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HomeMy WebLinkAbout10-10464 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780 -0020 10464 PLUMBING PERMIT Permit Number: 10464 Address: 6713 GALL BLVD Permit Type: PLUMBING ZEPHYRHILLS, FL. Class of Work: ADD /ALT COMMERCIAL Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: ZEPHYR COMMONS Est. Value: Parcel Number: 03- 26 -21- 0010 - 03300 -0010 Improv. Cost: 2,000.00 V77-10kf 77 77777 7 77:77:772117114P1 Date Issued: 5/13/2010 Name: SUN MEDICAL CORP Total Fees: 130.00 Address: 34619 STATE ROAD 54 Amount Paid: 130.00 ZEPHYRHILLS, FL. 33541 Date Paid: 5/13/2010 Phone: Work Desc: PLUMB LINES CAP OFF / PHONE & DATA INSTALL a fiti Ti;:AVA'MrVAFA SEALANDER CONTRACTOR SERVICES PLUMBING FEE 35.00 SEALANDER CONTRACTOR SERVICES IN BUILDING FEE 60.00 KTECH SOLUTIONS LLC ELECTRICAL FEE 35.00 (VD ( " -LC) x w _ ', te a � �E 4 4 , =' m tiMa _,, tr `' ; v 1,411 1ST ROUGH PLUMB 2ND ROUGH PLUMB SEWER WATER FINAL 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 a 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 Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances CONTRACTOR PER OF I • = PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER CITY OF ZEPHYRHILLS 5335 — 8TH STREET (813)780 -0020 10464 PLUMBING PERMIT Permit Number: 10464 Address: 6713 GALL BLVD Permit Type: PLUMBING ZEPHYRHILLS, FL. Class of Work: ADD /ALT COMMERCIAL Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: ZEPHYR COMMONS Est. Value: Parcel Number: 03-26-21-0010-03300-0010 I mprov. Cost: 260'6 74 0' I 4 ,:, 7 t ` 4 a ? f ,.., i° Date Issued: Name: SUN MEDICAL CORP Total Fees: 130.00 Address: 34619 STATE ROAD 54 Amount Paid: ZEPHYRHILLS, FL. 33541 Date Paid: Phone: Work Desc: PLUMB LINES CAP OFF / PHONE & DATA INSTALL SEALANDER CONTRACTOR SERVICES PLUMBING FEE 35.00 SEALANDER CONTRACTOR SERVICES IN BUILDING FEE 60.00 KTECH SOLUTIONS LLC ELECTRICAL FEE 35.00 I olittl /co M o d e a A s =r ;: # 1ST ROUGH PLUMB 2ND ROUGH PLUMB SEWER WATER FINAL 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 a 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 Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances ISO /, ;— CONTRACTOR PER OF I. PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO ► CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 3f 5/13/2010 11:19 Lion Insurance LION INSURANCE COMPANY -►CITY OF ZEHYRHILLS 1/1 Date CERTIFICATE OF LIABILITY INSURANCE 1 5/13/2010 Producer: Lion Insurance Company This Certificate is issued as a matter of information only and confers no rights 2739 U.S. Highway 19 N. upon the Certificate Holder. This Certificate does not amend, extend or alter the coverage afforded by the policies below. Holiday, FL 34691 Insurers Affording Coverage NAIC # Insured' Insurer A: Lion Insurance Company 11075 South East Personnel Leasing, Inc. 2739 U.S. Highway 19 N. Insurer B: Holiday, FL 34691 insurer C: Insurer D: 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 poi cies. Aggregate limits shown may have been reduced by paid claims. INSR ADDL Policy Effective Policy Expiration Date LTR INSRD Type of Insurance Policy Number Date Limits (MM/DD/YY) (MM /DD/YY) GENERAL LIABILITY $ Each Occurrence Commercial General Liability Damage to rented premises (EA Claims Made ❑ Occur occurrence) Med Exp $ Personal Adv Injury $ General aggregate limit applies per: _ Policy 0 Project 0 LOC General Aggregate $ Products - Comp/Op Agg $ AUTOMOBILE LIABILITY Combined Single Limit Any Auto (EA Accident) $ - All Owned Autos Bodily Injury - Scheduled Autos (Per Person) $ - Hired Autos Bodily Injury Non -Owned Autos (Per Accident) $ ... Property Damage (Per Accident) EXCESS /UMBRELLA LIABILITY Each Occurrence Occur a Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2010 01/01/2011 X I WC Statu I 1OTH Employers' Liabilk