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Home My WebLink About11-12006 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (sis��so-oozo 12�6 � FIRE ALARM SYSTEM PERMIT Permit Number: 12006 Address: 38105 MARKET QUARE Permit Type: FIRE ALARM SYSTEM ZEPHYRHILLS, FL. Class of Work: FIRE ALARM SYSTEM Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 02-26-21-0010-03900-0020 Improv. Cost: 1,870.00 Date Issued: 6/16/2011 Name: FMC MARKET SQUARE INC Total Fees: 150.00 Address: 38103 MARKET SQUARE DR Amount Paid: 150.00 ZEPHYRHILLS, FL. 33542 Date Paid: 6/16/2011 Phone: (813)780-8774 Work Desc: FIRE ALARM SYSTEM 5.0 FIRE INSPECTION FEES 50.00 � �' � � 7 � � � �r � c ,� ,�� C'�� '�3 ina FIRE ELEVATOR RECALL Chapter 633, Florida Statutes, authorizes the City to charge and collect user fees to pay for the costs of fire prevention and protection related activities such as inspections, plan review, administrative fees, and other costs related to the aforementioned. Complete Plans, Specifications and Fee Must Accompany Application. Commencement of work without written approval of the Fire Department's Fire Marshal or required permits or opening up for commercial activity without an approved final inspection shall be charged double permit fee per day of operation or a minimum of $100.00, whichever is greater. All work shall be performed in accordance with City Codes and Ordinances. "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." a.. CONTRACTOR SIGNATURE I IC R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOURS NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041 �,izy oi �epnyrnnis rire rax-es�s-iau-uuzi Chris Shultz Permit Application /' � SystemslntegrationConsulant l��S S�'�u Security Solutions� PhoneContactforPermit ,/� � � Stanley Convergent Security Solutions, Inc. � i ��' � �'`��"^T Owner's Phone Number �� 5610 W Sligh Avenue, Suite 104 �� p�., �l lls � � 3 Fampa, FL 33634 Phone 813.241.3500 Fax 813.929.7219 � � � Cell 813.416.1824 Titleholder Phone Number CShultzC�Stanleyworks.com ■ vvww.stanleycss.com FixEFZOOaoass,EFa000iii� EFmoosizEFaaom�z :`�``�� ' n �` ° ""�'�-' ` - � ` � a..� ��, � i u.s � 33s� �- �ot # 0 Sub Division Parcel # . _ .,�•r:�. _ _, .>....>...,., w..... .x > �:, . r,,. � _.. . . . a Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL � Controlled Bum � Hood Installation � Emergency Generator < 30 kw � LPlNatural Gas-Instaltation � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL �/�(_ � emi �n er � �`� Sprinkler � O ❑ ❑ � � Recreational Bum Fire Alartn � ❑ ❑ ❑ � � Sparklers Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations Hood Su ression � ❑ ❑ ❑ � � 5tandpipes (Sprinkler Sys) Fire Alartn Install Lon � Torch Roofingffar Kettle ire Pumps � Waste Tire Storage ANNUAL Fire Works � FlammableApplication-ANNUAL '} p ValUatiOn Of PfojeCt � Fuel Tanks � ' • + ..'°.oe; a3;�d, . ., . .. . �. . ,., . .. ., ie:,S:.' .,. -'<dAf: k "�a�a� r,?::°�e. � . ., . . ..a �" . . . ,. Contractor Company ,�"'rA1Jt�ry rJ✓=e6e`ur � L�UT`l S1tu r Signature Registered Y Fee Current Y/ N Address � 0 (J �-i � ✓� �A M PA �r � License # ELECTRICIAN Company Signature � Registered Y/ N Fee Current Y/ N Address License # PLUMBER Company Signature Registered Y/ N Fee Current Y/ N Address License # MECHANICAL Company Signature Registered Y/ N Fee Current Y/ N Address License # OTHER Company Signature Registered Y/ N Fee Current Y/ N Address License # _ ..... _ c. in .R.....:.