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HomeMy WebLinkAbout09-9286 CITY OF ZEPHYRHILLS t 5335 - 8TH STREET (813)780 -0020 9286 BUILDING PERMIT Permit Number: 9286 Address: 5034 18TH ST Permit Type: COMMERCIAL ZEPHYRHILLS, FL. Class of Work: ADD /ALT COMMERCIAL Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 11- 26 -21- 0010 -21500 -0260 Improv. Cost: 2,136.00 Date Issued: 6/25/2009 Name: LIL STAR LEARNING CENTER Total Fees: 67.50 Address: 5034 18TH ST Amount Paid: 67.50 ZEPHYRHILLS, FL. 33542 Date Paid: 6/25/2009 Phone: Work Desc: PAN ROOF TO GO OVER PATIO 6 X 23 w/ SLAB ACE ALUMINUM & ST CONRUCT 67.50 ION LLC BUILDING FEE �' " 6 ,,, s ___ ,,ocf i_, r FOOTER 2ND ROUGH PLUMB MISC INSULATION CEILING FOOTER BOND DUCTS INSULATED SEWER MISC. ROUGH ELECTRIC LINTEL MISC MISC. 1ST ROUGH PLUMB PRE -METER INSULATION WALL MISC. DUCTS INSTALLED WATER MISC DRIVEWAY PRE -SLAB SHEATHING MISC. MISC. CONSTRUCTION POLE FRAME MISC. MISC. REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection trips are necessary due to any one 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." 6 e)g.-- 21/' 44 /A- ' CO9 SIGNATURE • PERMIT OFFI r PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 813 - 780 -0020 City of Zephyrhills Permit Application Fax 813 - 780 -0021 Building Department it / Z . b Date Received / 23 Phone Contact for Permitting 113 7 -- / Owner's Name Lc / f ' Leu)24 aloe -tip C Owner Phone Number Owner's Address 3 3 y 1t/ Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS 5 5 V ilk U r /d. LOT # SUBDIVISION C tl Z lb'tJ4 PARCEL ID# l /� 0 b —a ()WO - c QCI (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED Ft1 NEW CONSTR ADD /ALT n SIGN 1 I MOVE I I DEMOLISH INSTALL REPAIR PROPOSED USE I 1 SFR 1 1 COMM I OTHER I TYPE OF CONSTRUCTION I I BLOCK �) I I \ � n FRAME 1 STEEL I 1 OTHER kh DESCRIPTION OF WORK " / ��'`�r2__ BUILDING SIZE 6 In X old ' SQ FOOTAGE L 1 V3 1 1 4 HEIGHT 1111 BUILDING $ (7 r 1 .d° VALUATION OF TOTAL CONSTRUCTION gib ELECTRICAL $ AMP SERVICE I I PROGRESS ENERGY I j W.R.E.C. I I PLUMBING ts/ 766 -3 4 1 MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION J f f I J GAS I 1 ROOFING 1 1 SPECIALTY I I OTHER �/1V" FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES 1 INO pe4. BUILDER l � J COMPANY k 7 e /i. LL ( . SIGNATURE �� V4 �pp 1 ' ' ( ,/`J REGISTERED I Y / N I FEE CURRENT 1 Y / N Address 4 o / -0L,t op ,L 2e /-7 . License # ELECTRICIAN COMPANY SIGNATURE REGISTERED I Y/ N j FEE CURRENT I Y/ N I Address License # PLUMBER COMPANY SIGNATURE REGISTERED I Y / N I FEE CURRENT I Y N I Address License # MECHANICAL COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N I Address License # OTHER COMPANY SIGNATURE REGISTERED I Y/ N FEE CURRENT 1 Y/ N I Address License # RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R -O -W Permit for new construction, Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions /large projects COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R -O -W Permit for new construction. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance SIGN PERMIT 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. (A/C 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 NC Fences (Plot/Survey /Footage) Driveways -Not over Counter if on public roadways..needs ROW which NOTICE may be more DEED RESTRICTIONS: � a County regulations. The undersigned a permit s umes espons b ity for compliance �with any which my 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, Water/Wastewater 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 of fill 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. rth in If I am the AGENT FOR THE OWNE in inform at permit the may be eq 9 red for i electr c l this affidavit prior to commencing truction plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A set aside an y p rov is io construed co nical codes, nor shall issuance of a permit prevent the Building Official from thereafter set asde any provions of the tech requiring a correction of errors in plans, construction violations of six of permit 'I work become authorized by unless the work authorized by such permit m a pb r is es ed, pend in d or writing, from Building ri Offcial for G a period not the time ninety days and will demonstrate may be requested, in g, from justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the \ j ob is considered abandoned. WARNING TO OWNER: YOUR FAILURE TO YOUR RECORD A PROPERTY. YOU COMMENCEMENT TO OBTAIN FINANCING, CONSULT PAYING TWICE FOR IMPROVEMENTS TO YO WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. FLORIDA JURAT (F.S. 117.03) { �- OWNER OR AGENT CONTRACTOR Subscribed and swom t. or • rme) before, '' e is Subscribed and sworn o (or ffirmed) before m th /7f - � by ' c�Cflu Who is by Who is /are personally known to me or has /have produced Who is/are personally known to me or has /have produced as identification. — as identification. / /10/ �-`J f_a__e. Lc.- 44 - fir _ Notary Public Notary Public Commission No. Commission l ' PUBLIC STATE OF FLORIDA Name of Notary t yped, printed or st" peg aT w ig Name of Not. +u� +' "a , . s P n 1 1.52189 ;G I T)652189 cur D 6 2009 I � I ,k ", OCT. T. 16 2009 ' , ro,,t BONDED Trig k Pti` ITC Y'�7h'pSNC CO., INC. ,f)ND � i '• 4926 Nrport Rd. Job No. Zephyrhiils, FL 33542 Phone: (813) 782 -2616 Lic. # CRC1329266 ACE Fax: (813) 783 -1804 ALUMINUM & CONSTRUCTION, L.L.C. SOLD TO G - 41,2 ADDRESS 6 3;1 e �- SHIP TO _ ,�. DATE C -I � : C ' `) PHONE 6 'x .3 (1.; c.r =7/ 7 65/L- Ac- 1 7, -7 432_ PERMIT PRICE <2 1 1(D . UO TAX The undersigned agrees to pay TOTAL PRICE INSTALLERS IN FULL ON COMPLETION DEPOSIT BALANCE C.O.D. .-e/ ____IZANN\Otajdak Rep. Customers Signature DESCRIPTION: BOUND, LOT 25, LESS THE SOUTH 11 FEET THEREOF, AND ALL OF LOTS 26 AND 27, MERIDIAN BAS OF WAY LINE BLOCK 215, A MAP OF THE CITY OF ZEPHYRHILLS (FORMERLY A MAP OF THE BEARING N 01 TOWN OF ZEPHYRHILLS) ACCORDING TO THE MAP OR PLAT THEREOF' AS RECORDED SCALE IN PLAT BOOK 1, PAGE 54, OF THE PUBLIC RECORDS OF' PASCO COUNTY, FLORIDA. FCIR 1/2" • No. 5387 NW CORNER t FIR 1/2" I LOT 32, BLOCK 215 NO ID No. 1 NE CORNER 1 LOT 32, BLOC I Q a I 140.00' (P) , o in U Z 1 ° o LOT 28 M r l I FIR 1/2" O 1 9 FIR 1/2" NO ID No. 20.9' Q � I'q NO ID No , „ = 0.15' W. S89 21 23 E it FIR 1/2" ,:3_ _ 6' WOOD FENCE 140.00' (F) NO ID N .o 0.50 _ 4' CHAIN LINK FENCE 140.00' (P) Q - ° 0 0.50 In a7 �1 wi " = N LOT 27 \\\ - 0 c) 0o a v o A /C o 0 0 a i v i , O mo t` b 28.19 \\ Cs; M cr 56.0' 55.72 \ z __ __ __ w 0.5C' o w _ 140.00' (P) � rz a WS_ 10 . o Z , 0' ONE STORY MASONRY �/ : ° °- N BUILDING No. 5034 ,� 0 U ( CREATIVE WORLD SCHOOL Z \ W 0 6 ' WOOD FENCE a U- �' LOT 26 ` �.? CD 27.98 24.0' b a P2dP.pA�TD CdI�Ek 0 o W ,261,00' _ ") STEPPING ` T , ID '6 140.00' (P) O o o N __ _ o a • o IO 22.0' LOT 25 1"....