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Home My WebLink About11-12428 CITY OF ZEPHYRHILLS 5335 - 8TH STREET • ' (si3)�so-oo20 12428 BUILDING PERMIT Permit Number: 12428 Address: 5230 6TH ST Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL. Class of Work: ADD/ALT COMMERCIAL Township: Range: Book: Proposed Use: COMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: Improv. Cost: 9,702.00 Date Issued: 10/10/2011 Name• SO Total Fees: 127.50 Address. 30 6TH ST � D� Amount Paid: 127.50 ZEPHYRHILLS, FL. 33542 �� Date Paid: 10/10/2011 Phone: Work Desc: CONCRETE SIDEWALK/RAMP FOR WELLS FARGO BANK },,.-�.' �t%� f 2-z- f 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 co�rections not made when inspections called d) worlc not ready for inspection when called e) permit not posted on job site � plans not at job site g) work not acxessible. 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 additionai permits required from other governmental entities such as water management, state agencies or federal agencies. "Warning to owner: Your failure to reaord a notice of commencement may result in your paying twice for improvements to your properly. If you intend to obtain financing, consult with your lender or an attorney before recording your notice of commencement." Complete Plans, Specifications Must Acwmpany Application. All work shall be pertormed in accordance with ' Codes and Ordinances. NO OCCUPANCY BEFO C.O. : ,.-- __.._ , , , i -- - CO CTOR S A RE PERMIT OFFI R EXP ES 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 Date Receivpd �O .� (�_`� Phone Contact for Permittin a Owner's Name �''�'-`-' � � � ' � �� . � �� j � Owner Phone Number �/ 3�7�°c ��7s� Owner's Address ✓�¢�� " � ��("/r'� �% � �'jL �% . p�y�e Phone Number c��3 � SZ�"r- Fee Slmpte Titleholder Name � Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS '�� 3c " �' �S� �c'�' �jYJ��2f//115� �L 3 35 4% LOT # �� 3UBDNISION PARCEL ID# (OBTAINED PROM PROPERTY TAX NOTICE) WORK PROPOSED B NEW CONSTR B ADD/ALT �� SIGN Q Q DEMOLISH INSTALL REPAIR PROPOSED USE Q SFR �] COMM � OTHER Ca�vc S��Z� t,� . TYPE OF CONSTRUCTION Q BLOCK Q FRAME � STEEL � DE3CRIPTION OF WORK ( O/U�.B,�Tt �.��f'L.� P�(.y� • � f IS � � a � � BUILDING SIZE � SQ FOOTAGE �� HEIGHT � BUILDING $ p 'D� -- VALUATION OF TOTAL CONSTRUCTION 7� QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY W.R.E.C. QPLUMBING $ " r � I�� " �V QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION OGAS Q ROOFING Q SPECIALTY � OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO BUILDER �_ • Ia ` ANY .L• �Ic�py� �G • SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N Address ��%.l�j� ��% y'�%5 ' � � �� . 3 � !� � License # CGL � Z� 7 S�C' ELECTRICIAN COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N Address License # PLUMBER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N Address License # MECHANICAL COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N Address License # �— OTHER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N 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 subdivisionsflarge projects COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R-O-W PeRnit 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. D(rections: Fill out application completely. Owner & Contractor sign back of application, notarized If over;2500, a Notice of Commencement is required. (A/C upgrades over 57500) "` Agent (for the contractor) or Pawer of Attomey (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTIN(i (Front of Application Only) Reroofs if shingles Sewers Service Upgrades A/C Fences (PIoUSurvey/Footage) Drlveways-Not over Counter if on public roadways..needs ROW NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" rest�ictions" 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 Iocal 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 understan s 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 aiso 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 Resou�ce 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 appiicant, 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 wili 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 wiil 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 idenfify 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 Environmentai 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 al�owed in Flood Zone "V" unless expressly permitted. If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed chn cal codesenor shall ssua a pe mitprevent the Iding Officeal from ther set aside any provisions of the te requiring a correction of errors in ph � e Ss�� t R ° menced l within s x perm t pssua e uo aif wo autho ed by unless the work authorized by suc p the permit is suspended or abandonhe Build n ial fosa per od not to exaee n ety f (90) days and will demonstrate may be requested, in writing, from t 9 justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned. WARNING TO OWNER: YOUR FAILU TEOT� UR PROP RT1f. YOU INT TO OBTA N FI�NANC NG C SULT PAYING TWICE FOR IMPROVEMENTS WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR N OF C CEM T. FLORIDA JURAT (F.S. 117.03) ' �. r . CONTRACTOR � `� OWNER OR AGENT Subscribed and swor{� to�or a rm b e Subscribed and swom to (or affirmed) before me this � b � � by � . bY Who tslare,personally known to me or ha ave produced Who isjare personally known to me or haslhave produced �:��, as identi8cation. as idendficaUon. � ^ Notary Public Notary Public _ _*: :;� �p�ion # 040520 Com ' 1 on ' ' Commission No. '•�q,.,, Bo�dedThuTroyFaqilnavanoe80a38S7019 ed, rinted or stamped Name of Notary typed, Printed or stamped Name of Notary typ P Pasco County Parcel: 11-26-21-0010-15400-0190 001 Page 1 of 2 Data Current as Of: Weekly Archive - Saturday, October 08, 2011 Parcel ID 11 (Card: 001 of 001) Classification 23 - Financial Institutions Mailing Address Property Value WACHOVIA BANK N A Ag Land �p C/O THOMSON REUTERS ��d $56,700 PO BOX 2609 CARLSBAD CA 92018-2609 Building $312,257 Physital Address Extra Features $56,194 5230 6TH ST Market Value ;425,151 ZEPHYRHILLS FL 33542 Assessed (Non-School Amendment 1) $425 151 L@Gal DeSCI'IDt1011 (First 4 Lines) � See Plat for this Subdivision �' Taxable Value ;425,151 TOWN OF ZEPHYRHILLS PB 1 PG 54 LOTS 19 20 21 22 23 & 24 BLOCK 154 OR 1575 PG 1898 Land Detail (Card: 001 of 001) Line Use Description Zoning Units Type Price Conditlon Value �� 2300 FINANCIAL OOC2 21,000.00 �F $2.70 1.00 $56,700 Additional Land Information Acres 0.48 Tax Area ZH FEMA Code � Commercial Code M 2AR Buildina Information - Use 23 - Financial Institutions (Card: 001 of 001) Year Built 1988 Stories 2,0 Exterio� Wall i Common Brick Exterior Wall 2 None Roof Structure Wood Truss Roof Cover Built-Up Tar and Gravel Interior Wall i Drywall Interior Wall 2 None Flooring 1 Carpet Flooring 2 None Fuel Electric Heat Forced Air - Ducted A/C Central Baths Z,p Line Description Sq. Feet Repl. Cost New 1 Q 4,080 $399,840 Z CAN 1,132 $33,320 3 F.