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Home My WebLink About11-12144 CITY OF ZEPHYRHILLS �-'' 5335 - 8TH STREET ' r � (si3)�so-oozo 12144 BUILDING PERMIT Permit Number: 12144 Address: 5828 10TH ST Permit Type: MECHANICAL ZEPHYRHILLS, FL. Class of Work: A/C CHANGEOUT Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s):11 & 12 Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 11-26-21-0010-02300-0111 Improv. Cost: 5,974.00 Date Issued: 7/19/2011 Name: SANCHEZ, REGINA Total Fees: 65.00 Address: 5828 10TH ST Amount Paid: 65.00 ZEPHYRHILLS, FL. 33542 Date Paid: 7/19/2011 Phone: (813)412-9219 Work Desc: A/C CHANGE OUT 2 TON HEAT PUMP 5. �`" / � � �� L� � ( `�� i /� f�" / DUCTSINSULATED 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 cailed d) work not ready for inspection when called e) permit not posted on job site � 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 commenceme " r CONTRACT SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER CITY OF / / / / BUILDINO ZEPI�IYRl�ILLS DEPARTMENT OF ADDITION OR CORRECTION �• • - • DR D E PERMIT f � 2� � �G c � 1 � �� THIS JOB HAS NOT BEEN COMPLETED. The following additions or corrections shall be made before the job will be accepted. -" ^' �,� � "-' �'SS� � " p ;� aCS 51.t, c= �� 5, SS 1� G, It is unlaw(ul for any Carpenter, Contractor, Bui�der, or other persons, to AFTER CORRECTIONS ARE MADE CALL cover or cause to be covered any part of the work with flooring lath earth 780-0020 FOR RE-INSPECTION or other material, until the proper inspector has had ample time to approve ►ne ��8c�uat�,. INSPECTOR �_ � OFFICE HOURS 7:30 AM - 5 PM MON.-FRI 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 � Building Department Date Received Phone Contact for Permittin -- — �TT Owner's Name e I a. �G�1� C e� Owner Phone Number � �(,8 Owner's Address c� Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS O /II LOT # � SUBDIVISION � � PARCEL ID# �� oZL 'oZ� � pZ3�— 0//� (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED e NEW CONS7R 8 ADD/ALT 0 SIGN Q Q DEMOLISH INSTALL REPAIR PROPOSED USE � SFR O COMM � OTHER TYPE OF CONSTRUCTION Q BLOCK Q FRAME � STEEL Q DESCRIPTION OF WORK Q'A/ G2, — o// /JeR (,(r!7 C, Q/i p� BUILDING SIZE SQ FOOTAGE � HEIGHT �BUILDING $ VALUATION OF TOTAL CONSTRUCTION DELECTRICAL $ AMP SERVICE � PROGRESS ENERGY O W.R.E.C. QPLUMBING $ � � �� MECHANICAL $ o � VALUATION OF MECHANICAL INSTALLATION � QGAS Q ROOFING Q SPECIALTY � OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO BUILDER � COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N Address License # ELECTRICIAN � COMPANY SIGNATURE REGISTERED Y! N FEE CURRE� Y 1 N Address License # PLUMBER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N Address License # MECHANICAL COMPANY L° Q /G (JIC SIGNATURE REGISTERED Y! N FEE CURRE� Y! N Address �! pc. � /��/'p �/ — �plli� / ` License # �°�� .�p�,� � OTHER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N Address License # 1111111111111111 111111111111111111111111111111111111111111111111111 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 8� 1 dumpster; Site Work Permit for subdivisions/large projects COMMERCIAL Attach (31 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. ••••• ' 1 1 1 1 1 1 1�..