�Fa.r R.z ' Av! B3fff. ._ . . ._. ..... , .. q, . ^ Directions: Fill out application completely. Ovmer 8 Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) 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 ficensed and is not entitled to permitting privileges in Pasco County. 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. tf 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. 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 CONTRACTOR Subscribed and swom to (or a�rmed) before me this Subscribed and swom to (or affirmed) before me this by 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. Notary Public Notary Public Commission No. Commission No. Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped Zephyrhilis Fire Rescue 6�)O7 i)air�- R��ad. lephyrhills. I�L ;3_542 ('ire Marshal L3us (813) 780-0041 Kerrv F3arnetl f;ar (81 �) 780-UU44 r E-mail: kbarnett(a),fire.Lephyrhills.tl.us Plan Review #: 11-080 Project: Fire Alarm System Number of Pages: 1 plus Cut Sheets June 16, 2011 1 have received and reviewed the plans for the installation of the fire alarm system located at 38105 Market Square Dr and will allow it to move forward. Paying for permit acknowledges the contractor will comply. Should anyone have any questions, please do not hesitate to contact the Fire Marshal's office. 1. Ensure system is installed in accordance to NFPA 72, Florida adopted version. 2. Ensure batteries are dated. 3. Ensure telephone lines are marked. 4. Ensure pull station and smoke is addressed to this unit when activated. 5. Ensure breaker location is noted on panel. 6. Ensure breaker is locked in the on position. 7. Strobe shall remain on when system is silenced. 8. Ensure panel is tagged. Inspection Required: 1. Acceptance Test KERRY BARN T, FIRE MARSHAL ***Please be advised this review of plans submitted is a cursory review to assist the contractor in compliance with applicable fire safety codes. This revie�v is not intended to be a final approval of the submitted plans. Tt is the contractor's sole responsibility to ensure that the plans are in complete compliance with all applicable NFPA codes and local ordinances. In the event that further examination or site inspection reveals areas of non-compliance, it shall be the contractor's sole responsibility, at their sole expense to bring those areas in compliance The City assumes no responsibility for the contractor's failure to be in compliance with all applicable NFPA codes and local ordinances. ��[��l��I��.S FIR� D�P'AR�"EiAEI�� 690�7 t�airy Road, Zephyrhills, F�L 33542 rere Chief Ke�rh Wifiiarr�s Bus (8'i3)180e0U41 F�x (813)780-pU�•4 FIRE SERVICE USER FEES Occupancy No.: � Plan No.: �' Contractor: ��►��4 ' .: � "��' �� ; —�� Business Name � y� t�.�l -- i: [ ' � �� I�v�.� Billing Address: (�cv 1 �.= : � 1 � � )"'sv�- `1 tv,� ,�� l- Busmess Address i �?`i ��. � ��;;3� � Business Phone No. Billing Phone No.: Business Fax No : Billing Fax No.: Contact Contact: PLAN REVIEW FEES {NSPECTION FEES PERMIT FEE FALSE ALARM FEE 8 Site Plan N1C Annual N/C Sprinkler $50 1 st Alarm N/C Multi-FamilylCommerual O6 sf 1 st Re-inspection N/C Standpipes $50 2nd Alarm N/C (Mm�mum Charge $25 00 2nd Re-inspection $100 Fire Pump $5U 3rd Alarm N/C � Plan Revisions DBL 3rd Re-inspection $250 oods $50 4th Alarm $�pp 4th Re-Inspection $500 Fire Alarm �� 5th Alarm $150 SPRINKLER SYSTEMS (Business closed until LP Gas $ 6th Alarm $Zpp 0- 25 Heads $50 violations corrected) Natural Gas $50 NON COMPLIANCE $150 26 plus Heads $100 SPRtNKLER SYSTEMS Fuel Tanks- �� a�k y5p STANDPIPE SYSTEM Hydro Undergrounds a45 Sparklers $�pp � Per Riser $50 Hydrostatic Test $65 per system Fire Works $5pp FIRE PUMP Acceptance Test �S per system Camp Fire $25 � Per Pump $100 Hydrant Flow $75 Controlled Burn $100 FIRE ALARM SYSTEM �\ Hood/Duct $5p �2 25 Devices (� ` FIRE ALARM SYSTEM Place of Assembty $50 Annual 6 plus Oevices $ ystem Acceptance �. Fire ProteGtion $� SUPPRESSION SYSTEMS Recall ACCeptanCe $50 Flammable Application $50 Annual Wet $50 OTHER Waste Tire Storege $50 qn�ua� Ory $50 Fire WalllSmoke Wall $15 perwan Generator < KW glpp CO2 $50 LP Gas $25 pertank Generator>30 KW 150 Other $50 Natural Gas $25 per system Bio-Hazard Waste a100 Annual KITCHEN EXHAUST Fumigation Tenting $50 � Hood/Ducts $50 Tent 10'x10' or greater $15 per tent Torch PoUApplied �50 OTHER Fire Pump $45 Haz. Materials $100 Annual LP Insiallation per tank $50 Fire Suppfe5510� $30 Fuel Tank Installation $50 System Acceptance ❑ (Per Tank) $50 � Exhaust Hood/Duct $30 Natural Gas Installation $50 Re-inspection DBL ( Per System ) (other than annual) � Spray Booth $50 � Inspection scheduled DBL 8 and cancelled less than 24 hours Construction Insp. N/C � Emergency Vehicle Aa $50 _,. �, FALSE ALARM PLANS TOTAL ��,�'a�� INSPECTION TOTAL � PERMIT TOTAI L� I TOTAL I I GRAND TOTAL „J'fb Commenfs Date �' � � � � Insq��ctor � �� ' �' J � s �v�.� ; ,-. ��° =.�F' ��i�r�..`,��, �� =.s_ C . ..Ji 4 •..:,c... - -. f ' i -�1,:t.L��.,. s ✓.� u�,.•.�_.__. .r,.,�.e �s`._It1.J .�.�L�� :a 7�..b,y:.�Yr' t.'L+:J'....a......ls� i � �''''. . � : ! .�� " :, i ,:':,.._� . � - - _` a�� .�'i��,�iFt.�CK% C�s��`t?t�,' C`�G�.S 'W � �..�:i�TS�I�TG �G.r.'�R� ;��U} u:8"e'`w �_39:� �., _ �� y9�0 �TQR'I'F3 ��lQ1�7�'JE �T��b' '"�o„� �'.��L��F��S�� FL 32399-D7�� JOIVS�JIT MICHAEL LEE S'I'�TLEY CONVERGERTT SECURIT3C SOLUTIOIVS I3�TG 4� 9 3� D ti�7EST Tdl��,.TERS A�TEhTLTE ��IP� EL 33634 �,.._ _l'�.-.. _STATE dl" FLORIDA - - - F�� `a t� �i i `t �"� _�: .Congratulaiions! With 4his license you become one oi the nearly one miliian �,4��° DEPARTMENT OF BUSINESS AND Floridians licensed bythe Departmentof Business and Professional Regulaiion ,�4` pROFESSIdNP_L RSGULATIOI�7 Our professionals and businesses range from architects to yacht brokers, from � -�- boxers fo barbeque restauranfs, and they keep Florida's economy strong. ! �g�0 0 017.17 0 8/ 14 / 10 1.6 8 � 3 4 6 6 5 I Every day we work to improve the way we do business in order to serve you better � For information about our services, please log onto v��wrw.rnyfloridalicense.coaro. CERT ALARM SYSTEM CONTRACTOR 2 There you can find more information abouf our divisions and the regulations that JONSON, MICHAEL LEE impact you, subscribe to department newsletters and learn more about the STANLEY CONVERGENT SECIIRITY SOLU DepartmenYs initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Is CERTIFIED under the provisions of ch 489 es Thank you for doing business in Florida, and congratulations on your new license! EYp;ration aaee: AUG 3i, zoi2 L10081400994 DETAGf� H�RE .��,� �^,F �.� S.i .,,�' �' :�$ � ��'Al'E �9F FL�RIDA 17�:P�.�2TNtE2�T Or k3USTNE�S ANll PROFESSIONAI, REGUI:.�AT7:C37.3 ET��CTRICAL CON'TR.k1.CTORS LICENSING BOARD ��L1G�814U0994 ,. - LTCENSE NBR � 08 14/201� 108034G65 �F0001117 _ The ALARM SYSTEM CONTRACTO� � . Namer� below IS CERTTFIED Under_ the proviszans of Chapter 489-,]FS; �xpira�ion date: AUG 31, 2012 _ J�?�SON, NlICHA�L LE� , STANL�Y CONVERGENT SECURTTY' �QI�TJT20�3S :�N'C 4893-T� ��•�ST W�iTER� A.V�NU� ` ' T.AMP�, �L 33634 CI-��sRT.