to Limits ER Any proprietor /partner /executive officer /member E.L. Each Accident $1000,000 excluded? E.L. Disease - Ea Employee $1.000.000 If Yes, describe under special provisions below. E.L. Disease - Policy Limits $1,000,000 Other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 Descriptions of Operations /LocationsNehicles /Exclusions added by Endorsement/Special Provisions: Client ID: 29 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. that are leased to the following "Client Company": Sealander Contractor Services, Inc. Coverage only applies to injuries incurred by South East Persomel Leasing, Inc. active employee(s) , while working in Florida. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937 -2138 or by calling (727) 938 -5562. Project Name: FAX: 813 - 788 -4028 & 813 - 780 -0021 / ISSUE 05 -13 -10 (SD) Begin Date: 11/25/2007 CERTIFICATE HOLDER CANCELLATION CITY OF ZEPHYRHIL LS Should any of the above described policies be canceled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to do so shall impose no obtigation or liability of any kind upon the insurer. its agents or representatives. 5335 6TH ST. /' ZEPHYRHILLS, FL 33540 ' S Vgt .� 813-780 -0020 City of Zephyrhills Permit Application Fax -813- 780 -0021 Building Department w l / V F� Date Received .S - II I D Phone Contact for Permitting 8/ 6 -- 791-q - Owner's Name (7 105/) • 0.707 r 'A-S Owner Phone Number A/ 3 - 7,93 -6/89 Owner's Address 7O6D 6,, 44 I3#t.az• Owner Phone Number Fee Simple Titleholder Name L/3, /7G , 2tJ //d1+L -4 Owner Phone Number I Fee Simple Titleholder Address >0..i 0 Gfi.i.k. 43/-a -. Z4/ y ai i s • (/' . J3,5 JOB ADDRESS v 723 (,3i_z ek✓e42, Z -11 - d 2 A/°2 LOT # SUBDIVISION PARCEL ID# 03 - G14, _a 1- de'10 03300 -C>d /O (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR FZI ADD /ALT I SIGN n MOVE n DEMOLISH INSTALL REPAIR PROPOSED USE I I SFR I I" COMM n OTHER 1 TYPE OF CONSTRUCTION I I BLOCK I I FRAME I I STEEL n OTHER I DESCRIPTION OF WORK / n ,,y..,„,„..�u- „.. [ic / _.; ,• E BUILDING SIZE SQ FOOTAGE HEIGHT I I BUILDING $ VALUATION OF TOTAL CONSTRUCTIO ■ 02, OCR . e I 1 ELECTRICAL $ AMP SERVICE 1 I PR• - NERGY I W.R.E.C. WI PLUMBING $ e sD "/ 3 -- I I MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION • I GAS 1 1 ROOFING [VI SPECIALTY r OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA I IYES I INO BUILDER 1,D, COMPANY SII,AlAfoou+vc LOn)1�/ellez_ fa V, SIGNATURE ge...ddr C' C..G�Gt �' W .t. REGISTERED 1 Y/ N I FEE CURRENT Y/ N Address 53o.5' 64,1, 6rIER,LIfi0 icy,jr. License # e6 C. /d - / /(D 76 ELECTRICIAN COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N I Address License # PLUMBER i I t L� C OMPANY l� LA �A9l 2 6 � I/. SIGNATURE REGISTERED I Y / N EE CURRENT 1 Y / N Address 5:3 CAm(oek.4.L41EA ,41/,f License # era. 1 ya2 7 A/G $3 MECHANICAL COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N I Address I 1 License # (:6 1;;E)11 - - COMPANY l4 - 7 't7 $ c,riCi U , . u"c IGNATU -. _,i1111t REGISTERED I Y / N 1 FEE CURRENT I Y/ N I • dress / 9 3`i 1 4 -€c . 44K -14‘,.< Sta..2 f Li- -? P.- ?3`.`t License # I �S 0-0003 9 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 A/C Fences (Plot/Survey /Footage) D ' - nver.Countiar iLon.raulam s..needs ROW MINIM . JAMS ism n3W$3e i NAM , . ,.,.«• a WI %OW • 3.1601 r ' % ' sown* • 3101'1 yISOti +,� _,_ ,, ,ft 0 N retas9 0 ; , ,f t quA e*rlgx3 .moo3 0 • � • it MO00•�9 $t1$tSGO1noinu ato3 • •'?