The URL can be used to link to this page

Home My WebLink About12-12909 CITY OF ZEPHYRHILLS 5335-8TH STREET � . �sis��so-oo20 12909 BUILDING PERMIT Permit Number: 12909 Address: 5929 18TH ST Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL. Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 11-26-21-0010-04300-0050 Improv. Cost: 7,280.02 Date Issued: 3/22/2012 Name: MCDORMAN ROBERT Total Fees: 165.00 Address: 6500 LITHOPOLIS WINCHESTER RD Amount Paid: 165.00 CANAL WINCHESTER OH 43110 Date Paid: 3/23/2012 Phone: 614-561-7934 Work Desc: REPLACE A/C DUCT/ PLUMBING REMODEL DUE TO WATER DAMAGE JAIME CENTRAL AC&HEATING � � 1 � (/ Gw V � J r'��/� V u � FOOTER BOND DUCTS INSULATED SEWER MISC. ROUGH ELECTRIC LINTEL MISC MISC. 1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC. DUCTS INSTALLED WATER MISC DRIVEWAY PRE-SLAB SHEATHING MISC. MISC. CONSTRUCTION POLE FRAME MISC. MISC. REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80(2)(c)when extra inspection trips are necessary due to any one of the following reasons: a)wrong address b)condemned work resulting from faulty construction c) repairs or wrrections not made when inspections called 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 additionai permits required from other governmental entities such as water management, state agencies or federal agencies. "Warning to owner: Your failure to record 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 wmmencement." Complete Plans, Specifications Must Accompany Application.All work shall be pertormed in accordance with Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O. CONT TOR SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER � c. .v'115��,.P_�• t��1 ) � �•.f��'" �;l r �5.. . City of Zephyrhills BUILDING PLAN REVIEW CO1��Ilv�NTS v � ,, ) _.,,1 �� -�, '",_._ � � � r CContractor omeowner: '� � � ( � �i � _ �- ''`' �''' Date Received: - �� /,� � Site: � �� '-' ��'�` `� Permit Type: � �_��: �? � �--�o�� ar � � - L , ��"�'J`" GiGf�-C �� ?�j • Approved w/no comments:❑ Approv w/the below comments: Denied w/the below comments: ❑ ,�� f� ��I� C � � -- ____---- � s � ,. �� /,�� ._--- This comment sheet shall be kept wi the pemut and/or plans. , � � :�`�1� Kal ' ' er 1 xaminer Date Contractor or Homeowner (Required en comments are present) 81��o City of Zephyfiills Permit Application F�-s��-�ao-oo2� au�iaing Departmer� �� Date Received "� - �� p�e Contact for Permittin 7 7 � - � ��"� Owners Narne 'r Or Owner Phone Number Owners/iddress � � T>+n �1 Owner Phone Number Fee Simple Titleholder Name Iv�1� Owner Phone Number Fee Simple Titfeholder A�ddress (J��' JOB ADDRESS 5 �_l T n S �" LOT# Q SUBDIVISION i p� c�G h �rl l ��S • PARCELIDAF � ( _�� +°��' ��'OHc� ��'J� �osra�n��ov�rr rwc�anc� WORK PROPOSED e NEW CONSTR B ADD/ALT Q SIGN Q Q DEMOLISH INSTALL REPAIR PROPOSED USE � SFR � COMM � OTHER TYPE OF CONSTRUCTION � BLOCK O FRAME � STEEL � DESCRIPTION OF WORK � �,�Ct S�'1 n "�' � n BUILDING SIZE SQ FOOTAGE� HEIGHT • � S �Q `e.I e C��n C Ct �BUILDING $ � VALUATION OF TOTAL CONSTRUCTION �J ��Q �O a � � IELECTRICAL ��z +�� AMP SERVICE � PROGRESS ENERGY � W.R.E.C. r-� J � �PLUMBING s 31�,��, o� �� __� /�/�jl.sm f�4� �MECHANICAL $ �540,�� VAIUATION OF MECHANICAL INSTALLATION �� QGAS � ROOFlNG � SPECIALTY � OTHER � �� FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES NO BUILDER ' COMPANY �GYY Y� SIGNATURE REGISiEREp Y/ N FEE CURREn 1 N Address � � 1 � � License� lTt,.. 0 ��,q,� ELECTRICIAN COMPANY SIGNATURE REGISTERED Y/ N FEE WRRE� Y 1 N Address License# � �05�J 0�3 PLUMBER ��-�Y �( CO ANY �l�� {• SI�r1S�'l l n�. P��Mb'GY ST•�G� SIGNATURE ��'V �� REGISTERED Y/ N FEE CuRREn Y/N �i � O � Address �,Q �t'r1� � ` J License# 0 MECHANICAL �� COMP Y TQm►�. Cc� r(� �, l�. F; � 1 n SIGNATURE `_� "'V� REGISTERED Y/ N FEE CuRREn Y!N Address � �Qd • License 8 �� ' �� t 3, OTHER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# 1111111111111111111111111111111111111111111111111111111111111111111 RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans,(1)set of Energy Forms,R-O-W Permit for new construction, 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 requi�ed 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 buiidings, 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.cer#ificate 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'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 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 wo'rk, 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 Wate� Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. - Army Corps of Engineers-Seawalls, Docks, Navigable Watervvays. - 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 tv 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 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 S scribed and s rn to(or affi b fore m Subscribed and sworn to(or affirmed)before m�th' �1�=i�bY bY Who is/are erson nown to me or a pr duc Who is/are personally known to me or has/have pro ced as i tlfication. as idenGfica6on. � ' - • __ a ! " ' otary Public Com ss,�t�:k�:. BOBBIE S.SWETLAND Commission No. ,••'"��"'�•. BO�IE S.SWETLANO � ,,; ;:: mmiss�on�EE"I�OTO - i�a :;: Ex 'res February 22,2016 �;• :,€ Expires February 22,2016 Name f 7019 � 'ZYP � Name of Notary typ 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department Date Received phone Contact for Permittin — Owner's Name Owner Phone Number Owner's Address Owner Phone Number � Fee Simple Titleholder Name � Owner Phone Number � Fee Simple Titleholder Address Ja8 ADDRESS LOT# � SUBDIVISION PARCEL ID# (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED e NEw CONS7R 8 ADD/ALT � SIGN Q Q DEMOLISH INSTALL REPAIR PROPOSED USE Q SFR Q COMM � OTHER TYPE OF CONSTRUCTION Q BLOCK Q FRAME � STEEL Q DESCRIPTION OF WORK BUILDING SIZE � SQ FOOTAGE� HEIGHT �BUILDING $ VALUATION OF TOTAL CONSTRUCTION DELECTRICAL $ AMP SERVICE � PROGRESS ENERGY Q W.R.E C. OPLUMBING $ �MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION �GAS 0 ROOFING Q SPECIALTY � OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO BUIIDER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address ` License# r— � ELECTRICIAN COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# �— PLUMBER COMPANY SIGNATURE REGISTERED Y I N FEE CURRE� Y/N Address License# � � MECHANICAL COMPANY SIGNATURE REGISTERED Y I 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,ConsUuctlon Plans,Stormwater Plans w/Silt Fence installed, Sanitary Facilities 8 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(10j working days after submlttal date. Required onsite,Construction Plans,Stormwater Plans w!Silt Fence installed, Sanitary Facilities 8�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 8 Contractor sign back of application,notarized (f over$2500,a Nottce of Commencement ls required. (A1C 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 Applicatlon Only) Reroofs if shingles Sewers Servlce Upgrades A/C Fences(PIoUSurvey/Footage) Driveways-Not over Counter if on public roadways..needs ROW , �ERVPRO of Tarpon/West Tampa 13911 West Hillsborough Ave. #306 Tampa,FL 33635 Client: McDorman,Robert Cellular: (614)561-7934 Property: 5929 18th Street Business: (614) 837-3421 Zephyrhills„FI.33542 Operator Info: Operator• PAUL Estimator: Tuggle,Paul Business. (813)855-0888 Bus�ness: 13911 W.Hillsborough Ave #306 Tampa„FL 33635 Type of Estimate• Water Damage Date Entered: 2/12/2010 Date Assigned: Eshmate: MCDORMAN-ROBERT-ELEC This estimate contains the electrical and lighting � , �ERVPRO of Tarpon/West�ampa ]3911 West Hillsborough Ave. #306 Tampa,FI.33635 MCDORMAN-ROBERT-ELEC Guest Bath LxWxH 6'0"x 5'0"x 8'0" _, '� 176.00 SF Walls 30.00 SF Ceiling � '` ,� 206.00 SF Walls&Ceiltng 30.00 SF Floor ' '� 3.33 SY Floorin 22.00 LF Floor Perimeter ��, �" g 48.00 SF Long Wall 40.00 SF Short Wall 22.00 LF Ceil Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL 692. Recessed light fixture 2.00 EA 0.00 89.69 179.38 Center recessed light in the ceiling over each s�nk in vamty top Totals� Guest Bath 179.38 Tub Area LxWxH 7'2"x 5'0"x 8'0" ,.--� ' a 194.67 SF Walls 35 83 SF Ceilmg �' "�%F -� 230.50 SF Walls&Ceiling 35.83 SF Floor ��' 3.98 SY Flooring 24.33 LF Floor Perimeter 57.33 SF Long Wall 40.00 SF Short Wall 24.33 LF Ceil.Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL 685. Recessed light fixture I 00 EA 0.00 89.69 89 69 Center recessed light in the center of the ceiling over the tub 687 Electrician-per hour 0.50 HR 0 00 81 42 40.71 Put ventilation fan on its own run/switch Totals Tub Area l 30 40 Bedroom 2 LxWxH 15'6"x 10'10"x 8'0" ,-'�� 421.33 SF Walls 167.92 SF Ceiling �J � -�� 549.25 SF Walls&Ceiling 167.92 SF Floor �'� %" / ��;�� 1 S 66 SY Flooring 52.67 LF Floor Perimeter 124.00 SF Long Wall 86 67 SF Short Wall 52.67 LF Ceil Perimeter MCDORMAN-ROBERT-ELEC 4/11/2012 Page 2 . $ERVPRO of Tarpon/West Tampa 13911 West Hillsborough Ave. #306 Tampa,FL 33635 CONTINUED-Bedroom 2 DESCRIPTION QNTY REMOVE REPLACE TOTAL 492. Smoke detector 1 00 EA 0.00 38.48 38 48 Hard wired with battery back-up 86 Light fixture 1.00 EA 0 00 53.18 53.18 Glass shade with brass ring Totals: Bedroom 2 91 66 Bed Two Closet LxWxH 5'9"x 2'0"x 8'0" �-'� 124.00 SF Walls 11.50 SF Ceiling ;�_- " %`� 135.50 SF Walls&Ceiling 11.50 SF Floor ��-�' 1?8 SY Floaring 15.50 LF Floor Perimeter 45 00 SF Long Wall 16.00 SF Short Wall 15.50 LF Ce�l.Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL 703. Light fixture 1 00 EA 0.00 53 18 53 l 8 Glass shade with brass ring Totals: Bed Two Closet 53.18 Bedroom 3 LxWxH 17'0"x 11'6"x 8'0" �- � f� 426.67 SF Walls 195.50 SF Ceilmg =''�� 6?2.17 SF Walls&Ceiling 195.50 SF Floor �_��V� ��,-'� 21 72 SY Floormg 5333 LF Floor Per�meter 136.00 SF Long Wal] 92.00 SF Short Wall 5333 LF Ceil Perimeter MCDORMAN-ROBERT-ELEC 4/11/2012 Page• 3 . �ERVPRO of Tarpon/West�ampa 1391] West Hillsborough Ave #306 Tampa,F[,33635 CONTINUED-Bedroom 3 Subroom 1: Offset LxWxH 3'8"x 2'S"x 8'0" ��' 68.00 SF Walls 8.86 SF Ceiling i =�� i" J 76 86 SF Walls&Ceiling 8.86 SF Floor �\` � �' 0 98 SY Floormg 8.50 LF Floor Perimeter ,�_�. 29.33 SF Long Wall 19.33 5F Short Wall 8.50 LF Ceil Penmeter Missing Wall: 1 - 3' 8"X 8' Opens into Bedroom 3 Goes to Floor/Ceiling DESCRIPTION QNTY REMOVE REPLACE TOTAL 693. Light fixture 1.00 EA 0.00 53.18 53.18 Glass shade with brass ring 493. Smoke detector 1 00 EA 0 00 38.48 38.48 Hard wired with battery back-up Totals: Bedroom 3 91 66 Bed 3 Walkin Closet LxWxH 6'9"x 6'0"x 8'0" /�� 20�00 SF Walls 40.50 SF Ceilmg ��" %'�� 244.50 SF Walls&Ceiling 40.50 SF Floor /� 4.50 SY Flooring 25.50 LF Floor Perimeter 54.00 SF I,ong Wall 48.00 SF Short Wall 25.50 LF Ceil.Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL 702. Light fixture 1 00 EA 0.00 53.18 53.18 Glass shade with brass ring Totals. Bed 3 Walkin Closet 53 18 MCDORMAN-ROBERT-ELEC 4/11/20]2 Page:4 , SERVPRO of Tarpon/West Tampa 1391 l West Hillsborough Ave. �306 Tampa,FT,33635 B 3 CLOSET LxWxH 3'0" x 2'0" x 8'0" �� 80.00 SF Walls 6.00 SF Ceiling r� %` � 86.00 SF Walls&Ceiling 6.00 SF Floor \�\7�-�� 0 67 SY Flooring 10.00 LF Floor Perimeter ?4.00 SF Long Wall 16.00 SF Short Wall 10 00 LF Ceil.Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL 701. Light fixture I 00 EA 0.00 53.18 53.18 Glass shade with brass ring Totals: B 3 CLOSET 53 l8 Hallway LxWxH 8'3"x 3'll"x 8'0" �'�� 168 00 SF Walls 32.31 SF Ceiling '' 1 2.00.31 SF Walls&Ceilmg 32.31 SF Floor � \ / 3.59 SY Floormg 20.33 LF Floor Perimeter � _ 66.00 SF Long Wall 3 I.33 SF Short Wall 2433 LF Ceil.Perimeter Missing Wall: 1 - 4'X 6' S" Opens into Exterior Goes to Floor DESCRIPTION QNTY REMOVE REPLACE TOTAL 695. Light fixture 1.00 EA 0.00 53 18 53 18 Glass shade with brass ring 200 Smoke detector 1 00 EA 0.00 38.48 38.48 Hard wired with battery back-up Totals Hallway 91 66 MCDORMAN-ROBERT-ELEC 4/11/2012 Page• 5 � . �SERVPRO of Tarpon/West Tampa 13911 West Hillsborough Ave. #306 Tampa,FI,33635 Entry/Foyer LxWxH 11'8" x 5'9" x 8'0" j�� 133.33 SF Walls 67.08 SF Ceiling � �-�`� 200.42 SF Walls&Ceiling 67.08 SF Floor ��,�' 7.45 SY Flooring 14.33 LF Floor Perimeter 9333 SF Long Wall 46.00 SF Short Wall 2833 LF Ceil Perimeter Missing Wall: 1 - 10'X 6' 8" Opens into Exterior Goes to Floor Missing Wall: 1 - 4'X 6'8" Opens into Exterior Goes to Floor Subroom 1: Offset LxWxH 3'3" x 3'2"x 8'0" �'� 50.67 SF Walls 10.29 SF Ceihng -'� �`�. - ,�� fi0.96 SF Walls&Ceiling 10.29 SF Floor '-�� - � 1.14 SY Flooring 6.33 LF Floor Perimeter � " 26.00 SF Long Wall 2533 SF Short Wall 6.33 LF Ceil.Perimeter Missing Wall: 2- 3'3"X 8' Opens into Entry/Foyer Goes to Floor/Ceiling DESCRIPTION QNTY REMOVE REPLACE TOTAL 696. Light fixture 1 00 EA 0.00 53.18 53.18 Glass shade with brass ring Totals: Entry/Foyer 53.18 Dining Room Formula Sloped Ceiling 12'3" x 11'3"x 10'4" � ��-� 314.59 SF Walls 140.75 SF Ceiling ��i 45534 SF Walls&Ceilin 137.81 SF Floor , g - ------ ----' � 15.31 SY Floormg 35.75 LF Floor Perimeter 3623 LF Ce�l Perimeter Missing Wall: 1 - 11'3"X 10'4" Opens into Exterior Go�s to Floor/Ceiling DESCRIPTION QNTY REMOVE REPLACE TOTAL 521. (Install)Chandelier-Install 1.00 F,A 0.00 108.36 108.36 Install large homeowner supplied hanging light fixture-92 1/2" off of vaall common with the gatage Totals Dming Room 108.36 MCDORMAN-ROBERT-ELEC 4/11/2012 Page- 6 , 5ERVPRO of Tarpon/West Tampa 13911 West Hillsborough Ave. #306 Tampa,FL 33635 Family Room Formula Sloped Ceiling 19'6"x 15'll"x 10'4" =�;, 504.65 SF Walls 313.69 SF Ceilmg 818.34 SF Walls&Ceiling 310.38 SF Floor - - -------- ' 34 49 SY Flooring 56.83 LF Floor Perimeter 57.17 LF Ceil.Periineter Missing Wall: 1 - 14'X 10'4" Opens into Exterior Goes to Floor/Ceiling DESCRIPTION QNTY REMOVE REPLACE TOTAL 704. Recessed light fixture- Adjustable 2.00 EA 0.00 115.34 230.68 light In header over fireplace-switched at light switch by pocket door 318. Smoke detector 1.00 EA 0 00 38.48 38.48 Hard wired with battery back-up Totals. Family Room 269 16 Kitchen Formula Sloped Ceiling 13'6"x 9'0"x 13'4" � �=-� 324A1 SF Walls 130.64 SF Ceiling ' ' � 454.64 SF Walls&Ceilin g 121.50 SF Floor ��-�- - - ---' � 13.50 SY Flooring 36.00 LF Floor Perimeter 32.03 LF Ceil.Perimeter Missing Wall: 1 - 9'X 13'4" Opens into Exterior Goes to Floor/Ceiling Missing Wall: 1 - 6'X 6' Opens into Exterior Goes to Ceiling Subroom 1: Pantry LxWxH 3'x 2' 6"x S' �� 38.00 SF Walls 7.50 SF Ceiling l� � �� - 95.50 SF Walls&Ceilmg 7.50 SF Floor :� , ��I_- "� 0 83 SY Flooring 11.00 LF Floor Perimeter 24.00 SF Long Wall 20.00 SF Short Wall 11.00 LF Ceil.Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL 517. (Install)Garbage disposer-reset 1.00 EA 0 00 1 1 1.07 1 1 I 07 339. Detach&Reset Microwave oven- 1 00 EA 0.00 0.00 85J2 over range w/built-in hood-Reset 5 I 5. (Install)Refrigerator-reset 1 00 EA 0 00 34.25 34.25 MCDORMAN-ROBERT-ELEC 4/I1/2012 Page: 7 , SERVPRO of Tarpon/West Tampa 1391 l West Hillsborough Ave #306 Tampa,FI.33635 CONTINUED-Kitchen DESCRIPTION QNTY REMOVE REPLACE TOTAL 516. (Install)Range-electric-reset 1 00 EA 0.00 38.61 38.61 669. Ceilmg fan&light-High grade 1 00 EA 0 00 340.84 340 84 48" ceiling fan-centered in kitchen 757 R&R Recessed light fixture 1.00 EA 8.05 89.69 97.74 Remove existing recessed light fixture and replace with matching fixture to added fixtures 756. (Install)Recessed light fixture 2.00 EA 0.00 6226 124.52 Add two recessed can light fixtures to the header in kitchen 758. Hanging hght fixture 2.00 EA 0.00 64.68 129.36 Add two hanging light fixtures-one centered over the sink and one centered over the miter of the h�gh top Totals• Kitchen 962.11 Breakfast Area/Room Formula Sloped Ceiling 12'x 7'x 8' �_ � 198.50 SF Walls 84.21 SF Ceilmg 282.71 SF Walls&Ceiling 84.00 SF Floor `-_-__ '.� 9.33 SY Flooring 26.00 LF Floor Perimeter 26.04 I.F Ceil.Perimeter Missing Wall: 1 - 12'X 8' Upens into Exterior Goes to Floor/Ceiling DESCRIPTION QNTY REMOVE REPLACE TOTAL 706. Chandelier-reset 1.00 EA 0.00 108.36 10836 Reset customer suppl�ed chandelier Totals: Breakfast Area/Room 108.36 Laundry Room LxWxH 9'10"x 5'9"x 8'0" � 249.33 SF Walls 56.54 SF Ceilmg �� 305.87 SF Walls&Ceiling 56.54 SF Floor �-,�- � 628 SY Flooring 31.17 LF Floor Penmeter 78.67 SF Long Wall 46.00 SF Short Wall 31 17 LF Ceil Perimeter MCDORMAN-ROBERT-ELEC 4/i l/2012 Page 8 � , �ERVPRO of Tarpon/West Tampa 13911 West Hillsborough Ave #306 Tampa,FL 33635 CONTINUED-Laundry Room Subroom 1: Closet LxWxH 5'9"x 2'x S' �� i?4.00 SF Walls 11.50 SF Ceiling i" � F , "` J 13�.50 SF Walls&Ceiling 11.50 SF Floor �` / ' 1.28 SY Floonng 15.50 LF Floor Per�meter ,�� 4b.00 SF Long Wall 16.00 SF Short Wall 15.50 LF Ceil.Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL 697. Light fixture I.00 EA 0.00 53 18 53.18 Glass shade with brass ring Totals: Laundry Room 53.18 Master Bedroom LxWxH 1570"x 15'1"x 8'0" �� 494.67 SF Walls 238.82 SF Ceiling ��/ �%`� 733.49 SF Walls&Ceilina 238.82 SF Floor �;-�� 26.54 SY Flooring 61.83 LF Floor Perimeter 126 67 SF Long Wall 120.67 SF Short Wall 61 83 LF Ceil.Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL 698. Light fixture 1 00 EA 0.00 53.18 53 18 Glass shade with brass ring 755. Smoke detector 1 00 EA 0.00 38.48 38.48 Hard wired with battery back-up Totals: Master Bedroom 91.66 His Closet LxWxH 7'6"x 5'x 8' , � � 200 00 SF Walls 37.50 SF Ceilmg F��- �-� � 237.50 SF Walls&Ceilmg 37.50 SF Floor ��/�� 4.17 SY Flooring 25.00 LF Floor Perimeter f�0 00 SF Long Wall 40 00 SF Short Wall 25.00 LF Ceil Perimeter MCDORMAN-ROBERT-ELEC 4/ll/2012 Page: 9 ' , SERVPRO of Tarpon/West Tampa 13911 West Hillsborough Ave. #306 Tampa,FL 33635 CONTINUED-His Closet DESCRIPTION QNTY REMOVE REPLACE TOTAL 699 Light fixture 1.00 EA 0.00 53 18 53 18 Glass shade with brass ring Totals His Closet 53.18 Her Closet LxWxH 7'6"x 5'0" x 8'0" ="� 200.00 SF Walls 37.50 SF Ceiling �` / � '.� 237.50 SF Walls&Ceiling 37.50 SF Floor �,; :-'" 4.l7 SY Flooring 25.00 LF Floor Penmeter 6U 00 SF Long Wall 40.00 SF Short Wall 2,5 00 LF Ceil.Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL 700. Light fixture 1.00 EA 0.00 53.18 53.18 Glass shade with brass ring Totals Her Closet 53 18 Master Bath LxWxH 8'x 6'S"x 8' �� 230 67 SF Walls 51.33 SF Ceiling C� '"�\� 282.00 SF Walls&Ceiling 51.33 SF Floor ��,I -� � 5.70 SY Flooring 28.83 LF Floor Perimeter 64 00 SF Long Wall 51.33 SF Shart Wall ?8 83 LF Ceil.Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL 690. Recessed light fixture 1 00 EA 0 00 89.69 89 69 Center recessed light in the center of the shower ceil�ng 691. Recessed hght fixture 2.00 EA 0.00 89.69 17938 Center recessed light in the ceiling over each sink m vanity top Totals: Master Bath 269.07 MCDORMAN-ROBERT-ELEC 4/11/2012 Page• 10 ' . SERVPRO of Tarpon/West Tampa 13911 West Hillsborough Ave. #306 Tampa,FL 33635 Toileb5hower Area LxWxH 6'0"x 5'0"x 8'0" J�'�� 176 00 SF Walls 30.00 SF Ceiling /�. ' ..� �� -` � 206.00 SF Walls&Ceiling 30.00 SF Floor �� ' 3.33 SY Flooring 22.00 LF Floor Perimeter 48.00 SF Long Wall 40.00 SF Short Wall 22.00 LF CeiL Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL 689. Electrician-per hour 0.50 HR 0 00 81.42 40.71 Put ventilation fan on its own run/switch Totals Toilet/Shower Area 40 71 Electrical Upgrade DESCRIPTION QNTY REMOVE REPLACE TOTAL 731. R&R Breaker panel-200 amp 1.00 EA 253.78 1,400.00 1,653.78 Remove existing electrical breaker panel box and upgrade to a new 200 AMP electrical breaker panel box 732. 1 10 volt copper wiring run and box- 5 00 EA 0.00 40 97 204.85 rough in only 110 voldt hard wire rough in for smoke detectors(original smoke detectors were battery powered only) 733 R&R Ground fault interrupter(GFI) 6 00 EA 3.44 24.55 167 94 install GFI's on both bathrooms,kitchen, laundry,and garage circuits 759. Lighhng-under overhead cabinet 5.00 EA 0.00 48.20 241.00 Totals: Electrical Upgrade �,�67.57 General DESCRIPTION QNTY REMOVE REPLACE TOTAL 447. Electrical 1.00 EA 0.00 250 00 250.00 Change recepts, switches,and covers to ivory. Light switches are to be lighted.New dimmer switch for breakfast area ceiling light. Replace dead patio recept. Remove ceil�ng fan outlet and remove electric wiring centered in the family room.,etc. Totals• General 250 00 Line Item Totals: MCDORMAN-ROBERT-ELEC 5,324.02 MCDORMAN-ROBERT-ELEC 4/i l/2012 Page: l l ' , SERVPRO of Tarpon/West Tampa 13911 West Hillsborough Ave #306 Tampa,FL 33635 Grand Total Areas: 7,039.20 SF Walls 2,702.43 SF Ceiling 9,741.63 SF Walls and Ceiling 2,684 87 SF Floor 298.32 SY Floonng 845.08 LF Floor Perimeter 1,659.37 SF Long Wall 1,164.25 SF Short Wall 888.29 LF Ceil.Perimeter 0.00 Floor Area 0.00 Total Area 0.00 Interior Wall Area 0 00 Exterior Wall Area 0 00 Extenor Perimeter of Walls 0.00 Surface Area 0 00 Number of Squares 0.00 Total Penmeter Length 0.00 Total Ridge Length 0 00 Total Hip Length MCDORMAN-ROBERT-ELEC 4/11/2012 Page• 12 ' , SERVPRO of Tarpon/West Tampa 13911 West Hillsborough Ave. #306 Tampa,FI,33635 Summary for Dwelling Ltne item Total 5,324 02 Material Sales Tax @ 7 000% x 1,427.86 99 95 Replacement Cost Value $5,423.97 Net Claim $5,423.97 Tuggle,Paul MCDORMAN-ROBERT-ELEC 4/Il/2012 Page 13 �ERVPRO of Tarpon/West Tampa 13911 West Hillsborough Ave #306 Tampa,FL 33635 Client: McDorman,Robert Cellular• (614)561-7934 Property: 5929 18th Street Business: (614) 837-3421 Zephyrhills„FL 33542 Operator Info: Operator� PAUL Estimator• Tuggle,Paul Business: (813)855-0888 Business. 13911 W.Hillsborough Ave.#306 Tampa„FL,33635 Type of Estimate Water Damage Date Entered. 2/12/2010 Date Assigned. Price List: FLTASB JAN 10 Restorat�on/Servi ce/Remodel Estimate. MCDORMAN-ROBERT-PER3 PLUMBING WORK: This estimate is to reset or replace the plumbing fixtures. It replaces the tub in the master bathroom with a shower. It replace the water heater with a tankless heater SERVPRO of Tarpon/West Tampa ]3911 WestHillsboroughAve. #306 Tampa,FL 33635 MCDORMAN-ROBERT-PER3 Guest Bath LxWxH 6'0"x 5'0" x 8'0" j�'� 176.00 SF Walls 30.00 SF Ceiling �"�i' � 206.00 SF Walls&Ceiling 30.00 SF Floor i� 3.33 SY Flooring 22.00 LF Floor Perimeter 48 00 SF Long Wall 40.00 SF Short Wall 22.00 LF Ceil Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL 2. (Install) Sink-smgle 2.00 EA 0.00 74.28 148.56 480. (Install)Sink faucet-Bathroom 2.00 EA 0.00 53.67 ]07.34 621. Angle stop 4 00 EA 0.00 24.29 97.16 Totals: Guest Bath 353 06 Tub Area LxWxH 7'2"x 5'0"x 8'0" �'�� 194 67 SF Walls 35.83 SF Ceiling i' - "�%� 230.50 SF Walls&Ceiling 35.83 SF Floor �:-�, % �- �,;� 3 98 SY Flooring 24.33 LF Floor Perimeter 5733 SF Long Wall 40.00 SF Short Wall 2433 LF Ceil.Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL 684. Plumber-per hour 1 00 HR 0 00 91.68 91.68 Raise shower head 1' 62. (Install)•Tub/shower faucet 1.00 EA 0 00 112.99 112.99 63 (install)Bathtub l 00 EA 0.00 306.06 306 06 62?. Angle stop 1.00 EA 0.00 24.29 24.29 Totals. Tub Area 535.02 MCDORMAN-ROBERT-PER3 3/13/2012 Page: 2 $ERVPRO of Tarpon/West Tampa 13911 West Hillsborough Ave. #306 Tampa,FL 33635 Kitchen Formula Sloped Ceiling 13'6"x 9'0"x 13'4" � ��- 324.01 SF Walls 130.64 SF Ceiling `� 454 64 SF Walls&Ceilmg 121.50 SF Floor t-- ---------� 13.50 SY Flooring 36.00 LF Floor Perimeter 32.03 LF Ceil.Perimeter Missing Wall: 1 - 9' X 13'4" Opens into Exterior Goes to Floor/Ceiling Missing Wall: 1 - 6'X 6' Opens into Exterior Goes to Ceiling Subroom 1: Pantry LxWxH 3'x 2'6"x 8' '�'� 88.00 SF Walls 7.50 SF Ceiling � �`�� 95.50 SF Walls&Ceiling 7.50 SF Floor \;"��" �'� 0 83 SY Flooring 11.00 LF Floor Perimeter 24.00 SF Long Wall 20.00 SF Short Wall 1 1 00 LF Ceil.Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL 514. (Install)Sink-double-reset 1 00 EA 0 00 ]09.23 ]0923 623. Angle stop 4.00 EA 0 00 24.29 97.16 Totals. Kitchen 206.39 Laundry Room LxWxH 9'10"x 5'9"x 8'0" �'�- 249.33 SF Walls 56.54 SF Ceiling %' � 305.87 SF Walls&Ceiling 56.54 SF Floor �"" . \�� 6.28 SY Flooring 31.17 LF Floor Perimeter 78 67 SF Long Wall 46.00 SF Short Wall 31.17 LF Ceil.Perimeter Subroom 1: Closet LxWxH 5' 9" x 2'x S' '� 124.00 SF Walls 11.50 SF Ceiling /� -- � \ " /'�`� 135.50 SF Walls&Ceiling 11.50 SF Floor �I�-� 1?8 SY Floormg 15.50 LF Floor Penmeter 46.00 SF Long Wall 1.i.00 5F Short Wall I5.50 LF Ceil Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL MCDORMAN-ROBERT-PER3 3/13/2012 Page• 3 , S,ERVPRO of Tarpon/West Tampa 13911 West Hillsborough Ave #306 Tampa,FL 33635 CONTINUED-Laundry Room DESCRIPTION QNTY REMOVE REPLACE TOTAL 633. Water heater-tankless- 15 to 20 kw- 1.00 EA 0.00 1,108.98 1,108.98 Electric Totals: Laundry Room 1,108 98 Master Bath LxWxH 8'x 6'S"x 8' �/�'�� 230.67 SF Walls 51.33 SF Ceiling �� 282.00 SF Walls&Ceiling 51.33 SF Floor � 5 70 SY Flooring 28.83 LF Floor Perimeter 64 00 SF Long Wall 51.33 SF Short Wall 28 83 LF Ceil.Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL 683. Plumber-per hour 1.00 HR 0.00 91 68 91.68 Raise shower head l'. 617. Angle stop 4.00 EA 0.00 24.29 97.16 467. Sink-smgle-reset 2.00 EA 0.00 102.26 204.52 631. (Install)Sink faucet-Bathroom 2.00 EA 0.00 53.67 107.34 Totals• Master Bath 500 70 Toilet/Shower Area LxWxH 6'0"x 5'0"x 8'0" �'�` 176.00 SF Walls 30.00 SF Ceiling i�/ `� 206 00 SF Walls&Ceiling 30.00 SF Floor �`� \\// 3.33 SY Floorin 22.00 LF Floor Perimeter �..