�.1 1 1 1 D�rections: • Fill out application completely Owner & Contractor sign back of application, notarized If over a2500, a Notice of Commencement is required. (A!C upgrades over E7500) " Agent (for the contractor) or Power of Attomey (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs if shingles Sewers Service Upgrades A/C Fences (Plot/Survey/Footage) Driveways-Not over Counter if on public roadways..needs ROW NOTICE QF DEEb RESTRICTIONS: The undersigned understands that this permit may be subject lo "deed" restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance wilh any applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or contractors to underlake 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 Counry 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 wili 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 entftled to permitting privfleges 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 buiidings, ar 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 occupa�cy" or final power release. If the project does not involve a. csr#ficate 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 permil 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'SIOWNER'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 instaliation 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 regulalions, a�d 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-Welis, Cypress Bayheads, Wetland Areas, Altering Watercourses. - Army Corps of Engineers-Seawalls, Docks, Navigable Watervvays. - Department of Health & Rehabilitative Services/Environmental Health Unit-Welis, Wastewater Treatment, Seplic Tanks. - US Environmental Protection Agency-Asbestos abatement. - Federal Aviation Authority-Runways. 1 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 mater(al is to be used in Flood Zone "A", it is understood that a drainage plan addressing a "compensating volume" will be submitled 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 certiy that fill will be used only to fill the area wfthin 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 owne� 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 a�davit prior to commencing construction. 1 understand that a separate permit may be required for electricai work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not spec�cally induded in the application. A permit issued shall be construed to be a license to proceed with lhe 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 vfolations 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 ff work authorized by the permit is suspended or abandoned for a period of six (8) months after ihe time the work is commenced. An extension may be requested, in writing, from the Building Official for a period not to exceed ninery (90) days and will demonstrate justiTiable 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 WIT YOUR LENDE OR A ATTORNEY BEFORE RE R I YOUR OTI E MMENCEM N. FLORIDA JURAT (F.S. 117.03) OWNER OR AGENT CONTRACTO Subscribed and sworn lo (or atfirmed) before me this Subscribed and swom t(or a rmed) b Tor by by O /Q Who is/are personally known lo me or haslhave produced Who fs/are personally known to me or has/have produced as identlflcaBon. as IdentlficaUon. Notary Public Notary ublic Commission No. Commiss(on No. -i'� - "'p's (}4�J� � �p�� pecenlbe� � 2 Name af Notary typed, printed or stamped Name of Notary r s Caldeco Mechanicai Services, Inc. . Residential Job Description � Lead # 2975 Job Start Date 7/20/2011 Salesperson Steve Seemann 