� 2,478 $242,844 4 � � 1,280 $50,176 Extra Features (Card: 001 of 001) Line Description Year Units Value � 1 ELEVATR 1988 1 $13,090 2 PRNKFP 1988 6,558 $4,919 3 ALRMSYS 1988 1 $255 4 PAV /�1SP 1988 13,648 $2,764 5 � 1988 770 $433 �--- 6 V?�� 1988 168 $2,213 I � � VAULTDR 1988 1 $9,716 � 8 DRINWIN 1988 � 1 $2,497 9 PN�� 1988 3 $17,557 10 NITEDEP � 1988 1 $2,750 Sales History http://www.appraiser.pascogov.com/search/parcel.aspx?sec=11 &twn=26&... 10/10/2011 i iiiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiii iiii . • 2011156690 - -� Rcpt:1392$56 Ree: 10.00 " DS: 0.00 IT: 0.00 10/10/11 K. Garcia, Dpty Clerk PRiILq S 0 'NEIL,Ph D PqSCO CLERK & COMPTROLLER 10oR BKl �� P� � � NOTICE OF COMMENCEMENT �� Permit No. Property Identification No. �� 2 j d 0/� ��¢vc� 4/ j0 THE UNDERSIGNED hereby give informs you that the unprovement will be made to certain real property, and in accordance with Section 713.13 of the Florida Statutes, the following information is provided in this NOTI�E OF COMMENCEMENT. •Y` �' c• f' �, C " ."l'N��r/. / S 1.Description ofproperty (legal descr�ptton:) � ��' f. :� _ : �jv,� � �T „��'.� , �� f- - r'�Ft�,�� t�4 .�.� -~� a) Street Address: �Z3 G � _ST. Z�P,�,�yy`��/ �'! 3 s<-% 2.C�eneral description of improvements: �"' o.', _�-� � ; �� , ,,�.- � - � � 3.Owner Information a) Name and address: �f�L[� �,�i t�d �Rr1� � � �`i'�Z i - j�f�� = ��,�` ") f' , ''s. F� .�'' ': -�`� b) Name and address of fee simple titleholder (if other than owner) c) Interest in property _ ��;,,,. 4.Contractor Information • � a) Name and address: /rl.�:� �. n L. �c' S'A',`° �'� ' F i.i.�`� I�d.ci_;. /I.' . �`�rJ� � b) Telephone No.: ��/ �- ZZ�' -_ c: �7 FaxNo. (Opt.) ��z � 34�- �c�! S.Surety Information � a) Name and address; _ �� . b) Amount of Bond: � c) Telephone No.: Fax No. (Opt.) 6.Lender a) Name and address: ,�f� Phone No. 7. Identity of person within the State of Florida designated by owner upon whom norices or other documents may be served: a) Name and address: b) Telephone No.: Fax No. (Opt.) 8.In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes: a) Name and address: b) Telephone No.: �-- Fax No. (Opt.) 9.Expiration date of Notice of Commencement (the expiration date is one year from the date of recording unless a different date is specified): WARNIl�1G TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFI'ER THE EXPIRATION OF TAE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE T�E FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK QR RECORDING YOUR NOTICE OF COMMENCEMENT. STATE OF FLORIDA :...................................�........: TERRY COLLURA C COUNTY OF PASCO ��wn�� ,$ �, yP ��. Comm# DD0777808 = � Expkes M13120t2 a e f Owner or O r's u or' ed O cedDirectodPartnedMenager : Florlda NotsryAasr►•� Inc • Q" `"� � ' , � '� Z "" ' ��`• Print Name q.......n.....usuu�nuuuu The foregoing instrument was acl�owledged before me this � day of �C�j�.� 201�, by h�( �.