-" � g 48.00 SF Long Wall 4�.00 SF Short Wall 22.00 LF Ceil Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL 607. Toilet-High grade 1.00 EA 0.00 439.08 439 08 Upgraded toilet-taller than standard 608. Remove Bathtub 1.00 EA 54.17 0.00 54.17 Remove existing tub 642. Shower faucet&head-High grade 1 00 EA 0.00 24834 248.34 MCDORMAN-ROBERT-PER3 3/l3/2012 Page 4 . $ERVPRO of Tarpon/West Tampa l 39l 1 West Hillsborough Ave. #306 Tampa,FL 33635 CONTINUED-Toilet/Shower Area DESCRIPTION QNTY REMOVE REPLACE TOTAL 639. Shower pan-Large 1.00 EA 0 00 178.24 178.24 615. Angle stop 1.00 EA 0 00 24.29 24.29 Totals: Toilet/Shower Area 944.12 Line Item Totals:MCDORMAN-ROBERT-PER3 3,648.27 Grand Total Areas: 1,562.67 SF Walls 353.35 SF Ceiling 1,916 02 SF Walls and Ceiling 344.21 SF Floor 38.25 SY Flooring 190 83 LF Floor Perimeter 366.00 SF Long Wall 253.33 SF Short Wall 186 86 LF Ceil.Perimeter 0.00 Floor Area 0 00 Total Area 0�0 Interior Wall Area 0.00 Extenor Wall Area 0 00 Exterior Perimeter of Walls 0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length 0 00 Total Ridge Length 0.00 Total Hip Length MCDORMAN-ROBERT-PER3 3/13/2012 Page 5 . SERVPRO of Tarpon/West Tampa 13911 West Hillsborough Ave. #306 Tampa,FL 33635 Summary for Dwelling Line Item Totai 3,648.27 Material Sales Tax @ 7 000% x 1,310 77 91 75 Replacement Cost Value $3,740.02 Net Claim $3,740.02 Tuggle,Paul MCDORMAN-ROBERT-PER3 3/13/2012 Page: 6 , SERVPRO of Tarpon/West Tampa 1391 l West Hillsborough Ave #306 Tampa,FL 33635 Client: McDorman,Robert Cellular: (614)561-7934 Property• 5929 18th Street Business: (614)837-3421 Zephyrhills„FL 33542 Operator Info: Operator• PAUL Estimator: Tuggle,Paul Business: (813)855-0888 Business: 13911 W.Hillsborough Ave.#306 Tampa„FL 33635 Type of Estimate: Water Damage Date Entered: 2/12/2010 Date Assigned: Price List: FLTASB JAN 10 Restorati on/Service/Remode l Estimate MCDORMAN-ROBERT-PER4 This estimate is to replace the existing AC ducts m the residence. SERVPRO of Tarpon/West Tampa 13911 West Hillsborough Ave. #306 Tampa,FL 33635 MCDORMAN-ROBERT-PER4 Heat,Vent,&Cool DESCRIPTION QNTY REMOVE REPLACE TOTAL 471. R&R HEAT, VENT&AIR 1 00 EA 0.00 3,540.00 3,540 00 CONDITIONING Furnish and install all new ductwork with new register boxes and diffusers. New plenums are included. Totals: Heat,Vent,&Cool 3,540.00 Line Item Totals:MCDORMAN-ROBERT-PER4 3,540.00 MCDORMAN-ROBERT-PER4 3/l3/2012 Page 2 Permft No. Parcel ID No NOTICE OF C�MMENCEMENT State of ��./J� � County of r �`-�C/ THE UNDERSIGNEO hereby gives notice that improvement will be made to certain�eal property,and in accordance with Chapter 713,Florida Stetutes, the following information is provided in thfs Notice of Commencement: 1 Descripkarrof P��rty: Parcel Identification No.��" Z�-2.� �' QQ�� —Q q'3O�–��S'Q Street Addross;�_e�_ � �8'�'� �-{-Y'��"' Z�H��,�s , �L 33s¢z 2. General Description of Improvement 6'�bl� C. _ ��11�j21,�Q �UE TO �1M1�[)L..�� /IM'jQ�✓ 3. Owner Information or Lessee information if the Lessee contraded for the improvement: '?a�a�-r ari�-t.�„ 4 3 t l o �aSoo �.r"r��o PouS I�JrNC+�ESr�.2 Gan�Ac_ W,N�N�sT�fL p� Address �, n City State Interest in Property: _ �W7l�Gf�– Name of Fee Simple Titleholder: (if different from Owner listed above) Address City State 4. Contractor: S .✓t V D _ p� �(,��T']��.M p� . . ��.3�l I� amW ��.-f�-(LL5 b�d✓LOr.tG N �E�'�i �'�.(IDf{- � �- Address Q City State Contrador's Telephone No.: �J�3 –Q�S –��$' g' 5. surety: I�JEST�.,/�� A Qf�-r'S/ AZIct'�ameT1��14Ei�R0� W�}Y - St�c�2C �FELCS � S� �� y state Amount of Bond: $�O�O e C�ZI . Telephone No.: g�" 3 3( -' (p�cS.3 6. Lender: Name Address r City State Lender's Telephone No.: 7. Persons within the State of Florida designated by the o�me: upon whom notices or other documents may be served as provided by Section 713.13(1)(a)(7),Florida Statutes: Name Address City State Telephone Number of Designated Person: ,.,, 8. In addition to himself,the owner designates of to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes. Telaphone Number of Pe�son or Entity Designated by Owner: 9 Expiration date of Notke of Commencement(the expiration date may not be before the completion of constructlon and flnal payment to the contractor,but wiil ba one year from the�iate of fecording unless a different date is specifted): WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE C�15$TDE MPROPER PA�.�AENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR AYING TWICE 1=0R IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED7NVD,POSTED ON THE JUB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Under penalty of perjury, I declare that I have read the foregoing notice of commenbement and that the facts atated therein are true to the best of my knowledge and belief STATE OF FLORIDA - , � COUN7Y UF PASCO :t �I� � - Signa.�re of Owner ar Lessee,or Owner's or Lessee's Authorized O�cer/DiredodPartner/Manager ....�.�� Signata s Title/Office The foregoing instrument was acknowledged before me this�'�;iay of�:�1-. �20%b . Y as (type of authority,e.g.,ofRcer,trustee,attorney in faet)for _ (name of o behalf of wh i tru ent was e ted), Personally Known[]�Produced Identification❑ Notary Signature D�–� Type of Identification Produced Pdame(Print��"'"'��"''�:, s:`� � "!=ic'`= Nota�'Pui�lk = � " {n an�(or tha S��ts ol0hia _*�� x_ a = . .�w :• 3�,,� s�y Ccmm�sips�Expirec ':°'' . ,�,� July 23,2�12 '�.-�>,. %;,.F� c�r�;,�� u�utut:l:P wpdata/bcs/noticecommencement�c053048 Pasco County Parcel: 11-26-21-0010-04300-0050 001 Page 1 of 1 Data Current as Of: Weekly Archive - Saturday, February 25, 2012 Parcel ID 11-26-21-0010-04300-0050 (Card: 001 of 001) Classification 01 - Single Family Mailiny Address Property Value MCDORMAN ROBERT A Ag Land �p 6500 LIT}10POLIS WINCHESTER RD Land $27,369 CANAL WINCHESTER OH 43110-9502 Buiiding $83 485 Physical Address Extra Features $2,055 5929 18TN ST ZEPHYRHILLS FL 33542-3870 �ust Value �112,909 Le�ai Descriotion (First 4 Lines) ��d(Non-Sthool Amendment 1) $112,909 See Plat for this Subdivisio�:: Taxable Value �112,909 CITY OF ZEPHYRHILLS PB 1 PG 54 lOTS 5, 6, 7, 8, &9 BLOCK 43 OR 4109 PG 1624 Land Detail (Card: 001 of 001) Line Use Description Zoning Units Tyrpe Price Condition Value 1 OlUO SFR OOR2 8,400.00 SF $2.72 1.00 $22,848 2 0100 SFR OOR2 12,918.00 SF $0.35 1.00 $4,521 Additional Land Information Acres 0.49 Tax Area 30ZH FEMA Code X Residential Code ZHLHLP2 Buildin� Information - Use O1 - Single Family Residential (Card: 001 of 001) Year Built 1977 Stories 1.0 Exterior Wall 1 Concrete Block Stucco Exterior Wall 2 None Roof Structure Gable or Hip Roof Caver Asphalt or Compositian Shingle Interior Wall 1 Drywall interior Wall 2 None Flooring i Carpet Flooring 2 None Fuel Electric Heat Forced Air- Ducted A/C Central Baths 2.0 Line Desc�iption Sq. Feet Repl. Cost New 1 BAS 2,202 $90,833 2 FSP 240 $3,465 3 FGR 836 $13,778 4 FOP 20 $206 Extra Features (Card: 001 of 001) Line Description Year Units Value 1 DWSWC 1977 3,200 $1,200 2 FIRE PL 1977 1 $855 Sales History Previous Owner MCDORMAN JAMES M SR&MARTHA B Year Month Book/Page 7'ype Amount i999 03 4109! 1624 WD $108,900 1992 09 3071 I 1682 WD $0 1976 12 0869 / 1043 WD $10,500 http://appraiser pascogov.com/search/parcel.aspx?sec=11&twn=26&rng=21&sbb=0010&bl... 3/1/2012 . � Fire&WatQr- Clea,up& Restoration'"' V CONT'RACTOR AUTHORIZED FORM STATE CERTIFIED LI� # CGC014994 PASCO CONTRACTOR ID# 004351 QUALIFERS NAME - �,AIRD, RANDALL W. BUSINESS NAME— SLRVPRO OF TARPON/WEST TAMPA ' I authorize the following individual(s) to sign for and obtain permits, record my state contractor license(s) and create passwords o:� my behalf regarding the above mentioned license. DONNA LOTZ of PERl`vIITS PLUS PAUL TUGGLE of SERVPRO of TARPON/WEST TAMPA �`*This authorization supersedes al� previous submitted authorizations** �---�, / f Signature of qualifier: ;'� � Sworn to and subscribed before this day :��. T w'�:�. :;-t.��.t�GttA =': :� PNY C�MMIS:�IGN#DD988734 Ttl r /� �. '.