_.." .Ault ¶Watt swag blase ` ' I MMO, AprowfT IOW 4.,.1% • 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, 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 Tots 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 shalt 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 TWICE FOR IMPROV OWNER: YOU MENTS TO Y PROPERTY. T IF YOU INTEND COMMENCEMENT O OBTAIN n FIINANCING CONSULT PAYING TWICE WITH YOUR LENDER OR AN ATTOR . BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. FLORIDA JURAT (F.S. 117.03 ) / hi / / / / �2' S2 �" OWNER OR AGENT Lf/ `��1 CONTRACTOR S • cr bed and swo - ' e� b - • M me th Subscrt e • •and swo • (or affirmed • efor u ' � Z ) V i / b u .. - C Who Is /a e p • all kno to e o as /have produced o s /ar-,• -rsona y known t. me or has/have produced as identification. . -- as Identification. 7 `.- 1� Notary Public � . ota P ' ./1 (�� ary Public / Commission No. Commission No. - - - - - - - - IN, — f — i r, ti SUSAN L. SENNETT „,... Name of Notary typed, P Public • Ms al NW, Name of Notary typ T `; .� t C 1. ien * M» n a \ ; wow bo Atl 11. • Y - CooliwNwn e 00 012111 CammNwe • 00 01!~111 f City of Zephyrhills BUILDING PLAN REVIEW COMMENTS / 7 Contractor/Homeowner: 3ea1 a1 I - adz, -- --Y c Date Received: 5 /r- /. Site: 6 "7 / 3 ; /.1--/ - / i / &' 14 Permit Type: ' C` L4 \ 1 (-\ c-c;' c ..9 lucwiL� p i-e`6 bu'F�%. P Approved wino comments: Approved w /the below comments: ❑ Denied w /the below comments: ❑ This comment sleet shall be k- .t with the permit and/or plans. 1 r-,,,lici Kalvin : witz - 5 1. 4 7 aminer Date Contractor and/or Homeowner (Required when comments are present) Jacqueline Boges From: Kerry Barnett Sent: Wednesday, May 12, 2010 2:15 PM To: Jacqueline Boges Subject: RE: do you need to review No From: Jacqueline Boges Sent: Wednesday, May 12, 2010 11:17 AM To: Kerry Barnett Subject: do you need to review Kerry, Sealander submitted plan drawing for 6713 Gall blvd he will be capping off plumbing lines and install data phone lines, would you need to review this ? Jackie Boges Code Support Specialist ext. 3513 1 K -Tech Corporate Information Legal Name: K -Tech Solutions, LLC Remittance Address: 19239 North Dale Mabry Highway Suite 211 Lutz, Florida 33548 Physical Address: 7604 Industrial Lane Unit 4D Tampa, FL 33637 Telephone: 813- 984 -7000 Fax: 813- 984 -7111 Type of Business: Limited Liability Corporation (LLC) State of Incorporation: Florida Date of Incorporation: February 14, 2007 Federal Taxpayer ID #: 20- 8456349 SIC Code: 1731 -07 State Certification #: ES12000097 Occupational License: 9970028269 Polk County 188054 Hillsborough County Corporate Personnel: Kirt Kiester, President Cell: 813.951.8129 Primary Scope of Business: K -Tech Solutions is a provider of low voltage structured cabling to include: data and voice cabling solutions — copper & fiber, fiber splicing both mechanical and fusion, wireless access points, security, video, paging /intercom systems. Outside Plant — pathways & spaces. Telephony & IT Services w /selected partners. Project documentation to include — asbuilt cadd drawings, test results, digital photos as required. :REFERENCES: Commercial Bank: GTE Federal Credit Union Contact: Anna Marie January Acct#:46579570 21827 SR 54; Lutz, FL 33549 Phone: 813.871.2690 x23141 Fax: 813.414.8141 Distributor: Accu -Tech Corporation Contact: David Hobbs — Branch Mgr. 9220 Palm River Road; Suite #103 — Bldg. 1; Tampa, FL 33619 -4426 Phone: 813.664.1919 Fax: 813.664.1434 Distributor: Graybar Electric Contact: Richard Squires — Branch Mgr. 4010 W. Osbom Avenue; Tampa, FL 33614 Phone: 813.253.8881 Fax: 813.259.4364 K V TECH 7604 Industrial Lane; Suite 4D, Tampa Florida 33637 SOLUTIONS Office: 813.984.7000 Fax: 813.984.7111 Certified Corporation Statement: ACKNOWLEDGMENT OF VENDOR, IF A CORPORATION STATE OF Florida COUNTY OF _ Hillsborough The foregoing instrument was acknowledged before me this 01.14.09 by Kid Kiester - President ._iLah.l, /QA. (Date) (Name of officer or agent, Ie o fficer • rag - n of K -Tech Solutions, LLC a Florida `— corporation, 0 (Name of corporation acknowledging) (State or place of incorporation) behalf of the corporation, pursuant to the powers conferred upon said officer or agent by the corporation. He /she personally appeared before me at the time of notarization and is personally known to me or has produced Florida Drivers License as identification and did certify to have kno • - o the matters stated (Type of identification) ,,, A,,,,, te S in the foregoing instrument and certified the same to be true 'sn a![ respects. +P � t; � „�p NDrCE Subscribed and sworn to ( affirmed) before me this 1` /day of 'JP G'‘' -; " • Y Cn;: mrss ui on b/� Sate of F� . n . p • i Jt;���il,�� 1.