�1 _�� flt'Z- as �/� (type of suthority, e.g. officer, trustee, attorney in fact) for �,�}�, �� ,:�; (name of party on behalf of whom instrument was executed). Personally Known � OR Produced Identification Notary Signature �. �-- Type of Identif cation Produced Name (print) � l rU � �`U� f C� � Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true to the best of my lrnowledge and belief. , �i' • S� ure ofNatural Person Si i g Abov FORMS/NOC,rvsd2007 ! ' , ; ; ; , PINELLAS COUNTY CONSTRUCTION ` LICENSING BOARD � �� THIS CERTIFIFS 'I7-IAT Kenneth W Florczky ! , , DBA M L Moody Inc � �- � � , , ` , ' ' ' STATE CERT # I-CGCA20756 '� Y . . , HAS FILED HIS/HER LICENSE AND PROOF OF REQUIRED � � <_ " ' ` ' ' ' ' ' � - LIABILITY AND WORKERS' COMPENSATION INSURANCE WITH THIS BOARD. I-C�CA�rOrIS6 [N GOOD STANDING UNTIL September 30, 2011 DATE OF ISSUANCE 07f09/2010 Florczky, Kenneth W * Please cut out license atong lines 4853 Boones Boro Ct New Port Richey, FL 34655 C# � � � �1 � c� � � STATE OF FLQRtD,A DBPAR��$��UC''�SE�� R��LIC��I��H��C;� f}3 , _ ,, � ,� .. ;. , . �.:,_. .. �. . _ .: :.:...,... . - _ I��Q06�302�.51 LTCE �NBR. : , � • -.�, o��°_. , .io:: os�:�:��i�5a�. c��,��,6-1; .:c��.t4�:. : . , =�e ��T'$�L C��1TI�ACTC�R � , : .. . , . . '��lnne�° -b��owt, TS �C��tTIF�,EI) �. �� .. � , -�der ��e p�rav�:�e3ons nf Chs�t��;:..#�� ='��., ...�.�,�` ,''-� : : ' ' Expiration date: AUa 31, 2012 �� -,', �;`;°�LL � � -• � ' '� ` , ,�:�_.� :r ' '""�� , .;� . � , . � -:��;��;�.� � , ;�:�o� i� ��r Ni��r� w : � ._��_��. . - '° , - � °�`��t� �' L x � , , � _ �<k�� '� ` � , 81.2�,�. 3 4'�i3 .�,�ti ' N , ; ,� �;��:._�: . .. f -_ _. - - ST . PETERSSURG FL 3 3? 10 � `�', " � CHAR�±�.E CR�:ST . ' - ��RF��Fs LIEM � C�S�R�1�R - - � � - �N'x'-$RIM �EGRE�.'�iRX DfSPL�Y A5'f'��t,�UlR��'8Y L,a�' 2011-10-04 12:32 WellsFargo Bank, NA 7278422015 » p 2�� ClTY �F ST. P�7E�SBURG, FLORIDA v � � �, LOCAL BUSlN�SS TAX RECEIPT � �J p�, �--� ACCpUNT N0. DA't'E � �'" 7892o EXPf �S 1 `� � August 31, 2010 �i2011 L3USINESS; � � �`' � ML MQODY INC � 8121 34T�T AVE N SAWT PETERSBURG FL 33710-2237 11'00040877 DESCRIPTION OF OCCUPA�'IpN, PROFESSION, pR BUSINESS CLASS A GEN�RpL, CpN'1'RqGTOR 65.00 t�ICGCA20756 082610 65,00 09bS461 '�'O1',�, 0.00 ��' 0.00 ML MOODY INC PO BOX 40983 Th�� aca1 business tsx receept doc.� not allow t6c holder to SAIl�1T p�TERSBURG �'L 33743 Or I �uI8t on t�t 15 aotiad�laltCp -----------------------------� cndorsemtnt, approval or ...."------------------- ---- d�pproval of the holdcr s skiti Changes in business name, address, mailing name or address, as well�as pc�ence, This businesa additions to the business activity, y p• or com ma re u�re additional applications r;� �pc ;,� not proor or t�,r Please contact this pifiCe before making changes or if the description on �mM��ce or non-compliancc this receipt does not reflect your eniire business activity, Additional or thc had�r w�th oc�er ��w�, activities may require additional taxes rc�Gulations ur a�tAndards i� FailurQ to renew before the expiration date may result ;n penalty fees being buicn s tax rcce,'pt tbe hoider assessed :ah•rll bc responsiblc for Disptay this receipt conspicuously at all times in the place of businass �O W�th all aAP�icab�e If there is no place of business, this receipt must be presented to any �a�'S+ �fiulations snd atandards police officer or officer of the city upon their request ��cN�din� but not li�nitcd to the Many busin�ss taxes a�e transferable from one owner to another, or one City's Construction Services location to another. To transfer this receipt, contact our office for information � � p � ent and price, and fil! in the following. �' hereby �ssign aIl my rights, title and interest in loc8;l business tax receipt # to , ________________..._.