3r Bill To Regina Sanchez Job at: SAME 5828 N 10th St Zephyrhills, FI. 33542 Ph 813-479-7268 Ph �oes Job Require a Permit? Y/ N Y Municipality Does Job Require a Notice to Owner ? �b Type GC New Const / Retrofit Standard Retail Chg Out Length of time to complete project 2 men 10 hrs Sales Price $ 5,974.00 Description: _ ��.a,� ��er Service Discount $ 207.00 $' . � /yT �P� Manufacture Rebate Teco Duct Seal Discount Teco Heat Pump Rebate Customer Responsibility $ 5,767.00 � of EEZ 1 QAV (Yes or No) YES �ystem #1 Comb 25HBC524, FX4DNF025, CE/ / Area Served Filter Size('s) �ystem #2 Comb / / Area Served Filter Size('s) �actory Warranty 10 year parts and 1 year labor Extended Warranty Type Purchase Orders Required 1 Equipment Purchase Requisitions Attached 2 3 4 Attached: Signed Proposal, Complete Take Off Sheet, Layout, Purchase Requisitions, Factory Rebate Forms, Utility Company Rebate Forms �� ,�. � ... .... � , �_ ,..�__�,.__ '.�,.� s � � �� s � �. � ,.� : .� _ � � — � � r.� � 1 .��. i AIR CtJNDITICJNINC & HEATIN�ii. July 19, 2011 City of Zephyrhills Building Department Re: Permit Authorization. To whom it may concern: Please allow Michael J Vanacore to secure HVAC permits in your municipality on my behalf. If I can answer any questions for you or provide you with any additional information; please do not hesitate to contact me. Sincerely, G�.��l, �c�� Richard Caldevilla CAC042723 NOTARy pUgLIC�TATE OF FLpRIDA ;,� '"�" Abimael Flores, Jr. ,,; Commission #DD682800 Expires: JULY 21, 2011 B�NDED THRU ATLANTl� gO�ING CQ, IMG �-I (ti� � . ��i`Zb�� YOUR HOMETOWN EXPERT www.caldeco.net 1721 N. HOWARD • TAMPA, FL • 33607 • 813-254-2211 • FAX 813-254-3264 STATE OF FLORIDA -_:_ - DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET a � �� TALLAHASSEE FL 32399-0783 CALDEVILLA, RICHARD STEVEN CALDECO MECHANICAL SVCS INC 1721 N HOWARD AVE TAMPA FL 33607 fi � 3 'ongratulations. With this license you become one of the near�y one million �� `�� - •�;�� ° "��'� ' ��w I ,.T . :':.':'w .. P.. � £ .�z � k �loridians licensed by the Department of Business and Professional Regulation. �,, ;��- - �` `': _:. )ur rofessionals and businesses ran e from architects to acht brokers, from .. ., � °�' '� ' � �� ' � .== � ,L ,.,, ��' � � o x e r s t o b a r b e q u e res tauran ts, an d t hey keep F lori da's economy strong. _- ��,� .;,, ,;,� z�, _. , y T q �,� :+', ,,v . `, . T ��, _ : _�`�?��3 ::�� , ��; $. �. ; F '' :very day we work to improve the way we do business in order to serve you better. _ s : -_ ; :-{z =','; ; :,,.''� �- -: , �„�� ,` -, :� � , -, 'or information about our services, please log onto www.myfloridalicense.com. ��" ` 'here you can find more information about our divisions and the regulations that '�" .� .��4. =� ° npact you, subscribe to department newsletters and learn more about the ' � {�;,- � •• u` � T �� )epartmenYs initiatives. ' _ _ � �= .3 • _ '�; 1 �;�� ' _ `r.:'�k� Y �'��, s� �i�..•> • °P , �' - � `.' � _ r V ;t,-�;'�� + i �'- ' -. ! `' � FS��w' �� , . , y , - )ur mission atthe Department is: License Efficiently, Regulate Fairly. We =�_=''`•==��'' `�'_ =�� .� fi s x�=. "° �=1'>` '`. �°, ;_ =�,N ��-,�;•z ; ,�;, � µi�. � , � , ° >r. �,� . onstantly strive to serve you better so that you can serve your customers. ;-'� '`�''�",`. �'��' �"'; °n .;��+�: ''.`'""`• ='�'`R.