� �X�iR�S;�1ay 31.2014 � �A`� D C �� 4 �0 398-0153 f ' pp� J� /` f� Nota Public State of Florida In�lepe�t�lejttll' ()tt�nrd�rn�l O�er�rte<l Client#: 100d010 02SPSTERNINC ACORD,�, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDlYYYY) 3/06/2012 THIS CER't'IFIG�r4TE.IS lSSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIF�,CATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BEL►OW.THI'S 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 hoider is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain palicies may require an endorsement.A statement on this certi�cate does not confer rights to the ce�tificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: BB&T Insurance Services, IIIC. PHONE 919 716-9777 F°'x .vc,No eX�: ac,Na: 3605 Glenwood Ave E•MAIL Raleigh, NC 27612 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC p 919 716-9777 — -- -- --- �NSUReR,n Restoration Risk Retention Grou 12209 INSURED �INSURER 6 Chartis Specialty Insurance Co 26883 Sternbrooke Inc. INSURER C StarNet Insurance Company 40045 13911 W. Hillsborough Ave#306 Tampa, FL 33635 INSURER D INSURER E• � � INSURER F. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 �VITH 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. TR TYPE OF INSURANCE '�ADDLiSUBR POLICY EPF i POLICY EXP INSR i4WD POLICY NUMBER {MM/DDlYYYY)i(MMlDD/YYYY) ' LIMITS q ceNerta�unsiuTV X j RGL081103 10/19/2011�10/19I�.A'I�EACH OCCURRENCE �$1,000,000 X COMM,ERCIAL GENERAL LIABILIN i � !DAMAGE TO RENTED �l� �PREMISES Eaoccurrence) ��$�Q��QQD _ _ JI CLAiMS-MADE `�OCCUR I �MED EXP(Any one person) $rJ i '0 0 0 _ � �PERSONAL&ADV IN,IURY I S��OOO�OOO ---� - _—____ ____. ' I �GENERALAGGREGATE !$Z�OOO�OOO _ GEN'L AGGREGATE LIMIT APPLIES PER: �'�,PRODUCTS-COMP/0P AGG ;$Z�OOO�OOO PRO- i X�POLICY JECT �L�OC � ,,$ � -- --'--- ------ - ' i �, �'� AUTQMOBIIE LIABILITY j ~ � � �COMBWED SINGLE LIMIT ' � �� - ' � Ea accidemL___ $ ' � ANY AUTO � f 'BODILY INJURY(Per person) ;$ � i ' ---.. - --- � I ALL OWNED � SCHEDULED �� ------�-----�-�-�-- AUTOS �AUTOS �BODILYINJURY(Peraccident)j$ � HIRED AUTOS '� NON-OWNED ��, PR EPO RTY DAMAGE i AUTOS � !(Per acader� �� __ I B_+ I UMBRELLALIAB � ' L— �� $- �X ; occuR t EBU024543133 10/19/2011;10/19(201 eacr+occuRRervice I$1 000 000 '4 X EXCESS_LIAB ; CLAIMS-MADE, i � �AGGREGAiE $'I OOO,OOO � DED i � RETENTION$ � '�, �$ C WORKERS COMPENSATION i BNUWC0115224 1107l2012 i 01/07/2013 X 'WC STATU- ' ''�OTH-' AND EMPIOYERS'LIABIUTY Y�N � TORY L IMIT � ER �� ANY PROPRIETOR/PARTNER/EXECUTIVE� Y� N!A� i � Y j E.L.EACH P,CCIDENT �$rJOO OOO OFFICER/MEMBER EXCLUDED? 1/ I(Mandatory in NH) � Y ' ' 'RPU080790 10/19/2011 10/19/20��E.�.oisease-E.n Er�a�ovEe;$500,000 -'Ifyes,describeunder � �-- —�--- t— .______ DESCRIPTION OF OPERATIONS below _____ _ _ ;E.L.DISEASE-POLICY LIMIT ;$SOQ,OOO A Pollution � � $1,000,000/2,000,000 � ; DESCRIPTION OF OPERATIONS/LOCATIONS(VEHICLES(Attach ACORd 101,Additional Remarks Schedule,if more space is required) "*Workers Gomp Information** Proprietors/Partners/Executive OfficerslMembers Excluded: Amy Richman James Richman (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City Of Zephyrhilis Building SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN DePt. ACCORDANCE WITH THE POIICY PROVISIONS. 5335 8th Street Zephyrhills, FL 33542 AUTHORIZED REPRESENTATIVE ��-�-�•� O 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25{2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S82722511M7917412 MF5 DESCRIPTIONS (Continued from Page 1) '`'`Supplerr�entnl Name'* Sternbr�oke Inc. dba Servpro of Tarpon dba Servpro of W.Tampa Certificate Holder included as Additional Insured SAGITTA 25.3(2010/OS) 2 of 2 #S8272251/M7917412 2019-2012 HILLSBOROUGH COUNTY BUSINESS TAX R,�CEIPT EXPIR�S 9-30-2Q12 FOLIONO S AMPS ACILITYES OR MACHINES ROOMS ' O n SEATS 0 EMPLOYEES �� RENEWAL � �_ 228175.0000 . OCG CODE BUSINESS TYPE H wnsre rnx 090.000 CONTRACT R/C ANIN AND ESTORAT ON S CS SURCHARGE 40 00 36 00 BUSINESS LOCATION HILLS COUNTY NAME SERVPRO OF TAMPA WEST v / MAILING �3�� yy H��SBOROUGH A�1E SUITE 306 AUDRESS '(]��PA fi��635 ��w �B U S I N E S S TAX R E C E I PT DOUG BELDEN,TAX COLIECTOR PA�D-15424 -85 HAS HEREBY PAIQ A PRIVILEGE TAX TO ENGAGE 81�3-635-52d0 �7/28/2011 '��]s.�Q IN BUSINE55,PROFESSION.OR OCCUPATION SPECIFIED HEREON 7HIS BECOMES A TAX RECEIPT WHEN YALIDATED. �f 001127 �ry�: CONTRACTOR CLASS C CITY OF OLDSMAR Vendor:o9i�s.i 100 STA1'E SI'REET WESI',OLDSMAR,FL 34677 Phone:813-749-1123 LOCAL BUSINESS TAX RECEIPT � Fiscal Year 2012 Expires:September 30,2012 Owner: SERVPRO OF TARPON/WEST TAMPA (813)855-0888 Issued: 08/10/2011 Bnsiness 261 DOUGLAS RD E A Tax: $93.00 Address:OLDSMAR FL 34677-2946 Qy � ��C� Name: SERVPRO OF TARPON/WEST TAMPA AuWorized Signature Ma�7ing 13911 W HILLSBOROUGH AVE f�306 Address:TAMPA FL 33635 Issuance and rete�fon of this receipt is contingent upou receipt holder's compliance with the City of Oldsmar Code of Orctinances.The City reserves the right to inspect business premises � LOCAL LUSINESS TA;:RECEIPT MUST BE CONSPICUOUSLY DISPLAYED AND IS NON-REFUNDABLE A a� • � _�._ __. - --- �� 's a,, �A��t�"r J� `�W y �"�� #� ;r �a� r' fi,+,a*y ,,. � `r �,� �'� � M � ��,^' :� ,�>s u w, �� ?�; -- h. : ,� �,,�, $ '.'��r, t�. �". y�$��^� i� ' '� .y � Y'4 '4 � t '�t i v.�i��,L � � � ,�n ti�, � x � �r '�i ��' 'I I I�I'� �"°'� '(��r'� �'r � � *��4 �' �` � �'' a ,�ffi �a t 9 t,.. § ' 4�' ��, �q �^ �'d .� , '� ' ;C, � R4 r,,,v � a'} $ ,�,� ; a d !�a � rYs � ,d � ,7 a'Y�, 6?�',„r A �-' t"'��`. ' ��'7�$y'n�,,�y�.a, '��'ry`6 ,�.�f� �qy'�, ,j, { '� �, 's4� ti �:' i a ��'' ' �� fi� `/� ya11"'1' " ';a � . , `\�� 3�7��1��"xe�,'� . ,. ;� �:� 3 'a, . . . „ ,a,�, "`y"�i�C� �'� w� �t� �� ` . � ,� ,y' „ '��" � s 2,G�.��^ �`�., "'�$ TF�lC RSCBIPT EXPIRES 09/3a/2011 ` , � fi �,�y��,v. � Y�CEIPT"��IHEN VAt,IDATED ^"•'k'• ^M�ia'� � 'A�<M'�� u i �,-R .'...,ry:.:��y;. ie.,., r Y$ � � �� S .REaCE�$T I3 CONTINGENT UPON RECEIPT HOLD '�3�� . =�"q'C�� 'CITY OF�OLDSMAR COD�s OF ORDINANCES. 'THS L,��°'�t�.'7C°� . V"E�'k� RI '.TO INSPSCT BUSINESS PREMISES. , y� �;... RSCEIPT CA'��`:CONTIt�1CTOR CIiA58 C �`�'.. i. SERVPRQ�<1�'�ARPON/WBST TAMPA ' � AMY RICFIMAN 1391T W. FIYLLSBOROUGH AVENiTE Vendor:09175 #306 TAX: $93.00 TAMPA FL 33635 �'� j A H .f''�G��AT � ; _ - _�.:.¢,_ . mh:�= :.,,' .. ��:::.�y:�''��_� .. � '!�`�� :. ; . . -, :. - .�;...., :.- __ ;:��-<: _ ; 5��"` '�� .._ ., ;..� _ _ ;��`��YM° '`�'r .. -'"e�. •`�i,�" -- �-'.i"c:at>" �. ��yp�`syt _ ° ;�� .., ` ; - 3. = ,•'.�its' ., . . " :. -:.. . " . 'v.�" , ._ _ I + '"i' �'C',,(`' ?'r �/`C uscrt' [ j `?'t"±'*r ,5"ri��`�x�> -a- ' a. --'r .:`.,^e„�;-sc�j_F'�°��.�C�+,�'��/rC'�y� J�y tv..��'i > '�' 'r�A ,y� �. fj, �?'»��`, 'L�'r'.�� J?",q °�'(d%• .� �,�...w . ,.,,,,�, 1 i�i. �J�. .C�t•l\....�,.'�'•1 a•° �..,Y��t� .r 'i � } � � :ii _ �z�-.F � i �.�` . � � ;'� , '(�1�;.--,.��(,�„`��}Y`�``��`,� �.,��'.�,,�,'��:� , ' �.. � ,;;��i,�'-`��;�`i��ra:;,�'k>r��(�"'�� !�"'r�} �_�;::;�:j"';f�;�,;��e> _ .�_ .�, �... _ s^,��t�,..-, Y�.,`• �� ,��. r},,,��L%' ��,a,•�ir. �,.,,�:s; ��-�r �w - ~5 M1r;y'.^...; -"+w�f '�,Y ,"Vr u:i5.'�••� ':i;r�'' ="°,•.�,� �'--`,°:;.i,�, ',r, _ r:;'� ,r;. "�:��..= t T.: '� ,y,w.�,y°x.'"��fy,s4 jw-� +,. ,\�'r F �.fi ,.L'�,`fw"�"'��,,. .�,, '4a,'d..;,.�.':_ f�-:'k.-""`�1�.�"ts, - br' +�'T,.".,-%;'t""` �, 'r�.. , �JI'h -Y d 'R .4 ��-y�� w.i�4,••}'�i� '.k.i.4 �'j1R�s .fj.'. � ,,.p��7� '��ia[1�� ' x%i " i�+�l �g R'p�b'0.�'�V � m4Yi5�'ri+ ;��f�'�'p:iv��yiyY4+F��'i�'�-�1�r•''\�(��r...y,�� ,�{ �':� ' Ji'i.e�i.:lkw��l��i•'y't��d'4�TPj !�4% yYµ,,. ,y� - t. �,. ,.rai:4'�14��'ud�!* a�r0.;1�PTM}�,. �,ir�a, �1r1,+,,� �� - _ g { ^�.�yL Y:L�'l� tV=+'. 1'..f� .;i�AW��"n`}m.'�"�YF�,�dP��X.„� , ",, ,�;�� Y� r �.,' i :..�,�� ` �� f _��"h')�T 3�� ;�r'�F� :� �,a �'` �~.,v'�.y°'��r'`k' 3�'z�;�s�C}�''f,.`�iy� �t4�`tja'.-r�.'��so�'�a''��i��«�,"E:" �i�'��:i+� .X'�r.�':�`.}�t''''-r4�t�;�' ��!�"� '�`<�i' .� �~ _l � a„ T,�' � � w ^a�;:.a,y,� ' ,'� �rcf'• ., �� ;,}% ��.,� ..`t-�j �`r+': 1 � :"�.3: `.w: iL°):ry �«'�': ':' i.:s; 1 :.^�. .,,� -- � ^ ..: �'.- ✓ • ti.✓ � �g, �( jy4...• '"�•. ._ � °�4. ''^ yy � +�f "'1� J� ��,y^�-l':,.. . „�\ _' { 'I ri�".�.F Ia'm! I�� '��i CI,1''4��'� �'.�.pi��.f... _ _ � � _ Y ` .q' `i 4.' � �L�",t- " > ��t'°ry �'x ';'�'� ,�.�' :.cj�. y.�r�, 'K� n,,.# +� J...... �,^-., �4r,_...�-r„ ' � ('.°`- b'�, �,� �a� i m�.��`': -"r,� ,/�1 3 �� ,�� r ,�+; 3� + "#�i'% �.'�r$ �,� xx �: � - -- - _ _ �-,,t� �`��_ ;��`C,:.?; �,.,,�tl t�,.} �.�', ;'�� t�'f�iv ._ �;�!l��"',1�sM`.-r�.�•_��`.'�i�,,•�,i^""k;��r� . 'i`,i�i'$,I ��.. '^.": aM�,�'yr,'��j'P*'�'!��,�'� ,'��'� - .;4_ _ '�:rr�^ -- _ - - -:- ��;.v ta�r;i./ r',,.�4;.�• /"°'n ��.ti��;;;,:; � � . .n �,�D`--`_�rv� -- '� ,�c''i��!'d,�A:� lti,z'};p�:..:e,�`�r�'..,�l�i=w,;:i�.��r. � �T'�^��'�"!