�_ � i � 1 " Commission number t i) c r �L 11.. — � @on o(,'n ;ss�n # gy ° p Ja 3 2010 ( icial Notary Signature a Notary Seal) ' ? a N Commission Expiration Date rY Assn. (Name of Notary typed, priothd or stamped) ■ ACKNOWLEDGMENT OF VENDOR, IF A PARTNERSHIP STATE OF COUNTY OF The foregoing instrument was acknowledged before me this by (Date) (Name of acknowledging partner or agent) general partner (or agent) on behalf of , a partnership. He /she personaily appeared before me at the time of notarization and is personally known to me or has produced as identification and did certify to have knowledge of the matters stated in (Type of Identification) the foregoing instrument and certified the same to be true in all respects. Subscribed and sworn to (or affirmed) before me this day of Commission number (Official Notary Signature and Notary Seal) Commission Expiration Date (Name of Notary typed, printed or stamped) ACKNOWLEDGMENT OF VENDOR, IF AN INDIVIDUAL STATE OF COUNTY OF The foregoing instrument was acknowledged before me this by _ (Date) (Name of person acknowledging) He /she personally appeared before me at the time of notarization and is personally known to me or has produced as identification and did certify to have knowledge of the matters (Type of Identification) stated in the foregoing instrument and certified the same to be true in all respects_ Subscribed and sworn to (or affirmed) before me this day of , Commission number (Official Notary Signature and Notary Seal) Commission Expiration Date (Name of Notary typed, printed or stamped) K Y TECH 7604 Industrial Lane; Suite 4D, Tampa Florida 33637 SOLUTIONS Office: 813.984.7000 Fax: 813.984.7111 V 0 N N O O 01 0 O (7 0 O 4t a Cf • w Zh 0 WU H aw H 03 I-1 C a U z a0 . - O H • CD 1-3 ■ G4 �z MCI WU M�+y Z p ,. Oa m v O O as w W '--i o H 3 E-0 5 .1 O wag, 0) N I LW W H H Q CO Cr `� I— z a o , a H } Cs] co h � 1 _ p N 0 Z el w H n cci) aI WH 0) o au o v] U O H co C Oa Z o cu 43 H w a -ic a CA CI H cc HW °m as W z ° WW -a a NH H A z N ..a U MI - Q ° W -a W Z H U a 00 0 to >,4,w h6-104 La ° a a W -co H fsl co CY) Z a A� Ar i 14 4r¢ N U W -a Z rnWchN g° !. , p- a H i u =. o aw w -a 4 D4�Ha CD 40 NZ0wa 2009 -2010 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT EXPIRES 9 - - 2010 FOLIO NO FACILITIES OR MACHINES ROOMS SEATS EMPLOYEES 0 0 0 13 RENEWAL 188054.0000 H. WASTE TAX OCC. CODE BUSINESS TYPE SURCHARGE 280.000 INSTALLATION SERVICE - CABLE 80.00 BUSINESS 19239 N DALE MABRY HWY STE 211 LOCATION LUTZ 33548 NAME K -TECH SOLUTIONS LLC MAILING 19239 NORTH DALE MABRY HWY STE 211 BUSINESS LUTZ FL 33548-5067 B /►c USINESS TAX RECEIPT PAID - 12029 -85 07/20/2009 80.00 HAS HEREBY PAID A PRIVILEGE TAX TO ENGAGE 813- 635 -5200 THIS BECOMES A TAX RECEIPT WHEN VALIDATED. IN BUSINESS, PROFESSION, OR OCCUPATION SPECIFIED HEREON. A °® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDJYYYY) 05/11/2010 PRODUCER Fax# 813 - 418 Ph "" 813 984 - 3200 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Baldwin Insurance Group, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4010 West Boy Scout Blvd., Suite 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Tampa, FL 33607 INSURERS AFFORDING COVERAGE NAIC # INSURED Faa a 813 289 - 1293 Ph.^. 