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Home My WebLink About07-6978 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 6978 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: 6978 FIRE ALARM SYSTEM FIRE ALARM SYSTEM COMMERCIAL Address: 7422 GALL BLVD ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 35-25-21-0010-07200-0011 26,889.00 Name: K-MART Address: 7422 GALL BLVD ZEPHYRHILLS, FL. 33542 50.00 50.00 8/24/2007 Phone: ADDITION TO F/ALARM SYSTEM -REFER TO PRMT#6874 IS; -D 7 fO- r:::" () c~,.\.Q cQ ,--< .QNV1 \t'SU-" I'OL fi2~ IV - ~fI C'~ ~(/Y'- I>.-U I "1-- ~ AN E FIRE ELEVATOR RECALL 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." c;;Q~ CONTRACTOR SIGNATURE PERMIT OFFI PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER Date Received 2. 3- 0 Owner's Name S t:.A- U \~ L,..~ h,l uS Owner's Address I 'S ~ '31 Bt.v~ ~ ( ~R'f-tAou hi. t Fee Simple Titleholder Name I I 813-780-0020 City of Zephyrhills Permit Application Building Department Fax-813-780-0021 Owner Phone Number I Owner Phone Number I l/(.,(. I I I I I Fee Simple Titleholder Address I 1'14 'l. '2. <> AU.. I D NEW CONSTR ~ ADD/ALT D D INSTALL t=J REPAIR PROPOSED USE D SFR [d- COMM D TYPE OF CONSTRUCTION D BLOCK D FRAME D I {.\.w:.O "1""~ Jo.1 7"'1> ~ \1\. <; vs. T"i..f"oo\ . I SQ FOOTAGE I I 1$2L.t ~'\- I 1$ I 1$ I 1$ I D GAS D ROOFING D FINISHED FLOOR ELEVATIONS I I JOB ADDRESS SUBDIVISION WORK PROPOSED DESCRIPTION OF WORK BUILDING SIZE Cj BUILDING D ELECTRICAL D PLUMBING D MECHANICAL ~LV':) LOT# PARCELlD# I (OBTAINED FROM PROPERTY TAX NOTICE) SIGN D DEMOLISH MOVE D OTHER I D STEEL OTHER I HEIGHT VALUATION OF TOTAL CONSTRUCTION AMP SERVICE D PROGRESS ENERGY D W.R.E.C, VALUATION OF MECHANICAL INSTALLATION Nut; SPECIALTY D FLOOD ZONE AREA OTHER DYES DNO BUILDER COMPANY SIGNATURE REGISTERED Address ELECTRICIAN I COMPANY SIGNATURE REGISTERED Add ress I PLUMBER I COMPANY SIGNATURE REGISTERED Address I U'!..!:!....J FEE CURRENT ~ License # U'!..!:!....J FEE CURRENT ~ License # U'!..!:!....J FEE CURRENT ~ License # U'!..!:!....J FEE CURRENT ~ License # FEE CURRENT License # I 6'F()[)D (211 MECHANICAL I SIGNATURE Address I OTHER I 'l () ~ 1"'\ - I SIGNATURE V~~ Address 1l..f7 0 I O~+Cti~ 0\ V V --rc~ 33~(6 COMPANY REGISTERED COMPANY REGISTERED 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. m*PROPERTY SURVEY required for all NEW construction, 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 PERMITIING (Front of Application Only) Reroofs Sewers Service Upgrades NC Driveways-Not over Counter if on public roadways..needs ROW Fences (PloUSurvey/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 'V. 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 TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT, FLORIDA JURAT (F.S. 117.03) ~ OWNER OR AGENT Q(a..l ~ ":::)- s~~~~~~w~~~tr~~~h.!ll~ \Nho is/are personally known to me or has/have produced as identification. CONTRACTOR ~ t~~1d~;o~rm 0 ~~l~ o is/are personally known to me or has/have produced as identification. Zephyrhills Fire Rescue 6907 Dairy Road, Zephyrhills, FL 33542 Fire Marshal Kerry Barnett Bus (813) 780-0041 Fax (813) 780-0044 August 24, 2007 I have reviewed and approved the plans for fire alarm notification devices upgrade located at 7422 Gall Blvd (K-MartlSears). I have attached the comments for the plan approvaL If there are any questions please contact my office at 813-780-0041. 1. System shall be installed using the most recent NFP A 72 edition (2007). 2. This is approved only as an upgrade of notification devices within the store to eliminate the current fire watch that has been established. Fire watch will be discontinued once an acceptance test has been completed and approved. 