--1 0 0 Q. o I - = 1 o p T N. _ o o METAL cp Cn 0 4' CHAIN LINK FENCE 2 6 SHED 0.3C' ' S8 9 ' 21 ' 23 " E ° ° 5.20' ° ; IR 1/2 6' WOOD FENCE O 2.4' NO ID No LESS SOUTri i 1.o' (JO' ∎ I - ` ,) 0.20'. PORTION LOT 25 NOT INCLUDED FIR 1/2"c' - � NO ID No. Li._I I 140.00' (P) o I 0 a I 0 LOT 24 d I o 1 ciIin oi I I 140.00' (P) t I I I I I O FIR 5/8" NO ID No. FIR 1/2" NO ID No. O LEGEND /1 OTES: F. = Found 1. Copeland & Sons, Inc. and or certifying surveyor CERTIFIED T0: S. = Set responsibility for right of way, easement restrictions LIL STARS LEARNING CENTERS, INC. LP. = iron Pipe matters effecting title to land surveyed other than t I.R. = Iron Rod in current deed and or instruments of record furnisl FUENTES AND KREISCHER TITLE COMPANY c = Concrete Monument and or their agents. CHICAGO TITLE INSURANCE COMPANY N. & D. = Pail & disk P.K.N. = P.K. Nail 2. Underground Encroachments, if any, NOT located. 3. Elevations based on Mean Sea Level (N.G.V.D.) R.R.S. = Reilroad Spike ( P) = Plat Dimension 4. Unless it bears the signature and original raised ((( = Field Measurement or Florida Licensed Surveyor and Ma pper this drawing, ; D = Deed Information Y R = Radial Line or map is for informational purposes only and is no 6l = Utility Pole 5. Occupation other than shown not measured. 0 = Fire Hydrant 19 = Water Meter P.O.B. = Point of Beninninn A. -; r. 7 t '1...._. 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C ti �� 0 � � 3 II � (U d e l O ":1): O a rl �7 r Z I 1 D : O N Q tC1 ! V N r £ ■ tri v0 � N X 3 moo- Q 3 O ~� X X a d =; cF I D X Z C I �� M z ' rt ..... t -1 1. \ City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contractor/Homeowner: ke . ak,„ ,\, Gt in Date Received: 6,- 23- 0 / Site: Sd 3'I 18 ` 31 AO Permit Type: ..ieee7W r .- P2'.6 / r a 2_ Approved wino comments Approved w /the below comments: ❑ Denied w /the below comments: ❑ This comment eet shall be kept with the permit and/or plans. , i K. in `wwfr - Plans Examiner Date Contractor and/or Homeowner (Required when comments are present) PASCO C NTY BUSINESS TAX RECEIPT 2008 -09 Issued pursuant and subject to Florida Statutes and Pasco County Ordinances. Issuance does not certify compliance with zoning or other laws. This license must be posted conspicuously in place of business. Expires September 30. Mike Olson ACCOUNT NO: 071622 TAX COLLECTOR TYPE OF BUSINESS: SIC CODE: 1541 PASCO COUNTY FLORIDA BUILDING CONTRACTOR oF LOCATION ADDRESS: 4926 AIRPORT RD ZEPHYRHILLS ACE ALUM & CONST LLC III - 4926 AIRPORT RD ZEPHYRHILLS FL 33542 -5276 "�o DATE RECEIPT AMOUNT 07/17/08 548340 31.25 iq -/\) I1. II1• 1ILJJ1J11L11111IJ111L1111111IL111LI1II1 „1•111 �fyc� - s ztt A) o Z_ c t,\J 5/‘J.0 /3 (47L19 fioe., /J�P7, ,7 1 ` STATE O F FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION: INDUSTRY LICENSING BOARD SEQ #L07050800184 DATE BATCH NUMBER LICENSE NBR 05/08/200710 QB54898 The BUSINESS ORGANIZATION , - Named below IS QUALIFIED Under the provisions of Chapte , 489 FS . Expiration date: AUG 31, 2009 , (THIS IS NOT A LICENSE TO PER Q !WORK. THIS ALLOWS COMPANY TO DO BUSINESS ONLY IF 'T V411,48, A g s QUA,LIFIER. ) ACE ALUMINUM AND CONSTRUCTION LLC! 4926 AIRPORT ROAD ZEPHYRHILLS FL 33542 CHARLIE CRIST HOLLY BENSON GOVERNOR DISPLAY AS REQUIRED BY LAW SECRETARY AC# ' ' STATE OF FLORIDA DEPARTMENT OP BUSINESS AND PROFESSIONAL REGULATION °C4NSTRU4nf XNDUSTRY LICENSING BOARD SEQ#L08062500881 DATE BATCH NUMBER LICENSE '',4$ "c' 06/25/2008 076008688 _= CRC1329 -2f The RESIDENTIAL CONTRACTOR Named below TS CERTIFIED u . Under the provisions „of ,,CYapte Expiration date. AUG 31, SHAFFER, RICHARD. bLA K �'r ACE ALUMINUM - AND CONST 2UCTTON 4926 AIRPORT RD ZEPHYRHILLS FL 33542 =x` CHARLIE CRIST CHUCK DRAGO GOVERNOR INTERIM SECRETARY DISPLAY ° AS REQUIRED BY LAW 06/25/2009 09:02 FAX 9417464138 GEE AND SEIPEL INS Z001 I A CORU ® CERTIFICATE OF LIABILITY INSURANCE DATE (MMlDD/ 4.----- 6/25/2009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Michael Gee Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 623 3 9th St. West, Unit 4 ALTER THE COVERAGE AFFORDED BY T HE POLICIES BELOW. Bradenton, FL 34205 (941) 746 - 1892 INSURERS AFFORDING COVERAGE NAIC# INSURED ACE ALUMINUM & CONSTRUCTION, LLC INSURER A: FIRST COMMERCIAL INS CO INSURER B: FIRST COMMERCIAL INS CO 4926 AIRPORT ROAD INSURER c: FIRST CCNMERCIAL INS CO ZEPHYRHILLS, FL 33542 INSURER D: q813) 782 -2616 INSURER E; 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. 'We ADO L P OLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR IN3RD TYPE OF INSURANQE DATE(MM/DD/VYYY) DATE(MM/DD/YYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ' DAMAGb JO RCNICO X COMMERCIAL GENERAL LIABILITY PREMISES (Es ocanence) $ 50 , 000 CLAIMSMADE I OCCUR MED EXP (Any one Person) $ 5,000 A PERSONAL & ADVINJURY $ 1, 000 , 000 — GL- 26974 -1 6/21/09 6/21/10 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS • COMPIOP AGG S 1, 000.000 POLICY n JEC PI LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMB 3 500,000 ANYAUTO (Ea accident) —_ ALL OWNED AUTOS BODILY INJURY S X SCHEDULED AUTOS (Per person) B MIRED AUTOS BODILY INJURY S — NON•OWNED AUTOS CA- 2 7 5 6 4 - 0 5 / 17 / 0 9 5 / 17 / 10 (Per academy I PROPERTY DAMAGE (Peracdoent) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S _ — ANY AUTO OTHER THAN EA ACC $ AUTO ONLY; AGG $ EXCESS 1 UMBRELLA LIABILITY EACH OCCURRENCE _ 5 —I OCCUR CI CLAIMSMAOE AGGREGATE 5 S DEDUCTIBLE .—� S RETENTION $ S WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y X I TORY LIMITS ER ANY PROPRIETOR)PARTNERIEXECUTVE EL EACH ACCIDENT s 100,000 C OFFICERIMEMaER EICCLUOED1 © ,L. ManAxey In NN) WC-30947 6/17/09 6 / 17 / 10 E.L. DISEASE • EA EMPLOYEE 100,000 E Cw.L P ROV ALP iOnunder 500,000 E ISIONS below EL. DISEASE - POLICY LIMIT s OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS '"' COVERAGE INCLUDES RICHARD SHAFFER LICENSE# CRC1329266 CERTIFICATE HOLDER CANCELLATION CITY OF ZE)?FIYRHILLS °Homo