�',;v��^:�l'�� 1 +� �n� '_"`X't" �'-vF��' _ �:�w;.� N�� y'k��_„ Y��Si..,,'a� � f��.:��r'� `Y .&-°y. v �} ,s�{, �f� _ r•:''r,'" ,�5,��:.�y�, i�.�;�x�('�, j n'�"� i, � ..,,,. ' �6. �sT �i�'� ?h .:,�,:; �!• � t�,�y.�-4�.�'1,,,; j`,Sy�y,.,,'�,"�rd;�,` �4t� t ��;1 r,�" �;`�n<6�,.;�1"' {�;x':;:Y. �`'� '�� y -��. ��/-,.. �.d„'�if; �."� �;�_..•„�� .. 2^' .�,.::�w: ' /' .�v � '�'�r.'. .,�.'.-. !-^• i' /"•-. ,---c��: J �, �`. .. ' �2., �'��r _ ,..I(r�'t�5,��u��t%Y"C� '�f*. �iD►.�.+ �. � -s• ' ' �,,�; �-i"r \�. \ I-,` ti.,:J!�^�8 i-�-� ,.!� t , � '�=-' .1' �` � _ is it'"'��: `�.4,''`�''.-,i - �`,�"��1,'�1:�C �'^k ..4 � `�.',-'L,�s=� °'F , -C ��'� � `}(,�k1L�� '�..� �+ �� i�-ha �:.:,y;�;,,. 4'-;.p,. _ :�,��_ _ ?I��c: -F '�i` /�y i:s.;._- �,��.-...:.,�:� /��^-,,, �1,�,.,`,.,�..�,'� (�fn;ktr ,�; �y. �'a`�'�`:-kl" r:`�,a �,�r�;.�r'•, (,�} ,,��t,"-;f'°'�` :e-'^, i.a`r - V ,';.' _� -Y,�� :�,,, ,r�r- `� .,�w..;;:' �.;t .'k� ,:;'"�.�s�l '';�r ��',`)o. !'l�iFl,� 's�'�»;.4'.` !� �c:i'.x"r- ;t' .,�I� r,p�' 4?, " ,'f,:V f.".c`, �;.K;¢-,3,� ,,p •�;�y�1'*'.'`c E..�:.��t,,,..�._ ��...- �..J.,n:..-.�',,:.+��,s, :"�,�,,,, '.`"+'':' �+, _ "� �M,r,,,y»r ,�.�tr �;-'':"' + �1f ��t'�� y� M �i „•'�,r�y �.y - �y��i", _' r a 6'!....• _ ��ti..='-•}� �`'��•'_JF,r�y•��"r:"°',`,�._'. n�'�}F.i.n,,, '��in,� j�^�`'��7 .wid:.:,;�1�3;'F�Crw: ,p,�p^� ...�'�.,+ �,,.P:� ,�"�„ ',..�!'�� '/" /� t, .,b ;�`�_ I";FY: i�' �. /;�'$r�(3;.a,:�, ."�:;�w * :';"' 7i� �"a°{- �r '�"4;:."3i.."". �a r,'•�.y,.J�, Ci:",'Wra,�(;+,;�t•1�;,,�`^;i,. •'� � ,,�e ,`_ �� s.�':;� .,+ ��,,. .�,. ,.`,tt•�� , ,'��,� •�' i '�. _ _ ��l,�.ks,�C�,*":ia� ,:!';".��^.��GT� � _^a;,.,..,,, l-{A�..�:C�:�C .I<ti,::'I,ip , .,;4��: fA. _ �� 1+YK'a,`'��?.;��'�'�`'y � �t'•��"�n;61.f a�yre��., ,i_.�;,.,:-;•� *�, �,.,,1,� '4..1.a,.."�,��'.J�:__��1: � .�;�.,_ (:c;,i�'F'w�:�.a�;,::tf.i,. s� ° �� fr' -• �� f��{�i ,7y .yi�".�' t";" � �'" ;�,-�'.:' '�,�� l *1�'� �, � �b�l�� '^4'/�.:.i\^.��.,:/\:.•4 �Jy.�l`q k�,,`.�,a��''�1�:4.� ��I��`rf'�."/,-i'}�� ,� '� ... '`:� �.� .J�.., t.e—��,�,,� �k.....��+;.:.�:,�,�,�:;;.;, �� ..,.� .., �..,� �, •� .-�� ' ''�` �r �� #��,��f3��,`�'"X ="•`J�°" /�y��ry� ::� y+�, :?. P`. :d. ,��, :<3. :E:1 .:�: '�: '��3.� w: ? �LY�''.,�1� ,��;l�} ��.�7y��l�� {� ��y�+�.�� ,�w� /� p, f \ ,-_. �y �' � '" •� p�° ��..: �, t,..,r,�, , �;�� 4 J AE_ti,5;1` • �k"��.* 6 l 4�!A�' `./ � �, }�,pM +/ii' � '� � �^.qG'-,,� �,�'y!-.'r��I'�i"�i�ir� 's^.. .wy •M," :r �-.;� a rJ;,"e,.�''� y�.:,�-.--"' �,�'-- � � �+��'s�,%'`+^r"T�E�ZP�•�'�t�'°Ft �'y'�>y'r i'�.,...r:�t.��' f'.. r?x r,..,^.•" �,� 'k ��,+ � '"-y, .:'wa�`- :'�,:- �_ �.'�F; �,�x�'�:r�t:'��' :�'� ��'�• -t .�i9 '6`'i'�.w'r^',>l�£.i�,-��' �i'��'�r�','"�J h,it��)��S��i �l?�� i '.'� �f��'F )�" =f� � �:t'''��` :"i`� f;;' �E•', i /1, ,,y�, .----_,�'". � �,�+ � ��' .�:�%•�,�,;,�.�.v' ��w "``"',. �v3�'��' -,� t", '��i}t�r.;f,,'•,�L��'(: �s� ��,n�,#� '"� \ W'� / , S"°'° ..iti.... �:�.'---''�"' ;;W;� '.'k; :G�S`. � � ::`�:""t�"h�..,",��i.�,.�'"�''�c�w,�,'��„}Y'�n:�4.�{�} t�t�' a 1V�?�b,�';�°',7� :e'�e��€'4�^�;��;I`,,.ri�, �;��;��% � ra�, ��','. �r .`"-4�.�;;;. �f,xY, , ��: .?`y',;,,`''L'i.,�Diti"��'�[Ili tit.".S�y�1\ _ [ u,i .�q-: ;y�-m.�� , �J y��°Fye'�e�,!,�,�, � � } ;:�. ��,-,�q f�a�: ;d4,;�. 4�,.��F ;��;:�c.�,��;,,, �:-� ,�u.�;� ' �';'�`1,�,:.{r '„5+.'.,',��'.s.�i��s'+,.,..`,�;��'f`+ti►�+.i�;/:�.�" �_: 4�° �• ''�^"�'�` ti;� ��'��.�%`F:4�+ � '��,hre�' �'e "� r�^F 9�'ri'�'"; e,;y,� (^^., .,�..�� z ; ;;/�'�� :a�� - +,.".'��. �.,. w::-�� -"yl...'•tg ��,,,:F. a3". � '.'�'� (� :o. �? ��r.. :,�,. t w.'..,, � �,�� r.-.�:;.a. Jrti��_..� �, '" y./�" ;w.'t. ;"i DBPR- GUERRERO, JAIME; Doing Business As: JAIME CENTRAL AIR CONDI[TIO... Page 1 of 1 1:25:10 PM 3/l4/2012 Licensee Details Licensee Information Name: GUERRERO, 7AIME (Primary Name) JAIME CENTRAL AIR CONDITIONIER AN6 HEATING SPECIALIST LlC (�sA Name) Main Address: 16825 TAYLOR WAY ODESSA Florida 33556 County: PASCO , � License Mailing: , �� / ✓�► � LicenseLocation: ��af�� License Information G�� License Type: Registered Air Cond� ioning Contract� �� Ra n k: � --R'��— /�.{� � , , License Number: /RA13067 77_—__._-� �J � � Status: V urrent,Active �) Licensure Date: 03/23/2007 �J � � Expires: ,v08/31/2013 ,� � V Special Qualifications Qualification Effective Class B 03/23/2007 �� Construction Business 03J23/2007 View Related License Informatian View License Compiaint Contact Us '; 1940 Nortt�Monroe Street 7a11ohassee FL 32399 :: Ca11.Centert�i�dbpr.sYate.fl.us :. ��ustom?!Contact CcnLer 25i-:8i 1395 ;h�a S;aYr.,c,t;i,rE�7a is an;,i+;=c{.;c�=�,�icye� Co ri ht ZOU7-2014 State of Flarida.Rriva..y Statemenf �;r.dc-r�forid:3!a.�: e-ma�l:,r;�iresse� c.- -.,C�ic re��,rUt, r� /c.i•i�;r:o'v:a3,c vour e-r�ar adc��ess;�leased�n respGrise te a rn<ra:.-rUcords reque,:.Co nr.:=.;en�i ir!e�r y�;��:nrd t:,rt;is er;tety Jrstead,� �rLa.t the of4�::e;J�r phene of ty tradibonal rnau If yn�; 'tavr any�a�e>t�ons re��ar:;�r:G DB�F��;_a�,�ret;acces�ibi!3ty ;;:ea,e conia:?v�,3 bveo�4as.e=a*,webmastera�dbpr.state.fl.us. https://www.myfloridalicense.com/LicenseDetail.asp?SID=&id=4EF6F766C 11 BB4�AA... 3/14/2012 ��,�,i?; ^sR l.� ?�':�.� T'.�`i �;rs(?J. ��S�7C3i�q,� �Utl��.tSr ��cx�tC.�. .B�TILDdNC�S�'.��'IC'�`,�'.�'7I�'I,SI01V� � �� tEG C?.�iS� � AIR�Ct�►I� Ct�N�'R1�,CTO�R� RA�3�l1�73"�i C;ertific�te Nun��r KU13;�12!)�:� 1Gicen�c Fx�iratir�,�Aut€� I,�sued! to: �t1EI�.�.EIt4C� JA��'V!E �8�: ��.��r,� ��r�Y�r�a�, �� x��c��r�� s��:�: �,�� wo,�� ,�: �;�� r.t1�� -�=��;___ 1s9uin�Ufffrer r{� At.osvo C,u�r�K �O'PTE17 LzNS�3,FCrz,D �tnar� ��-� t�i:�DLS noTTEU �xr�� k:.�7CE 2!d TYALLfiT -- --..'^"•----°-•- -°- - •-•°--------- - I i al0Y1 1"bl7it t'.7�Ap . j'rhl,� c�Y+3 i� nott-Czanefer.sb7e e�nd ia rev40Ab.ie f:c�z caugr� t i � ;"_'aa a�z9CZdctvr ilaCSd kerea� will btr h�ld rea�xZ��}y;,d �tor ail. permits SO�u�d q�dqr triie aard �f Chil� crud �,p( laat or ,�rs7d�, ndtlly �. m Hi2laborot�g;� Co. Contraat7r � Licer�aing Team 7,nMg13 8 at t8 635LL'33478f7309_ ! �Y'�uY Wrd mue= bE � �ewe pri To Che raki6rt 3m1_e ( !ahawn nn t.he �rc�n , � �° ( � � .�s a z - no s aigrapa----. __._. � � _•• .•_--- - -"C16ylTSp'2'Cl1'CE'uF L't16�f�ES�y � � BISL7[,a9vRL'�faY. COCtti2z� &'WJ3tdDA � � Type,lzEC; c7.�+�& B AIR/Ct�iD C�T.itAC1'6RY � � Nf1 6�FiRMI!' CfiT�'TL S'SA�'B R�Y9T8'tt�Lr, x}' AP�;CAEILE � RA'L3067d"r7 lii/31/2(S1� I ! Ca�t3flcate DFa. @.xpirati0aa b+ata t � laauet4 T�; � � CiLT�ASlRZ7�tb �A.t� s 9 �H71:31►Ia4 CCNTR7►T 1#,��.' S� HY.ATT:fy 9i'7P�C LLL i =�� _ �JJ�(///�A�Jl'/V/`�� -` / � ��'°�� ' 4� }f�� M/DD/YVYV) � �_�� CERTIFICATE OF LIABILITY INSU ANCE � �y 3�2 �2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA I'IOLDi3 - CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE'ffOLICI BEIOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER�$)jQ,UTH IZED 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 tertns and conditions of the policy, certain policies may require an endorsement. Astatement on this certifcate does not confer rights to the ceRifica[e holder in lieu of such endorsemenqs►. PRODUCER NAME Buhl Insurance Agency Inc. a"c°.No,Ext 813-876-0057 arc,No>813-877-8540 P.O. Box 152698. - ADDRESS Tampa, FL, 33684-2698 INSURER�S) AFFORDING COVERP�GE NAIC# INSURER A OHIO CASUALTY INSURAIVCE COMPANY INSURED JAIME CENTRAL AC & HEATING INSURER B SPECIALIST, LLC INSURER C 16825 TAYLOW WAY INSURER D ODESSA, FL 33556 INSURER E 813-601-0643 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE f=OR 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 SUEIJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE P.DDL suea - LTR INSR WVD POLICY NUMBER (MM/DD/YYYY LIMITS ) (MM/DD/YYYY) GENERAL LIABILITV EACH OCCUf2RENCE $ 1 OOO OOO X COMMERCIAL GENERAL LIAB�LITY PREMISES(Ea occurtence) $ ZOO OOO ICLAIMSMADE �'OCCUR MEDEXP(Anyoneperson) $ 10 QQQ A BL053720540 03/05/12 03/05/13 PERSONAL&��DVINJURY $ 1 QOQ QQQ GENERAL AGGREGATE $ �Z�OOO�OOO GEN'L AGGREGATE UMITAPPLIESPER PRODUCTS-COMPIOPAGG $ 2 OOO OOO POLICY PR0. JECT LOC S AUTOMOBILE LIABILITY Ea accident $ 1�O/�0 0 IANYAUTO BODILV INJURY(Per person) $ ALLOWNED SCHEDULED BA053720540 04/03/12 04/03/13 A I AUTOS CI AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS $ (Per aa�tlent) $ UMBRELLA LIAB OCCUR EACH OCCUf2RENCE $ EXCESS LIAB CLAIMSMADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY �,�N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N�A E L EACH ACCIDENT $ OFFICER/MEMBER EkCLUDED� (Mandatory in NH) E L DI'sEASE-EA EMPLOYEE $ If yes,describe under _ DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ HILLSBOROUGH COUNTY 5015271 02%11/12 02/11/14 $5,000 A CONTRACTOR'S CODE COIdPLIANCE BOND DESCRIPTION OF OPERATIONS/LOCATfONS I VEHICLES (Ariach ACORD 101,..ddtlional Remarks Schedule,rf morespace is requved) Job Location: 5925 18th St, Zephyrhills, FL 33542 CERTIFICATE HOLDER CANCELLATION � SERVEPRO OF TARPON/WEST TAMPA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 13911 W HILLSBOROUGH AVE #306 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TAMPA, FL 33635 ACCORDANCE WITH THE POLICY PROVISIONf�. FAX:813-854-4059 AUTHORIZED RFPRESENTATIVE - erved. ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD Jd::FF ATW,ATER S 1 A E t UF" rViR[I{JA G1��FkTiANCWILd�FiG6R DEPARTM�NT' OF �iN�►NC1AL 5�tVICES DIVISIOM OF WORK�RS' CDMP�SATION � � c�rn�ca►� a� ��rroN �ro � �x�a�r �aw� �.eRro�► wo�s� ca��sA�ncuaa �aw � � CI�NSTFtUCT1QN INDUSTAY EX�IIAPTION T�is certi�ies that thg irnfividnai listed below has ei�ted to he exempt fram Florida Workers' Campertsa�fian law. �FF�CTIVE DA7E: 01/72/2411 �XPIRATION I�AT�: �7111l2013 �RSOr+� �a JAnul� P�EIN: �fl829�5A0 �USINESS NANI� AND ADDRESSc �Ail� CEKi'RAt AIR GONDtTI01�lIER A1� FI�A�'IN�r �PECxAI-IST U.0 �!8825 'i'AYI.GM ftAY d�QESSA FL 338se 4CCIPES OP BUSINESS �i TfiA�E: '�- AIR GOIQTTlONIIM� CON'�ACTaR 2- REPAIR SERHxC� }I- HEATING & AIR COI�x?20NXN6 �� IINPGIiTAn74 Purmaar !e CMqNr.r RAO . O5�t41. F_S_. an eliicer af � carperntlnn rMO e1M�s exeMMtan h� IMix ch�prer hy �i�+^9 r �.n`��Shce nl cleerie� aodr.r �h�s eq�[nn mm� fM rec�var U+!rtefib 9Y eeepe�liee e�Mr fMie cMpter. Par!ir�M te �pf�► R�II.Od(121, F.S_, Gr1lNales M r.tetliert m � e�!aqn..- �FTiy nnly .:H+In ihn c�:npe p! �he bvNa�.ss or tt� iis�e� �n t�c rrc�n M slec�an to Iw e�e*bl. Pmso�l N CM►t�t 'M0.061133, f.3.. llNiecs o1 efeelimr � dr. exntq+� ond snrtalka�ea af r.�nHinn ta h� a�c�t Wfl be 5p�rest m �oeation iL al M!y thee �It!►t� 111tng al th. notlee ar �Oe N+�e�ee M !Me eenNione. M. p�sa+ n.nm� en n�c nnr;r.e n. a„rNF�ane nn Inqer r�nah IMe r�irenMMS el p�1s reetlon Far is�o� ol e teellfica�e. T�e dn0�e�t 1AN1 re�eRC ■ eerliltale �n wy �tnir 1•�� failRr. af mc p�rzm� rr�rnMa oe nic �1�enr a� mMt �ler. r�ep�mhs M ihls uertr�e. D.UESTION$� {R5[f1 h13-7609 rnNC•T.52 CERTIFICATE OF ELEC'C10N TO 8E EX�NIPT RE11iSE0 Q1-11 pLEA$E CUT OUT tHE CARD BELOW AND R�'�AIN FI?R �U'fVR� REFE�t�p'� S�na�aF�oa�o�a IMPORTArirt' ��.� F pyr�t to Chaprer 44Q0511a1. F.S, an aftice• af a corporarian wno f,MDIrS"!'�IL?�O�E Il�plS7'RY Q eNCCis eXemP� fram thi5 che�ter bY 'Filin9 x certificate nf eler.tion �R'r�ICATE 0F B.Eet1oN1'Fd a�F.�MIP1'FRo�FLORmA L aMe� this section nroY ►mt rceover ber►ef its o� cemper9at'on urn�Fr th;s wa►mc�'cotAP�a1Ya+i.aw D chepter. . EF•'FEG7IVE: 01/12/'1411 �XPIIlA'TxON pATE: 01/tt/'�013 p��yp�� to LTIBP�► 444.45{721. FS. C¢rtifi�-s of election to be P�FiSOPI: •!A� ��'EitO H exe+nOt- �PP�Y mily within tfte scape of the �usinass or trixle lisi�d m, 208Z9A54Q E�fic natice of etecNO+� to bc exemat ��nr. R ��E�� r,�,�r; �p�� m (�epter �1�40.05�iS}, P.S, NatiGCS oF aiecrinn to be exempt .i,�,e,�E CEUrrrni a� col+DmoNIEp iwo r1�A'rv�G sPEC�ntts'r�.�.c a�d eertificeAes of Ne4Kion to be exempt sPali bc subj¢c't ta reunr.ation �g9xs Tnv�ew wnr if. � any tilne afSer fhe firx►g at fhc natir.e ar tn� fssum�r.c af the dc�ssn. F�, sassa eertifieate. t� peYSOrt r�arned on the aotice or certlficnte �I� 1n11qEr meFts the Peq�'ttlenedtS Of 'IMiS seet�on fo► i55venCe sf 0 certifFCatr.. The Aepertr,ront ShPll re�oke a ce�'�iffcate at anY ri�e fot Fail�ne ot thc Si:�PE OF BUSINESS OR TRAD� persen rAmed an ehe eertifi�tc to n,eet tfie rc�ui�mments ni thi� d. nm cornsmotiMO ewrfRAC1'AR �- REPAIR SEA� sBCtion_ ro�snowsr �aso� ��3-,�os .- r�nrwc a e,�n ca+omonn.o �-- CIJT HERE * Carry bottom portion on tt� ��6, ke�p upPor pa�oft for your recarn�s. Dw`•y�252 CERTIFIGA7E 0� ELECTION �0 BE EILEM�' RErn5ED 07-1Z ru . , \ W '�' � � R m O I--�G t-I N r-� � � � m � b a1�� 7 ' Li1 W W 1"l � � � � �. Cl]ltiL=J p4 v' W10 � ��i � � � �W � � � �H47n u' °o o ��m 3 A� C"�[i""=]'iry�J W N Ci � � �'g ' C7 ' [-�"�1 r�yy � "'f��' S2. N � lrf� r�y fl. � �� rO O tJr�'Q` d � �� /t W �� .� !d ��y� N rl � W � � �� . � � � � G � � $i,y �P 8 0�� t" . �" ��' b.?m � "�' [� �6 m W � �-�3 �;�$ � F,�� o F-4 _ � �C" � "'$ o 41 �,N�, g'�3� N � °'�5' O O � "� a1 F' "d � 'a s L�] {]'rd a �� -+ � w W N � �� a�'' -� co � o ��" o � .m CHI] Cd � � S!� � � 'P r �R °' ,3 p � tl�D g� � �3NCa a'. �= a �°� m a�� ,s�P M w �� m w S� ;� w �� o K]'0] G5t � � v r t�]q m [9� _ �� p? ��g � t''1 �! �-• ° h7 W{] a �¢3 O p�'�p'� T'" ��" F.-' N�� 1 -- r �,1 r- Yi y.' �� N ' .� �� iz� �ti:,i!,,. � - 3 � --I .....` :�4 '� .- ' ��'' � � �� i!'� �- S,� �« i,- .�•�� ', � � �.` m �:�,f V: — j � �.e '�� •, I�- '�1_' i Iti� N f9 , I,f �' i,J 1} r I� :J Q��--� t�� '�� T _ ' � .. lD C7 _C.. •�^ -- � — '!' r� ;i'i :� ('�O .. �-Yi �rt.'�d.:. �,^ � ,� w�C' - `ri��; . . ,y�yj t�s ;� "�� N , � '�..�.d r 5T 2.''�Ir.1" ..3 �Ga a� r m ? � � O� � C]N Q L; �—m Dz ..a �n � `; m� j v t fIx tnQ py � � $ r"' y z�, o +cs � � � ° s' N � � � � � , � m ��,v4� a� op r' _ % ��/� mwDC�vt �W m U� Y � �// �Cil 4b.� �JS � i '° pDrm �D y, Q � � � 'n�mXl wr�- � � • � g " c�aon� �a c) � ' C o ��„e�� o us G] � � �`�'�m � o m � . - f � �� c � � z m p � � � z n � a b C - � m � � � . � � � • � m � � i �N O � O A � .Z7 � � ' m � � r � y�� ti r'"yc w� �; , st"--� �wX 4 m N I �On � � � � z n � p 0 � r � � p "��. � � m ti a s � ��, °'• ,� � o� � � ��. �- i m � � '� �m, N �y � � j� � � � ' a � x C? � �� N � . �� • ,,'. �� "' � ns � ,, 1 � �� ...s b � O � � o � o� o o Q 0 DBPR - DENICK, DONALD J; Doing Business As: BILLY THE SLTNSHINE PLU]VIBE... Page 1 of 1 1 48.38 PM 3/14/2012 �.ICQI1Se� Detc"�11�5 Licensee Information Name: DENICK, DONALD ] (Primary Name) BILLY THE SUNSHINE PLUMBER OF ST PETE INC (�sn tvame) Main Address: 6335 HAINES RD N ST PETERSBURG Florida 33702 County: PINELLAS License Mailing: LicenseLocation: 11000 60TH ST N „„n�l a� PINELLAS PARK FL 33782 �'�� d Count ,r/�� Y� PINELLAS � �, f ��tr i,, r License Information � � ;� License Type: C,ertified Plumbing Contractor �1� � Rank: , �er Plumbing � /�� \ �y�p� � License Number: (� C058073 � �, , c�� Status: Current Active � � ` Licensure Date: 12/06/2001 � �� Expires: �8/31/2012 Special Qualifications Qualification Effective Construction Business 02/20/2004 View Related License Informatian View License Complasnt Cantact Us :. 194t}ryorth Monroe_Street,TaElahassee��32398 :; Cail.Center;adbprstate.fl.us '. !�ustorn?r Cnntar.t:..?iat�f £'•S�a87 1395 !ne$tate��f s-'on�ia i,.3n AA:EY(i ernnleyer Coovriqhf 2007-20I0 State of F[orida Privacy Statemeni �.;nde� =lorida':ava e-r�iail a6dre:,>e>��put��ic�ec�ids.F`y<;�do i�ot::•arrt•r�ur r-mai�address eleased�n res�;en:;e E�e a �EUb��_-recer::s reques' d:r rn,!>en�,rieri„i,c ntril t: �hi5 er;titv Ir;st:P,�d,�vi:3acI.IY�Y OffECP.:lY 15hene Cr hY t:ra.lilic�r�31 ma�: if a�,i, navfl ar.y�.uestions rega-C:n:�^C+af�;,:�- :;�b nc_essibil:i;r p:ea;e cortac*.��r 41e��'�tas:ef a*webmastert`�dbnr.state.fi.us. https://www.myfloridalicense.com/LicenseDetail.asp?SID=&id=1 FF 1 DCFDF261 FAC�C71... 3/14/2012 To; 813J800021 From; 9olly Spanglet _ / 9-13-12 3:37pm p. 2 of 2 V Aco� � CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DDfYYY`� `.,.��" 4/13/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CER'i1FICATE 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 BE7WEEN THE ISSUING INSURER(S�, AUTHORI2ED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certiflcate holder is an ADDI710NAL INSURED,the policy�ies)must be endorsed. If SUBROGATION!S WAIVED, subJect to the terms and conditlons oi the pollcy,certain policies may requlre an endorsement. A statement on this certiflcate does not confer rights to the certiflcate holder in Iieu of such endorsement s. PRODUCER �ME: Barbara Norman 3olace Insurance P�� . (800)915-0969 FAC No: �800>915-0970 10125 Ulmerton Rd, 3te 200 .bnormanQrestinsured.com INS S AFFORDING COVERAGE NAIC• I,argo LrL 33771 irisu�Ra:3tarr Ind�emni & Liabilit Co iNSU�o iNSU�R s:FUBA Billy The 3uashiae Pl�mot�er of 3t. inisu�RC. Petersburq,=ac DBA Silly the Suashine Plumber i�u�o. 6335 Haiaes Road INSURERE. 