______ (�ame pf now owner (signature Of pro�ious owner) ------------------------- � ------------------------------- -------------------- Office hours = Monday through Friday, S:oO a,m, to 5:0o p.m. Phone = 727-893-7241 m:LaPlante Agency To:Certificate of Insurance ML Moody Inc {18137800021) 13:52 10104/11GMT-05 Pg 01-02 Please see attached certificate as requested. Sincerely, Patsy Penn LaPlante Agency Phone.(727)796-8566 Fax:(727)791-1412 No coverage or change request may be considered bound/amended via the e-mail or voice mail system unti! written response/confirmation is received from our o�ce. A� p" CERTIFICATE OF LIABILITY INSURANCE °"TE"�'°°"""" ioroa�2oi � THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPONTHE CERTIFICATE HOLOER.THIS CER7IFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTERTHE C01/ERAGE AFFORDED BYTIiE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEENTHE ISSUING INSURER(3), AUTHORIZED REPRESENTATIVE OH PRODUCER, ANDTIiE CEFtTIFICATE MOLDER. IMPORTANT: Ii the eertifiate holder is an ADDITIONAL INSURED, the policy(bs) must be endoraed. H SUBROGATION IS WAIVED, subject to the terms end eondNions of the poliry, oertain policles may rcqulrc an endorsement A statdnent on thb oertifiate does not confer rights to the artHlcate holder In Ileu of such endoraemenl(s), PpODUCEp RiskTranster Prograrns, LLC � � 219 East Livirgston Street �E . B88-481-9363 F � No : Orlando, FL 32801 �� ADDRE88: INSURER(8) AFFORDING COVERAGE ��s �NSUaea A:CastlePoiM Natlonal Insurance Com 40134 IN6URED Human Resouroes IIIC. INBURBH B. /00 SBCOIIdAVB, SOUIh INSURER C. Suite 303 South St. Petersburg, FL 33701 INSUpER D. IN6UpER E INSURER F . COVERAGES CERTIFlCATE NUMBER:VDR2NVOA REVISION NUMBER: THIS ISTO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED. NOTWITHSTANDINO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTHACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUB,IECT TO AILTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LNu11TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I �p TYPEOFINBURANCE P�D�Y PODCYEXP V � POLICY NUMBER OENERAL UA8ILRV EACH OCCURRENCE $ COMMERCIALGENEFiALLIABILITY PREMISES EaoccuRence S CLAIMS-MADE � OCCUR MED EXP (Arry one rson) S PERSONAL 8 ADV INJURY E GENERALAGGREGATE $ GEN'L AGGREGA7E LIMR APPLIES PER PRODUCTS - COMP/OP AGG E POLICY PR � LOC a AUTOMOBIIE LJA8ILITY a cd erA ANVAUTO BODILVINJUHV(Porpe�son) S ALL OWNED SCHEDULED AUTOS ALffOS BODILV INJUfiY (PeracaderA) E HIREDAUTOS NON-OWNED nuros a Per accident $ UMBpELU WB pCCUR EACH OCCURRENCE E EXCESS LUB CLAIMS-MADE AGGREGATE y DED RETENTION S A WOpKERECAMPENeATON WSLTHP 0006408 10/01/2011 10/D1/2012 WCSTATU- OTH- AND EMPLOYERS LIABILITY Y/ N / X OFFICEWMEMBERXCLUD D XECUTIVE ❑ N/A '/ EL EACHl1CCIOENT a 1,000,000 �� ✓ E.L DISEASE-EAEMPLOYEE $ 1,000,000 Hyec describe under DESL�RIPTION OF OPERATIONS below E l DISEASE - POL�CY LIMIT y 1,000,000 $ S 5 a DESCRIPTIONOFOPEIiATONB/LOCATIONS/VEhNCLEB (A1LehACORD101,AddltlondRem�rk�gcl�SdWe�HmcreaP�oe�a�aq��rad) Cwerage is extended to the leased employees of altemate employer (Alabama, Colorado, Florida, Gaorgia, Penm3yhrania and Tennesaee Operatio�s Only): ML Moody # 000201 (C-ifective 1/1/08) CERTIFICATE HO�DER CANCELLATION SHOULD ANY OF7HE ABOVE DE3CRIBED POUCIES BE CANCELLED BEFORE THE EI�IRA710N DATE7HEREOF, NO710E WILL BE DELIVERED MI ACCORDANCE WI7H7HE POLICY PRONISION3. CITY OF �PHYRHILLS BUILDING DEPT AUTMORQED REPRESENTATIVE " 5335 STH ST ZEPHYRHILLS, FL 33542 .iK:'��''";. • ' Page i ot � m 1 ggg-2p10 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD m:LaPlante Agency To:Certiflcate of Insurance_ML Moody Inc (18137600021) 