3. Additional plan shall be submitted along with scope of work to show the next step in certifying the system to be compliant with the most recent edition of NFP A 72. A time frame of 90 days from the approved acceptance test will be allowed for additional work to be completed. Inspections Required 1. Acceptance test of new devices. Fire Chief Robert Hartwig ZEPHYRHILLS FIRE DEPARTMENT 6907 Dairy Road, Zephyrhills, FL 33542 Bus (813) 780-0041 Fax (813) 780-0044 FIRE SERVICE US~ Si Billing Address: e::c", Occupancy No.: Plan No.: ()7,-O Il) Business Name: )C-~ ~ BusinessAddress: ~ )+\ I Business Phone No.: Business Fax No.: Contact: PLAN REVIEW FEES ~ Site Plan N/C Building Plans ,04 sf Revision ,06 sf STANDPIPE SYSTEM o Per Riser $25 SPRINKLER SYSTEMS o 0 - 25 Heads $30 D 26 plus Heads $60 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 PUMP o Per Pump $100 FIRE ALARM SYSTEM FIRE ALARM SYSTEM uP .l~evices $30 ~ System Acceptance ~ ~ ~~evices $60 D Recall Acceptance $50 SUPPRESSION SYSTEMS OTHER ~ Wet $35 Fire Wall/Smoke Wall $15 Dry $35 LP Gas $25 C02 $35 Natural Gas $25 Other $35 Fuel Tanks $25 Tent $15 GREASENENTILATION D Hood/Ducts $35 PLANS TOTAL I 'Comments: INSPECTION TOTAJ!5tJf GRAND TOTAL (I J3-I(;))~- 57,t8'2- Billing Phone No.: Billing Fax No.: Contact: PERMIT FEE 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" SPRINKLER SYSTEMS o Automatic $15 FIRE PUMP o Fire Pump $15 FIRE ALAR~STEM o Det~v~ OTHER ~ LP Gas Natural Gas Fire Works Fuel Tanks $45 $45 $25 $45 GREASENENTILATION D Hood/Ducts $15 D Kitchen Suppression $15 I FALSE ALARM I PERMIT TOTAL TOTAL 9~1 Date: 111ft # ~~ ~y,..)~ ~ Inspector: ~ /~ STATE OF FLORIDA ;.; ;;.. f \ DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION !~ I ~ j ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 ~~~~~/ 1940 NORTH MONROE STREET ~ TALLAHASSEE FL 32399-0783 KLINGENSMITH, WILLIAM JAY II SIMPLEXGRINNELL LP 1929 OAK STREET NORTH CLEARWATER FL 33760 ,~ STATE OF FLORIDA AC# 3058525 DEPARTMENT OF BUSINESS AND ~" PROFESSIONAL REGULATION EF0001211 02/01/07 060345052 CERT ALARM SYSTEM CONTRACTOR I KLINGENSMITH, WILLIAM JAY II SIMPLEXGRINNELL LP IS CERTIFIED under the provisions of ch,489 i'S. Expiration date: AUG 31, 2008 L07020101201 DETACH HERE AC# 3 0 5 8 52 5 -----------------------------.---------------------------~----------------+---------------------------------------------.------ STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD SEQ#L07020101201 : . LICENSE NBR 02 01 2007 060345052 EF0001211 The ALARM SYSTEM CONTRACTOR I Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2008 KLINGENSMITH, WILLIAM JAY II SIMPLEXGRINNELL LP 4701 OAK FAIR BLVD TAMPA FL 33610 CHARLIE CRIST GOVERNOR DISPLAY AS REQUIRED BY LAW HOLLY BENSON SECRETARY z CD '" :r N c: ,. '" '" c: 0 Z :r 0 m m '" :ll -..,j ,'" m (J) I '" " -< N " " 0 g ,. -- 0 is UJ 0 ." 0 m Z 0 ,. '" ,. UJ <D 0 0 00 '" " 0 ~ r 6 " =< l' <' m 0 0 0 iii I 0 r 0 10 0 '" " m 00 0 r Gl (J) 0 8 m " r --< m ;: 0 ,. (J) ,. 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(), . . 0 0 ?;~ N ./>., 0 0 ;0 en 0 0000 0 0 Gl -1 0 ~CJ1 m m --.J CO N 0 CO -n --.J 0 0 r UJ 6 00 UJ UJ -l 0 Z 0 <:) 00 $( 0 0 0 0 0 0 0 0 0 \Crv\~\Ft.. "612.b}Ol Simplex6rillllell SimplexGrinnell LP 4701 Oak Fair Blvd, Tampa, Florida 33610 (813) 626-5482 FAX: (813) 664-1731 www.simplexgrinnell.com August 23,2007 City of Zephyrhills 5335 8th Street Zephyrhills, Florida 33542 To Whom It May Concern: I, William J Klingensmith II, do hereby authorize the following person(s) to act as my agent in securing permits on my behalf: Eric Brockmeier Thomas J Akos Robert McNeil Michael Jayko I understand that I am responsible for all work performed under these permits. My Florida State Certification N s EF -0001211. fd y---- day of ,2007, by e or who has produced Notary Public State of Florida County of Hillsborough My Commission Expires: January 10,2011 Fire, Security, Communications, Workforce Solutions, Sales & Service Offices & Representatives in Principal Cities throughout the World II~ ~ J;j ~ t .~ 8 o z ii' 0 8 ~ . f ~~S ~llil ~<1 a ; 8 iiil :.0 i '" N I't If ;;fa.... V:l t *~ ;: ~ ~ ! ~ i l ~ ~~ .~! 