ANY OP THE ABOVE DESCRIBED 'woes se CANCELLED BERNIE THE EXPIRATIDM 5335 6TH STREET DA TIMR!OF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN ZEPHYRHI LL S , FL 33542 NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT, an FAILURE TO DO 90 SHALL ATTN: JACKIE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR F33(813)780-0021 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE t C ACORD25(2009/01) 61988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 06/25/2009 08:30 FAX 9417464138 GEE AND SEIPEL INS Zi001 /001 I DATE(MMIDD/YYYY) AC c R D CERTIFICATE OF LIABILITY INSURANCE 6/25/2009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Michael Gee Inc HOLDER- THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 623 39th St. West, Unit 4 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Bradenton, FL 34205 5941) 746 - 1892 INSURERS AFFORDING COVERAGE NAIL# INSURED ACE ALUMINUM & CONSTRUCTION, LLC INSURER A; FIRST COMMECIAL INS CO INSURER B: 4926 AIRPORT ROAD INSURER 0; ZEPHYRHII,LS, FL 33542 INSURER D. 8 782- .16 INSURER E; 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 UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ILSA IIISR TYPE OF INSURANCE POLICY NUMBER , DATE(MMIDD/YWY1 DA M MID I L D/YYYY% LIMITS M INSRD GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000 _ DAMA ,b 10 RENTED X COMMERCIAL GENERAL LIABILPTY PREMISES (Ea occurence) S 50,000 1 CLAIMS MADE OCCUR MED EXP (Any one person) $ 5,000 A PERSONAL EADV INJURY $ 1,000,000, _ GL- 26974 -1 6/21/09 6/21/10 GENERAL AGGREGATE S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS • COMP/OP AGO S 1 , 000 , 000 _ T POIICY in JECT FT LOC AUTOMOBILE LIABILITY t� a B � IN .d E e D I SINGLE LIMIT s 500,000 ANYAUTO _ ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) MIRED AUTOS BODILY INJURY 5 A NON.OWNEO AUTOS CA- 27564 -0 5/17/09 5/17/10 (Per *cadent) PROPERTY DAMAGE S (Per *cadent) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 5 ANY OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE 5 ^ I OCCUR CI CLAIMSMADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION 5 S WORKERS COMPENSATION .... WC oTH- AND EMPLOYERS' LIABILITY , X YIN TORY LIMITS ER ANY PROPRIETOMPIIRTNERIEXECUTWE � E.L. EACH ACCIDENT $ 100,000 ER OIIFICA/EmBER EXCLUDEDT -. I A Mandatory In NN) WC -30947 6 / 17 /09 6 / 17 /10 EL. DISEASE • eA EMPLOYEE s 100,000 SPE CIAL PROVISIO deacllbc under NS helOW E.L. DISEASE - POLICY LIMIT $ 800,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES / EXCLUSIONS AODED By ENDORSEMENT / SPECIAL PROVISIONS COVERAGE INCLUDES RICHARD SHAFFER LICENSE# CRC1329266 ' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TH! ABOVE DESCRIBED POUCIEs BE CANCELLED BEFORE THE EXPIRATION CITY OF ZEPHYRBILLS DATI THEREOF, THE ISSUING INSURIR WILL ENDEAVOR To AWL 30 DAYS WRITTEN 5335 8TH STREET NOTICE TO THE CERTMICATE HOLDER MANED TO TM LEFT, BUT FAILURE TO 00 30 SMALL ZEPHYRHILLS, FL 33542 Impose NO OBLIQATION OR LIABILITY 01 ANY HIND UPON THE INSURER, ITS AGENTS OR ATTN: JACKIE FR# (813)780-0021 RI PREEtENTATrvBS. _ AUTHORIZED REPRESEN WE L t c & . 1 ACORD 25 (2009/01) ®1988 - 2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD