
EL DISEASE. eA EMPLOYEE
DESCRIPT10N OF OPQlATlONSILOCATlONSIVEHlCU!ll/8PECIAL ITEMS
,.
'^3_~9i'-:~ ", .,'~~
CITY OF ZEPHYR HILLS
5335 8TH STREET
ZEPHYR HILLS FL 33542
',.
73 liHOULD ANY OF THE ABOVE PIiliCIIlIIED POUCIES IE CANCI!U..Ila IfFOllE 'THE
ElCPlRATION PATE THS!EOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAll
-UL DAYli WIll'I'TEN NOTICE TO THE CElmFlCATE HOLOS! NAIIIED TO THE LifT,
BUT fAlLUIlE TO MAl&. SUCH NOTICE SHALl. ..JIOSE NO 08uGATlON OR LlA8IUTY
OF ANY KIND UPON THE COU~ ,rrs AU S OR REPIlESI!HrATlVES.
AUTHORlZIP REPIlESl!NTATIV
.,'~':,',',:,'r,'. .'
}.,....
. .-!"..
'. ",..~..,,~.....c-\
. . .... .'~ - - . :'.