1:1 ~ ~ !!l 'l" =t....... .. ~ % N l::l .g 2 =1\) ~ [ ~ i~. ~ ~o c: ~ c f ~ g ~ CERTIFICATE OF INSURANCE CERTIFICATE NUMBER 388608 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE POLICY, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Marsh, Inc, POLICIES DESCRIBED HEREIN, 1166 Avenue of the Americas New York, NY 10036 COMPANIES AFFORDING COVERAGE Telephone (212) 345-5000 COMPANY A: AI South Insurance Co, COMPANY B: American Home Assurance CO, INSURED COMPANY C: Commerce & Industry Ins Co COMPANY D: Illinois National Insurance Co, SimplexGrinnell, LP COMPANY E: Insurance Company of the State of PA 4701 OAK FAIR BLVD TAMPA, FL 33610 COMPANY F: New Hampshire Ins, Co, United States COMPANY G: New York Marine & General Insurance Co, (Lead) COMPANY H: White Mountain Insurance CO, COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIRMENTS, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES LISTED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MMIDDIYY) DATE (MMIDDIYY) B GENERAL LIABILITY GL 1595415 6/29/2007 10/1/2008 GENERAL AGGREGATE $15,000,000,00 X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMPIOP AGG $15.000,000,00 '-- tJ CLAIMS MADE [R] OCCUR PERSONAL & ADV INJURY $7,500,000,00 I--- OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $7,500,000,00 I--- FIRE DAMAGE (Anyone fire) $1,000,000,00 I--- MED EXP (Anyone person) $10,000,00 B AUTOMOBILE LIABILITY CA 1606993 (VA) 6/29/2007 10/1/2008 COMBINED SINGLE LIMIT $7,500,000,00 B X ANY AUTO CA 1606992 (MA) 6/29/2007 10/1/2008 B - CA 1606994 (AOS) 6/29/2007 10/1/2008 BODILY INJURY (Per person) ALLOWED AUTOS - SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY (Per accident) 7 NON-OWNED AUTOS I--- PROPERTY DAMAGE I--- PROPERTY B EXCESS LIABILITY BE 9835073 6/29/2007 10/1/2008 EACH OCCURRENCE $10,000,000,00 4 UMBRELLA FORM AGGREGATE $10.000.000,00 OTHER THAN UMBRELLA FORM B WORKERS COMPENSATION AND SEE PAGE TWO SEE PAGE TWO SEE PAGE TWO X I we STATUTORY I I OTHER LIMITS 0 EMPLOYERS' LIABILITY EL EACH ACCIDENT $2,000.000,00 C THE PROPRIETOR! A PARTNERSIEXECUTIVE RINCL EL DISEASE-POLICY LIMIT $2,000,000,00 F OFFICERS ARE: I EXCL EL DISEASE-EACH EMPLOYEE $2.000,000,00 OTHER DESCRIPTION OF OPERATIONSILOCATlONSNEHICLESISPECIAL ITEMS Please see page 2 for additional insureds and any additional language, CERTIFICATE HOLDER CANCELLATION City of Zephyrhills SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE INSURER AFFORDING COVERAGE WilL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER 5335 Eighth Street NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON Zephyrhills, FL 33542 THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES, OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC, BY: ~ )(frc4~ Katherine O'Leary, Casualty Program MM1(3/02) VALID AS OF: 8/2312007 ADDITIONAL INFORMATION PRODUCER COMPANIES AFFORDING COVERAGE Marsh, Inc, 1166 Avenue of the Americas New York, NY 10036 Telephone (212) 345-5000 INSURED SimplexGrinnell. LP 4701 OAK FAIR BLVD TAMPA, FL 33610 United States TEXT WORKERS COMPENSATION POLICIES Carrier Policy Number Eff, Date Exp. Date State (B) American Home Assurance Co, WC 1616576 6/29/2007 6/29/2008 CA (B) American Home Assurance Co, WC 1616584 6/29/2007 6/29/2008 AOS (D) Illinois National Insurance Co, WC 1616577 6/29/2007 6/29/2008 MI (C) Commerce & Industry Ins Co WC 1616582 6/29/2007 6/29/2008 FL (B) American Home Assurance Co, WC 1616581 6/29/2007 6/29/2008 NJ (A) AI South Insurance Co, WC 1616578 6/29/2007 6/29/2008 GA (B) American Home Assurance Co, WC 1616579 6/29/2007 6/29/2008 PA (F) New Hampshire Ins. Co, WC 1616580 6/29/2007 6/29/2008 NY,WI (B) American Home Assurance Co. WC 1616585 6/29/2007 6/29/2008 OR (E) Insurance Company of the State of PA WC 1616583 6/29/2007 6/29/2008 AR,MA,VA LIABILITY PROGRAM Project: Zephyrhills If there is a question regarding this certificate please contact Lea Hervish (Email: 1hervish@tycoint,com Phone: 813-623-2991) CERTIFICATE HOLDER City of Zephyrhills 5335 Eighth Street Zephyrhills. FL 33542 CERTIFICATE NUMBER 388608