13:52 10I04I11GMT-05 Pg 02-02 Phone: (813)780-0020 Fax: �813�780-0021 Aco ' CERTIFICATE OF LIABILITY INSURANCE DATE�MWDDfYYYY) 40/04/ 011 TH13 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS (�RTIFlCATE DOES NOT AFFIRMATiVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POlIC1ES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{S), AUTHORIZED REPRESENTATNE OR PRODUCER, AND THE CERTifICATE HOLDER. IMPORTANT: If tha certificate holder is an ADDITIONAI INSURED, the policy(iss) must be andorsed. If SUBROGATION IS WANED, subjsct to tha tsrms and conditions of the policy, certain policies may require an endorsemenL A statemant on this ceRificate does not confer rights to the certificate hoider in lieu of such endorsemerK(s). vaoouc�i �E � Patsy Penn LaPlante Agency PHONE 2 ies-e5ss � N: iv �st-�at2 2T15 State Rd. 580 E �"'� ts la Iantea �n .com Clearvvater, FL 33761 iNSUR S AFPORD�IG COVERAGE N,vc r n+wReR,,: Mid-Caitinent Casual Grou � piSURER B : M� Moody �r1C INEURER C: PO Box 40983 qiSURER D; SaiM Petersburg, FL 33743 MSURERE: M8URER F . COVERAGE8 CERTIFICATE NUMBER: 00000965-0 REVISION NUMBER: 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE IISTED BELOW HAVE BEEN ISSUED TO THE lNSURED NAMED ABOVE FOR THE AOLICY PERIOD lNOICATED. NOTVYITHSTANDING ANY REQUIREMENT, TERM OR CONDRION OF ANY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM&. �L � T1'PE OF iNfURANCE �� pOLICY NUMBER �� POLICY EXP Li1R8 A 6ENERALW181UTY N N 04-GL-000806938 11/2�/Z01� �1/20I2�11 �EACHOCCUi2RENCE $ �� QQQ X COMMERCIAI GENERAL LIABILfTY PREMISEB�Ea o�cawrence S � OO OOO CLAIMS-MADE � OCCUR MED EXP (Arry o�ce person) S EXCIUdt� PERSONAL 6 ADV INJURY S � OOO OOO GENERAL AGGREG/1TE S Z OOO OOO GEML A(`�REGATE LIMR APPLIES PER PRODUCTS - COMPlOP AGG S Z OOO OOO X POLICY PR LOC S A(JTOMOBILE LYIBIUTY Eo ecci eM ANY AUTO BODILY INJURV (Per person) S ALL OWNED SCHEDULED AUTOS AUTOS BODILYlNJURY(Perecudent) E HIRED AUTOS NON-04VNE0 P OPERTY AMAGE AUTOS PerecadeM S S A X �""�«^ � X occua N N 04XS169347 11/20/2010 11120/2011 EACH OCCURRENCE s 5,000,000 IXCESE UAB CL/�IMS-MADE AGGREGATE 5 S�OOO�OOO DE� R TION 5 WORKERf COMPEriSAT10N WC STATU- OTH- AND EMPLOYERS' IIABIIRY Y 1 N aNY PROPf8E70RIPARTNERfEXECU'i�vE E l EACH ACCIDENT 5 OFFICERIMEMBER EXCLlAED7 � N f A pA�nd�tory in NH) E L DIS£ASE - EA EMPLOYE S tlyes desuibe w�der DESCRIPTION OF OPERATIONS bebw E L DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS 1 LOCATIONS ! VEMICLES (Alud� ACORD 101. Addkional Rrnarks �q, @ mon spae� ls nquNW) CERTIFICATE HOLDER CANCELLATION SNOULD ANY OF THE A80VE DESCRiBED POLIGES BE CANCELLED BEFORE Cih/ Of IRpllj/rF11II5 �£ �p�T�� DATE TNEREOF, NOTICE YYILL BE DELNERED IN ACCORDANCE NRTN TNE POLICY PROVISIONS. 5335 8th St Z�I��/�I11IIS� FL 33542 A REPRESEN7ATNE e�`�" --� PJP � 1968-2010 ACORD CORPORATION. All rights reserved, ACORD 25 (2010I05) The ACORD name and logo are registered marks of ACORD Printed by PJP on October D4, 2011 at 01 _07PM � k � "r '�"' G'c i � � � � � 2 .e°' � � 1 � ._ _.._ � � � '�''�`' e � � ��n [ 's°"i�"r'� � ".'`_" ; ♦ " 4 { � � � r.. � ; f � � �� c -� � � � ..�a �� F �,.:. ; � �� :: i *,, � -d_: �� \ � ` �� ``, _ �''��-� • '` �,., � 4 �.,�, ..�. , �_ ` � � � � � Y �� '� �4? . _ _..�r�..—_.,...q � � _ C � � I �� . �4.� �► J . � � � �� d�� _ � � i -� � � � � i � ;�.`. _ � -- � �...._ � .��.�_.... � � ' � ' .� � � ,.�.,, a,� � - � � ; , � � �.. x r �..._. 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