�� CRT,�`�' CHARLTE Z,TEM G�V F�NC?P, S�CRETARY C!SPt_P.Y AS REQUIRED �Y LAW I j � { � < - fb f• SU• i`' i6•l`4 1•_ � i' '. � y � -.L\ �� fE`c, /�+ p � '.'l"I :S' ` '6�Y�.. e.�.. i` -.ar- --- «1� :.d �u ra.Si.u1�...s1` �, di.p .� V `..�C e �..aRI,L ° � ' '��n��`--NS�ar.:�.i,�5..a r .t ,:.i.^_,CS:.,.i_�w,.�.R �l..I:� � � �� . . o! ,^ 1L1��'y RTC13L: COPd� `t�,.�`T`��S �:�CENSII�FG .?C.�i�� ( �3 � U ) �i:8? � _�.3 9 a �°�.•, � 9� 0 NQRTI3 M�1v�'OE �'Z'R�� b ''�o,�t�` �'ALL�F�F�SSEE FL, 3�399-07�3 Jo�vs��v, �acx�EL vEE ST�NLEY CONVERGEIVT SECURIT� S�LUTIOI�TS I1�TC 4�93�D WEST V�A.TERS .AVEI�TUE T�iP�3 F'L 3363� �____�.' _.�._ .� ---__ --- -._.,__ . _- - -- - - ------ - � � � STATE OF FLORt4A AC'�'� _�.+ � �i 5 `t � _"•t •Con rafulafions! With this license ou become one of the nearl one million ;' .•�= 9 Y Y ! �� DEPARTMENT OF BUSI�tESS P.ND Floridians licensed by the Depariment of Business and Professional Regulaiion. !'�.�6�`' pROFESSTONAL REGULATION Our professionals and businesses range from architects to yacht brokers, from � -- boxers to barbeque restauranfs, and they keep Florida's economy strong. � �F 0 0 01 I 17 0 8/ 14 / 7. 0 I 0 8 0 3 4 6 6 5 Every day we work to improve the way we do business in order to serve you better � For information abouf our services, please log onto www.myfloridalicense.corro. CERT ALARM SY'STEM CONTRACTOR I There you can Fnd more informafion about our divisions and the regulations that JONSON, MICHAEL LEE impact you, subscribe to department newsletters and learn more abouf the STANLEY CONVERGENT SECURITY SOLU DepartmenYs initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Is CFs'RTIFIED undar the provisions of ch.489 Fs Thank you for doing business in Florida, and congratulations on your new license! Expiration aaee: AUG 31, 2012 L10 0 814 00 9 94 'JETF,CF; HEf2E AC� �f �� i°t � F � ,� � �TAI'E OF FLORfDA DEPAR'.PI�tEi�TT O�` BUSTNESS ANl� PI20F`ESSIONAI, REGUT,e'�.TTaN EI,ECT�22CAL CC3N'TRACZ'4RS "LICENSING BOARD ��1G08T400994 � ,. - LICENSE NBR OS 14/2010 108034665 EF0001117 ` ' i The ALARM SYSTEM CONTRAC'FOI� I ' ' i I�Iamect belov3 IS CERTIFIED � Under_ the provisions of Chapter 489--,FS; ' Expira�ion date: AUC 31, 2012 ;-- J�NS�P�i, MICHAEL LE� - �'=:'' � � i STA1vLEY CONVERGENT SECURITY SpLTTTI0I3S � ZI�I'C 4893-I� 6VEST WATERS AVENUE - . ` T1�MPA FL 33634 � I CIiARL�:. CR�S`:� CHARI,TE LTEM GQVERNUR, SECR�;TR.RY C�SPLP,Y RS REQU{RED �Y LAW . i 0 a z a � � I o �rj I � � I Q Q i�- I r � F ( 0�0 � i a , � � � � U ; � y OC � � � �7 Q � O � � � � � N N � � W ' � Z � °� 1 a � d� � X i � � A � T w � { a ` Q � } � . � � . 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Sligh Ave. #104 Tampa, Fl. 33634 813-241-3500 To Whom It May Concern, I, Michael Jonson, as Florida State license holder (EF0001117) and electrical qualifier for Stanley Convergent Security Solutions, Inc, authorize the following person as an agent for me to apply for and pick up permits on my behalf. Chris Shultz Patrick Kelly Alex Tsvetkov Christine Perry Bridget Lehmann Thank you very u , Sincerely, � C � Michael Jons A� � CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYW) asn er2o� � THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this ceRificate does not confer rights to the certificate holder in lieu of such endorsement�s . PRODUCER CONTACT MARSH USA INC. NAME: 99 HIGH STREET PHON o t: F A/C No : BOSTON, MA 02110 ADDRIESS: Attn: stanleyblackanddecker.certrequest@marsh.com INSURER S AFFORDING COVERAGE NAIC # 72800 -SCSS-GAW-10-11 iNSURER q. Hartford Fire Insurance Co 19682 INSURED INSURER B, N/A N/A STANLEY CONVERGENT