888 - 340 - 9442 INSURER A. Illinois National Insurance Co 23817 Advantec 10, LLC INSURER 8 4890 West Kennedy Blvd., Suite 500 INSUKEN L Tampa, FL 33609 I INSURER D Z 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 AI 1 THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ii4SR ADD'll P OI MY NUMBER POLICY EFFECTIVE POLICY EXPIRATION 1 LIMITS LTR INS TYPE OF INSURANCE DATE IMMIDD D/ /YYYY1 DATE IMMIDYYYY1 GENERAL LIABILITY ,I EACH OCCURRENCE ( S • ; 'CST+M�E ED I_ LOMMERGIAL GENERAL LIABILITY q PREMISE (ETO a RENT oee ED ) $ J i. 1 CLAIMS MADE 1 I OCCUR MED EXP IAny one parson $ - i , PERSONAL & ADV INJURY 8 GENERAL AGGREGATE S GM_ AGGREGATE LIM'T APPLIES PER t - PRODUCTS • COMP/OP AGG S IPRO I POL.CY I _ JECT - . E LOC 1 i AUTOMOBILE UABILITY COMBINED SINGLE LIMIT ' $ i ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY I SCHEDULED AUTOS (Per person) 5 HIRED AUTOS °_ -- - BODILY INJURY S IPer accdent) NUN- LANNtU AUTOS s . . _. _.... { PROPERTY DAMAGE i 5 ,,. .. - .. 9 (Per acWenl) 'GARAGE LIABILITY � �U70 � ` Y N EAACCIDfNT ; S 1 AGG S ANY AUT EA ACC $ -_ _- -.. ....._- i �� EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ `.. n(niR 1 - -_.' CLAIMS MADE I AGGREGATE 5 . I IS DEDUCTIDLE -. j _S I I RETENTION S I i 3 WORKERS COMPENSATION ! WC STATU• • LOTH AND EMPLOYERS' LIABILITY Y / N Y I TORY LIMITS:.. Eft A ANY PROPRIETOR,PARTNER/EXECUTIVE 1 E L EACH ACCIDENT $ 1,000,000 y OFFICER/MEMBER EXCLUDED? © ' 080759637 04 /01 /10 04/01/11 -- 1 DISEASE - EA EMPLOYEE - - -- _�. (Mandatory in NH) E L DI $ 1 ,000,000 If yes, describe under ... _.... _... SPECIAL PROVISIONS below E L DISEASE - POLICY LIMIT 5 1 ,000,000 OTHER DESCRIPTION OF OPERATIONS 4 LOCATIONS / VEHICLES l EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS For the benefit of employees leased to K -Tech Solutions, LLC from the captioned named insured. The certificate holder's actual effective and expiration dates may differ from the dates above and are subject to the terms set forth in the Client Service Agreement between AdvanTech and K -Tech Solutions, LLC and the regulation of the state of domicile. CERTIFICATE HOLDER Fax# Phone# CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE ICANLELLtU BEFORE THE EXPIRATION City of Zephyrhills - Building Department DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 5335 8th Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO 00 SO SHALL Zephyrhills, FL 33542 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Baldwin Insurance Group, LLC ACORD 25 (2009101) © 1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • CERTIFICATE OF LIABILITY INSURANCE OP IDEN DA'E'"P"°D"""' KTECH -1 05/11/10 PROOIDER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MORROW INSURANCE GROUP ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LENORA C. OLNEY /A196064 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 16606 NORTH DALE MABRY HIGHWAY ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CARROLLWOOD FL 33618 Phone: 813- 963 -1669 Fax: 813 - 961 -3743 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A' AMERICAN STATES INS CO 19704 INSURER 8. K -TECH SOLUTIONS, LLC INSURER C: 19239 NORTH DALE MABRY HWY 211 LUTZ FL 33548 INSURER O: 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 CONTRACTOR 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, ESTI ADDS LTR IM8TA TYPE OF PEEWEE POLICY NUMBER DATE AIMEDA YY) DATE (1 E]IPRA YY) DATE n DATE IIYUMTTY) LIMITS GENERAL IJABLITY EACH OCCURRENCE S 1000000 DAMAGE TO RENTED A X COMMERCIAL GENERALLNBILITY 01CH43503440 02/23/10 02/23/11 PREMISES (Es mown* $ 1000000 CLAIMS MADE X OCCUR MED EXP (My one person) S 10000 PERSONALSADV INJURY S 1000000 GENERAL AGGREGATE $ 2000000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG S 2000000 PRO X POUCY JECT LOC AUTOMOBLE LIABILITY COMBINED SINGLE LIMB S 500000 A X ANY AUTO 01C120337820 03/29/10 03/29/11 (Facade") ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS ( person) X HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Pef accident) E PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT i ANY AUTO OTHER THAN EA ACC 5 AUTO ONLY: AGO S EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE S 1000000 A X OCCUR CLAIMS MADE 01XS15730620 02/23/10 02/23/11 AGGREGATE 81000000 DEDUCTIBLE i X RETENTION S 0 i WORKERS COIPENSAG 111 %RC STATU- OTH AND EMPLOYERS LIABILITY TORY LsIrrS ER r/ 11 ANY PROPRIETOR/PARTNER/EXECUTIVE ( E.L. EACH ACCIDENT E OFFICERAIEMBER EXCLUDED? ( ary in ) E.L. DISEASE - EA EMPLOYEE E It yes, describe under SPECIAL PROVISIONS belay E.L. DISEASE - POUCY LIMIT E OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIED POLICES BE CANCELLED BEFORE 711E EXPIRATION CITYZEP DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MIL 30 DAYS YEMEN NOTICE TO THE CBt11FICATE HOLDER NAMTD TO 711E LEFT, BUT FALIAE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON 714E INSURER. ITS AGENTS OR CITY OF ZEPHYRHILLS BUILDING DEPT REPRESENTATIVEL 5335 8TH STREET ESENTA1T IZEPHYRHILLS FL 33542 ACORD 25 25 (2009/01) © 1988 -2009 COR CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Aco ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) `-w.- 05/11/2010 PRODUCER Fax# 813 - 418 - 5173 Phone# 813 - 984 - 3200 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Baldwin Insurance Group, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4010 West Boy Scout Blvd., Suite 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Tampa, FL 33607 INSURERS AFFORDING COVERAGE NAIC # _ INSURED Fax # 813- 289 -1293 Phone# 888 - 340 -9442 INSURER A: Illinois National Insurance Co 23817 Advantec 10, LLC INSURER B: 4890 West Kennedy Blvd., Suite 500 INSURER C: Tampa, FL 33609 INSURER D: I 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. INSR ADD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD TYPE OF INSURANCE DATE IMMIDD/YYYY) DATE IMM /DD/YYYYI GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurence) $ CLAIMS MADE OCCUR MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ — 1 POLICY JF LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ I NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ I (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ ■ OCCUR CLAIMS MADE AGGREGATE $ ■ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION / Y 1 N WC STATU- OTH- AND EMPLOYERS' LIABILITY T ORY I IMITS ER A ANY PROPRIETOR /PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER /MEMBER EXCLUDED? N 080759637 04/01/10 04/01/11 (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If SPEC AL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS For the benefit of employees leased to K -Tech Solutions, LLC from the captioned named insured. The certificate holder's actual effective and expiration dates may differ from the dates above and are subject to the terms set forth in the Client Service Agreement between AdvanTech and K -Tech Solutions, LLC and the regulation of the state of domicile. CERTIFICATE HOLDER Fax# Phone# CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Zephyrhills - Building Department DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 5335 8th Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Zephyrhills, FL 33542 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Baldwin Insurance Group, LLC 1 ACORD 25 (2009/01) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • . . -1 I - nil 1,,111110stp, ,\%,\\A% I I I L ( : : I : - • : • ) ' ° ' l ()()OL (', 1 S ) :.11.101.1,1 4. (St 0 1 )1 "1..1 -1111- 1 I - C 01111 ‘X 0 1 13 C1 'NI ('); ..• , 4 , • , . . ,. . i • - • - . ; • . . . uoputi42.1su■ ...... . - Jopd telosoH em.loi, aql qnm i, 1 ..-'—'\. : . ' •-•:".: . • . , H •, :._:... 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