-`-°, �'� �- °,.. � 'hank you for doin business in Florida, and congratulation y i_:��_:`��,�� ... •��`i` �rx� i 9 s on our new license . � y �� y./ � A � r,a ---- ' � ( � Ry � ' � ' }/ � S - � 'y � ' � + �� y{.q � ,y/ � - '1-"}!'�:i?�T'��'e�3 ,� ' �?�T ��6'.� t 4i r i ` � 't . ..'.`� _ _ �. .. � tl. ✓ : t J.w�� - i1+• � ,._ . �. 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' rc _ ` , �- ' ' r ' ' . � , ,, �� ,,��,�'�i��'� `"� ' �r _ , Vt ' ;�ar �',"` �,`�'�°':,; �"�t`, °` �9�;'' - ._ _ _ "'�'�� . , , _ - , �_ :.', � �i_ ��xr� n�- " '+� r r� � � . . .. �s��;��:�i:. ��e : �' ' 31, _� � h H� ��;;��{,Cµ� . � � � � . ) , . . "'[�,}j w !��_Y' __''$�?' :r��H . . . , : t. � r . i � _ L''A,; � - • . . w �t.� R�� `. .� ,;�,:�.��C� d'). �" � � `,;� i k' , -. � , " ��'�:x�� w �-'�� . �� : " . - _ , , , , ` . � � ,.,ti „ �: �,�- - �7 ;I� �x� ,-_.. ' 1: , . , � FL 3360'7 ,�'��,' �� "�a � � , , ��` �."� `�''T �$a. =��t ��N'��t . ,�. '��;� . ' � 1'1't1\r1f KN� w iw Ma'F�nf �.tiY�r� i��i • wsfs � � Recei t# 2012001652 Control No. 036600 For Period Commencing �NLY 1ST, 2 Ol l and ending September 30, 2 012 fotal: $ 315 . � Dated 0 6/ 3 0/ 2 011 q lication No. fhis Business Tax Receipt does �ot permit the holder to operate in violation of any City Law or Ordinance including, but not limited to, Zoning and other land ise regulations. If in daubt, the holder shouid verify that he or she has the appropriate zoning by calling the Office of Land Development Coordination at ?74-6405. This Business Tax Receipt must be conspicuously posted in piace of business. Classification Description Amount 3g026 BEVERAGE MACHINES 1 15. 1 2012 993000 ADMIN HANDLING FEE 10 •�TTyOFTAMPA 38072 AIR COND CONTR/CLASS B 289, TAX RECEIl'T : � BUSINESS :1 t t, t i.�pl�t_� +v �F! i e t i� �'i�tAt �5��;�r�_� �P !l� �� ';i t f�±.�z�� ;� ��.�:�.� s�r��f�r�€�� ir.?� 7tL�1 �?;I'� ��1 Ty:<' �[,.i�i; _-•35i 3��. ��. �.f i�� .�:� !. �, 9 _11 : Y �'t"� 1 t- f: 3!'s� :� I€, i j _�L� ��_��ItdE�'� LZ 'E�-j=E f_:I�I�i��:�L�# t�yrrij}'I Sy: LCM �usiness Name and Address Business Name and Location RICHARD STEVEN CALDEVILLA RICHARD STEVEN CALDEVILLA CALDECO MECHANICAL SVCS INC CAC 042723 ' 1721 N HOWARD AVE 1721 N HOWARD AVE TAMPA FL 33607-3429 TAMPA FL 33607-3429 .7�1 N HOWAIlll Av�; ,.,,,� �� ......z.,_,,, �.,�. 'AMPA FL 33607-3429 I TAMPA FL 33607-3429 I Business Name and Location usiness Name and Address :ICHARD STEVEN CALDEVILLA RICHARD STEVEN CALDEVILLA 'ALDECO MECHANICAL SVCS INC CAC 042723 , .721 N HOWARD AVE 1721 N HOWARD AVE 'AMPA FL 33607-3429 TAMPA FL 33607-3429 } � ' ' _ -:..--w - 2010-2011 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT EXPIRES 9-30-2011 FOLIONO. PACILITI S OR MACHINES ROOMS SEATS EMPLOVEES 0 O O 10 RENEWAL 1022.0000 H. WASTE TAX OCC. CODE BUSINESS TYPE SURCHARGE 090.001 CONTRACTOR - CLASS B A/C 40.00 18.00 susiNess 1721 N HOWARD AVE LOCATION TAMPA 33607 NAME CALDEVILLA RICHARD STEVEN/CALDECO MECHANICAL SV� MAILING 1721 N HOWARD AVE ADDRESS TAMPA FL 33607-3429 B U S 1 N E S S TAX R E C E I PT DOUG BELDEN, TAX COLL.ECTOR PAID - 7797 ** - 85 HAS HEREBY PAID A PRIVILEGE TAX TO ENOAGE 813-635-520Q 07/16l2010 58.00 � BuSiNESS, aRO�ssiorr, oR occuPnnoN SvEC�FiE� HeReori. THI$ BECOMES A TAX RECEtPT WHEN VALIDATED. �� OP IQ: TR '`��°R CERTIF[CATE OF LIABILITY INSURANCE dATE�MM10D/YYYY� 07/19I11 THIS CERTIFICATE I5 ISSUED AS A MATTER OF INFORMA'CION ONLY AND CONFERS NO RIGHTS UpON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATNELY OR NEGATNELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BEL.OW. 7HIS CERTIFICATE OF INSURANCE DOES N�7 CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S}, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERT[FICATE HOLDER. IMPORTAN'f': If the certiftcate holder is an ADDITIONAL INSURED, the po[!cy(ies) must be endorsed. lf SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certaln po[icies may require an endorsement A statement on this certtficate does not confer righks to the oertiftcate holder in fieu of such endorsement(s). PRODUCER 813-223-3911 NAIiE Tan a Russo Lykes Insurance, lnc 813-221-9857 p"oNE .873-223-3911 F^x 400 N. Tampa St, Suite 2200 E�NIAIL �vc No : �13-221-1651 Tampa, FL 33602 PROO �s: trusso I kesinsurance.com Rieha�d P. Russo� J!'. A226626 cusTOnnereioa•CALDE-2 ' INSURE S AfFORDING COVERAGE NA1C # INSURHP Caldeca Mechanical Services, INSURERA FCCI Insurance Com an 10178 Inc. iNSUReR e: National Tn�st Insurance 20141 1721 N. Howard Tam pa, FL 33607 INSURER C: INSURER D : INSUREFt E • IPlSLIRER F • COVERAGES CER'fIFICATE NUMBER: REVISION NUMBER: THIS IS 70 CERTIFY THAT THE POLICIES OF INSURANCE L15TED BELOW HAVE BEEtJ I5SUED TD THE INSURED NAMED ABOVE F�R THE POLICY PERIDD INDICATED. NOTWITNSTANDING ANY REQUIREMENT, TERM DR CONDITION OF ANY CONTRACT OR O7HER DOCUMENT WITW RESPECT TO WHICH TH1S CERTIFICA7E MAY HE ISSUED OR MAY PERTAIN, THE INSURAMCE AFFORDED HY THE POLICIES 0£SCRIBED HEREIN IS SU8JEC7 TO ALL THE TERMS, EXCLUSiONS AND CONdiT10NS OF SUGH POIICIES. IIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �� TYPE OF 1NSUFtANCE POUCY NUM9ER MMIDDlYYYY MMlDOIYY�YY LIMIT9 6ENERAL UABIU7Y EACH OCCURRENCE S ') �OOO�DO /4 X COMMERCIAL GENERAL LU481LITY GL0007708 09I25/10 09125l14 pREMI . E e ce S � �a�� CIAIMS�MAOE � OCCUR MEO D(P (Any one parson) S 5,00 PER50NAL 8 A�V INJUAY S 1,000,00 GENERALAGGREGATE S 2,000�00 GEMLAGGREGATELIMITAPPLIESPER: pRODUCTS-COMP/OPAGG S Z,OOO,OO PDLICY X PR � LOC S AUTOMOB]LE LIABILlTY COMBINED SINGLE LIMfT S '� �QOQ�OO B X ANY At1T0 CA0011838 o��2sli o o9lzsrl � �Ea °`aa°m� BODILYINJURY(Perparson) S ItLL OWNED AUTOS 9001LY IN.fURY (Per eeNdeM) 5 SCHEDULEO AUTOS PROPERTY �AMAGE X H1RED AUTOS (Per aaltlenl) $ X NON-UWtJEp AU'fOS S 5 UMBRELLA L1AB X OCCUR EACH OCCURRENCE S 'I�DOO�00 F.l(CESSLIAB CLAIMS-MA�E AGGR£GATE S 'I�040�00 B UMBOd07568 09125l10 09125I14 DEDUCTIBLE . S X RETENTION S �IO DOO s WORKE3t5 COAAPENSATION WC &TATU- OTH- ANp EMPLOYERS' LIABILITY Y/ N X T '�'� A ANY PROPRIETORlPARTNERIEXECUTIVE fl�� WCOB/4-sOJ2 001 09/25110 a9/25/11 E.L EACH ACCIOENT S SOO�QO OFFICERfMEMBER EXCLUDED? � N!A {�landatory tn NH� E.L OISEASE - EA EMPLOYEE S 500,00 Ifyes, desaipe under DHSCRIPTION OF DPERATIONS ba�aw E.L DISEASE -?OLtCY LIMIT S SOO�OO q Contractors Equtp- CM0004i3b 09125/1Q 09125/11 Leased � 1UO,00 ment Rented OESCRIPTION OF OPERA110NS l LOCA710NS J VEHICLES �Altoeh ACORD 1D1, Addlllonal Ramarks Sehodu[u, if mara apace is raqulrad� CERTIFICATE HOLDER CAWCELLATION ZEPH533 SHOULD ANY OF THE ABOVE UESCRIBED POLICIES BE CANCELLED BEFORE THH EXPIRATiON DATE THEREOF, NOTICE WlLL BE DEL.IVERED IN City of Zephyrhills- ACCORDANCE W1TH THE POLICY PROVISION3. Building aepartment AUTHOR¢EO REPREBENTATiVE 5335 8th Stree# A% � s �� . Zephryhills, FL 33542 i O 1988-20D9 ACORD CORPORATION. Atl rights reserved, ACORD 25 (2009109) 7he ACORD name and [ogo are registered marks of ACORD