SECURITY Twin Ci Fire Insurance Co 29459 SOLUTIONS INSURERC. � (FORMERLY HSM ELECTRONIC PROTECTION INSURER D. NIA N/A SERVICES, INC.) 55 SHUMAN BLVD., SUITE 900 iNSUrtert e. Harttord Accident 8 Indemnity Co. 22357 NAPERVILLE,IL 60563 INSURERF. COVERAGES CERTIFICATE NUMBER: NYC-005995927-t0 REVISION NUMBER:2 THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �L7R TYPE OF INSURANCE ADDL UBR pOLICY NUMBER MMIDD MMIDD/YYYY LIMITS A GENERAL LIABIL�TY 02 CSE J77005 O7/O1/?O�O O7/O1/ZO'I'I EqCH OCCURRENCE $ ?,OOO,OOO X COMMERCIAL GENERAL LIABILITY A N 2,000,000 PREMISES Ea occurtence S CLAIMS-MADE � OCCUR MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 2,000,000 GENERALAGGREGATE $ 2,000,000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMPlOPAGG $ X POLICY PR � LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY Peraccident $ AUTOS AUTOS � 1 NONAWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per acddent $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ C WORKERS COMPENSATION 02WBRP47700 (ND WIJ O7/O'I/?O'IO O7IOIIZO'I'I X VoC STATU- OTH- AND EMPLOYERS' LIABILITY � A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N 02 XWE J77002 (NY OH � 07/O'IIZO'IO O7/O'IIZO�'I 1,000,000 OFFICER/MEMBEREXCLUDED� � N!A E.L.EACHACCIDENT $ E �Mandatory in NH) 02 WN J77000 (CA) 07/011201 O 07/O112011 E.L DISEASE - EA EMPLOYE $ 1,000,000 If y es, describe under CONTINUED ON ATTACHED 1,000,000 DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $ A PRODUCTS LIABILITY/ 02 JSE J77014 (PRIMARY) 07/Ot/2010 07/01/2011 EACH OCCURRENCE 500,000 COMPLETED OPERATIONS DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD t07, Additional Remarks Schedule, if more space is required) VIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION CITY OF ZEPHYRHILLS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 5335 8TH STREEET ACCORDANCE WITH THE POLICY PROVISIONS. ZEPHYRHILLS, FL 33542 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Hilary Zeller �--�� -� O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD � ADDITIONAL INFORMATION DATE(MMIDDlYY) NYC-005995927-10 06/151201 -- --- --- — – -- -- ------ PRODUCER MARSH USA, INC. 99 HIGH STREET BOSTON, MA 02110 Attn: stanleyblackanddecker.certrequest@marsh.com 72800 -SCSS-GAW-10-11 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER G. STANLEY CONVERGENT SECURITY SOLUTIONS, INC. INSURER H: (FORMERLY HSM ELECTRONIC PROTECTION INSURER I SERVICES, INC.) 55 SHUMAN BLVD., SUITE 900 INSURER J NAPERVILLE,IL 60563 TEX Other � Policy Covers � PRODUCTS LIABILITY/ I COMPLETED OPERATIONS Policy Details � Insr Ltr' A Policy Number. 02 JSE J77015 (EXCESS) EB. Dt. 07101/2010 Exp. Dt. 07101I2011 i Limits EACH OCCURRENCE 2,000,000 I GENERAL AGGREGATE 2,000,000 , ADDITIONAL WORKER'S COMPENSATION POLICIES: I 02 WN J77000 -- HARTFORD INSURANCE COMPANY OF THE MIDWEST (AK, AR, AZ, DC, DE, ID, IL, IN, KS, LA, MA, MD, ME, MI, NH, NJ, NM, NY,OK,RI, SC, SD, TN, TX, UT, VT) �� 02 WN J77000-- HARTFORD CASUALTY INSURANCE COMPANY (AL, MN, NC, VA) j I I � 02 WN J77000 -- HARTFORD FIRE INSURANCE COMPANY (CO FL, GA, IA, NE, N� (PR, ND, WA - STOP GAP EMPLOYER LIABILITY COVERAGE ONLY) � 02 WN J77000-HARTFORD ACCIDENT 8 INDEMNITY COMPANY - CT, KY,MS,MO,MT,OR , PA, AND WV I 02 WN J77000 - HARTFORD UNDERWRITERS INSURANCE COMPANY- HI � I I I � � -- -- - — ---- - - - - - -- - CERTIFICATE HOLDER CITY OF ZEPHYRHILLS i BUILDING DEPARTMENT i 5335 8TH STREEET � ZEPHYRHILLS, FL 33542 AUfHOR12ED REPRESENTATNE o( Marsh USA Inc. Hilary Zeller �_�-r _ c �� I .� Page 2