3sint Petersbur FI� 33702 INSURERF. COVERAGES CERTIFICATE NUMBER:CL1233001324 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOUV 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 VMiICH 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.LIMffS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L7R TYPE OF INSURANCE POLICY NUABER MMLICY EFF MM�1 XP LIMITS GENERAL LIABILRY EACH OCCURRENCE $ 1�OOO�OOO X COMMERCIAL GENERAL L WBILITY PR MISES Ea ocaurence $ 5O,OOO Pa CLAIMS-MADE a OCCUR IPGGL00136-01 �2/2012 /2/2013 MED EXP(My one person) $ 5,��0 PERSONAL&ADV IN,AIRY $ 1�OOO�OOO GENERAL AGGREGATE $ Z�OOO�OOO GEN'L AGGREGATE LIMIT APPLIES PER PROWCTS-COMPlOP AGG $ 2�OOO�OOO X POLICY PR� LOC 3 AUTOMOBILE LIABILfTY Ee acaderd ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY MJURY(Per ecc.�deM) $ AUTOS AUTOS NON-OV�NED PROPERTY DAMAGE HIREDAUTOS AUTOS Perecaderd $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSA110N X WC STATU- OTH- AND EMPLOYERS'LIABILITY y!N ANY PROPRIETORiPARTNER�CUTIVE E.L EACH ACCIDENT $ S OOO OOO OFFICERfMEMBER EXCLUOED? � N�A 0642792 /1/2012 /1/2013 (Msndrtory In NH) E.L DISEASE-EA EMPL.OYE $ 1 OOO OOO Ifye s,descriDe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1 OOO OOO DESCFaPT10N OF OPERATIONS 1 LOCATIONS!VEHICLES�Akech ACORD 101,Addkbnd Rsmvka Seheduls,if mors ap�es i�requiro� CERTiFICATE HOLDER CANCELLATION (813)780—0021 SMOULD ANY OF TNE ABOVE DEBCRIBEO POLICIEB BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Zephyrhiils Suildiaq Divisioa ACCORDANCE WITH TNE POLICY PROVISIONB. 5335 8th street Zephyrhills, EZ 33542 AVT�wZEDREPRESENfAl1VE Robert Childress/SPHO �.rfi�� ACORD 25(2010105) e0 1988-2010 ACORD CORPORATION. All rights reserved. INS025�zo�oos�oi The ACORD name and logo are registered marks of ACORD To; 8137800021 From; flolly Spangler 4-13-12 3:3Tpm p, 1 of 2 Date: 4/13/2012 To: 8137800021 From: Holly Spangler Subject: BILLY THE SUNSHINE PLUMBER- Certificate T0: ZEPHYRHILLS BLDG DIVISION Attached please find updated current certificate on behalf of Billy the Sunshine Plumber of St Petersburg. Thank you, Holly Spangler, Commercial Account Manager Solace Insurance 10125 Ulmerton Road S#200 **PLEASE NOTE NEW ADDRESS** Largo, Florida 33771 1-800-915-0969 x174 Fax# 800-915-0970 hspangler@restinsured.com<mailto:hspangler@restinsured.com> www.Restlnsured.com<http://www.restinsured.com/> DBPR- KUBISZYN, LESZEK MIREK; Doing Business As: POWER PHASE ELECTR... Page 1 of 1 1:29:08 PM 4H 1/2012 Licensee Details �� (��,�C� � r � Licensee Information r A ,� � ��,1�y �.��,� Name: KUBIS2YN, LESZEK MIREK (Primary Name) � � ��1 POWER PHASE ELECTRIC INC (DSA Name) '" C ne 2 � Main Address: PO BOX 3219 i ��" HOLIDAY Florida 34692 `�`�(j'��(��r`�""� N,,.�'J County: PASCO G(� �� t) �� 1 .� '� ,lt License Mailing: � � lL ��J� t1� C p� LicenseLocation: 3523 COVINGTON DR. HOLIDAY FL 34691 County: PASCO License Information License Type: Registered Electrical Contractor Rank: Reg Electrical License Number: ER0015219 Status: Current,Active Licensure Date: 06/23/2000 Expires: 08/31/2012 Special Qualifications Qualification Effective Pasco View Related License Information View License Complaint 1940 North Monroe Street Tallahassee FL 32399 Email Customer Contact Center Customer Contact Center� 850 487 1395 The State of Florida is an AA/EEO employer Coovriaht 2007-2010 State of Florida.Privacv Statement Under florida law,e-mail addresses are public records.If you do not want your e-mail address released in respcnse to a public-records request,do not send electronic mail to this entity Instead,contact the office by phone or by traditional mail.If you have any questions,please contad 850 487 1395. https://www.myfloridalicense.com/LicenseDetail.asp?SID=&id=F90DCE2C6CC20F 1319... 4/11/2012 . � -- -._..� .__ �. --� -- --� --� . � � � � ' � � - � , .� �, � � � , � � � � � �� ; � � � � � � � � �, � �� m � �' � � �� , � ....� � �- � �.'�'� o � `� . � � �� g�� , � � , � � �_ �� .{ � � � � j t+`� � � � � ;�'� �, ,� s � : -a •\ �+�i Ct �.n � �� h3 � � � $ fA i ' k 3��_v7�, �3 �� 2 �' __ _.. .._ _.�.�� siw �,�e,��,�m��; - a�r�c�aaPUV c,�c DEVELOPMENT REVfEW 3ER'JICES{7EPT. �* • C�NT'f�ACrOA LICENSING CEFiTIFIGATE OF CDMI?ETENCY ;:;� ��; I.D.# �� 17#E� _ . s� ��r.-sna '� 8e it k'nown tha�„ ,� �''.� 4��.G.{::' ' , E�EC TR Y C O 1 '� � �l * ,. , C�'C1 PC]WER PH � _�L, � ., ." �5�3 �O�tT • N DI�• R . � < WOL i LiAY �...� . ' F'i,. 3�b"-r�' 1 �UNDEti SE�. 18 PA9C0 COUNTY GODE HAS MET THE PROVISIONS FOFi A CERTIFICATE �F C�MPET�iVCY; � EXIRIN • . .• 3 , ' ` - , �t�'.�.. ��t � , BUY�,DI ` r .DJII�, �'�� t/�d «Z848856[ZG aIa1J3l33SYHd?l3MOd fiZ'£Z 60-4Q-ZtGZ 2�12-=s4-0�23:30 ROw'fR Pt±ASE£LECZFtIG 7279388482}� p 1/1 $TATE OF I�LO�#IDA � bLP11A'x'M�'1' U�' �UStI�T�$$ AND PROFS�BIQNAL RS'4�UL11TION �LS�:T��CA�, CONTR�C'�'aR8 LICBNg�Nt� SOARD (6�50) 467-1395 ' F19�0 NdRT�1 MoNRdE ��'RS�T !� ��►r��r,sss� �L �33s9-o7a3 R178I ZYN L� !� IR81C PO xB3�S9 �L�'��YC INC FIOLI Y FL 3469Z , , �� . ... - - _ ... --� - t _ . �� ;� ,� .,�.� ti f,�.. _ Cong�lufstionsi WNh�is lioer yGla twcOntr �f enca m ; . ��,- . �'I.'�,��.�`�i�"�• Floridlrns il�ndhu tM��y,��mmnt Of 9usinps �d 81i R 'on. �' ;"�� `, ;,,, r �7 'iv}'� .6' � �. � + ,�"'��:. Otir pFoieedonal�and��elns�ebs r+�ng�firam� brdc � om } � ,S� ,*f ��^-rr��,�"�: �K�I'6;0 bOf�1Ji 1'��ILIf8�8��f%�1}liy kYO��I I�p01f t${(�pf��, :ty�� ia�'i,ti. ,•,i,.,;r `� 4 �v•+ _'�,� ,�; ',.i,�;!}:.'�•�' .� � �..-,�f,/,�,�, � ; *, � �, �VEify d�y w�i�'k tb i1YlprOv@ the W8y vt�A d0 bUSinaaB IIt wder to oNVe you better r �+'- � "L3��'�`� `��'��'"��:''"I �'ar�nforrr�adoA�ab�t auraaM 8 pl�aae�op dnto www.mynarwsNc�+�e,com. .;� �� - ''" ' .,�. -i{Y� There you caM flnd rnare 1Mo on et��o4t bur dhrintqrfs snd the requ{�tions that ��' �"4 i �mpact you,a�bsaib�tdr depa�nieM n�wsle�e��nd Isaim mare abaut the � '� 41�`I� ,��'"'�� oapanmeM'a,Inib�tiva, ° .f,;�'� r �� •,� .��'V Our rr�fa��t thA L�pe�tmint{1s•LIO�hse�'ffi�ntlY�RpYlate F�; We �' I . ,,,;�';�.�'�'.�;�'�.� oonsterr�y�trlw to��rv�yau b�tt�r w that you c�n-�erw your c�s rniKB �r'� ' '• w}. '.;,.. ,;-:.�;f Y,<"�' ";,. Thank you 1tr dang busu�sc ip Fbrid�,��d congraRukatlOne ora y r�sw lioonse} �• :. ;�, ., ,^. � i �y� `4 �'�tr.� ,+� L.Y� ��^i4„ � .��j�*,,;, `i u�, �4' t��5�• ` 'a�,3; �.ti::. :,;�'� ' # �;;,y �., 'y:, '�'i:, ,..y:^-'' � ' � _ � � � � _ �•--.�-----� - � . , _ .. ,_�. .....DE?AGH HE�E _. ... - , . , : ; � �; , � �---. — z � _ 'r. � '?�i� .C'c1)' :4. �.`% •, ,.h... �.�• r, . .. r '$'ti:,�{.� � y Je.. ��, �t, ,�1;.. . %) �!� {. � �,�'•?""` -�c ,i �- �,"�' ,,.. �.� . .' ,. .�i��7,• � : ,r�!w, v'� �• � � ti'�� '�"'+r{w'.., �q.::c' ,.r..�.�� ';?R`)��1i�;tly � .�;�'=� ,��"'�-�. Sk.(��..�t1'�lY'9i:,.��4'ii:,. '.,;V'.:C ,vr, . '',fr' ;e��'j,� �r ''i '�":�� '� �.. .�,. ,�..,�'' �, !y.�. .��qt•e �.}ca';' �r, �' '.., I. '�' "'V. t' � i+W M ��rl�,;47� r p`I t'� •�' ��I, ':t ��. •1.i � :�,�� a, Y� �rp ��ySrf`�/ tt 3 „��.�r(��+•• 1 J 41�'1 � d�M � ;h4i,'M�W'iA,.'.x5� �H. 7yM 1�+ ,1 ,� , n �� ',� �r � � f � �p^,'.:' �,�� '�.ILL�.,lSwt f „}4. t; ��ny��t.� 'wl i, ,.i � .� i;f',L1'"1� _�;�_ +� ,��, .�.�1> 4i r", �v;,'r. �4�.� y, h,;�'�``.*;"' 1g,yr �,� .,�;��;y.�7'iyl � ei:•.�,. �3.� k. � . � ��.,`, :,�;., .�, ��,�F JZ •, :� �fi, '. ��;, ��!a%'` '.r�.., �Y:. � �' .. ,.r,�..,.. i �� i�:�"kr� ,��. � �til�' ,'F�fl'!'�Y"•��` !�' , .„k. .1�. , ti '�?/' ••?• � • — ��+��'.� *l�� ;� ♦�, ;�.�'.i�\ ,. ��,i�»I.'I, +�aiY ; il�' ' - ",r, '�i,�'��`�n.r �c''c.1.;:.,,,','� .. ., ik,�y��k';r'r,,.', : Q, �'�') /�. r ` .'S:�^ �.'.;:;. 1 ��+ax. �..�iF"m �.'c.�:"'.''�;+�4��/�+. �+'. ; � ��l�_• ._,�l• ��,��, : �c. '�'o} +�A�' ��f�,� �k, :?''�t� ��.},� .�'' ,,i, i, '; ', � }''�';�' W��.. ' IIIR, }r� ... .y ' _ '„� ��;��)u�y��.,, , �.:w;.�.�y * �r�,f� l �Nj�'��x��,{�,�f�� ,{}, :��^-�k �'• atF.;:�c. ., .;, c.� �F�Y'•- (�-u`��-a. ..;� 'i ��y� ��,a .�� r �+..:��,,;�,:;.,�,.>; .,.r;�,,,��:��'. ,.�� . _. : .p 'i �' ..� .+�:1.:(�"�;��k�� ",' �;Gy y�:i��N�� , t:i4. .+:!'!V�. i�,,` � .R �-• � "�� , J�{,� + , .,�� k�F �r�I' hr'YiV a'•J""'„��u �r:�" :.�� .} -�'�,;�� ILL'5�;:..�� n�� "-ry!!�'f/`y.F� ' h It }�'e,: , ��,,, r� .r; � � � �:G��.1,�" � ,:f, "�', :�'U, y.. '•a'� i�i,'�,; � , • � i ,� r '`{' ,«, . �' � �F � , .r� ,, .;4 ••�� r' x. .}.' �J M�� ':�. - °;., .5� ,� . .r� �,t�►`^• �;�. `';��:�f�7�);�.- . , ��;; .� , ... .. . .•.�A ;;, , �� ,. � , '-�� , ' :�, ',: ��.• ; ��,- � -f)',.Y ''�f)�,�y'�� _, r,� . iwt*y•.. 1„ 'Y� �,1 ,r .� >}1.. ..� — �.�..�� ,�j• ��.+'' �' i!r�yi�',•�. �.�n-, '��k'�1:�,. 'A, C�Ca.�,�":�.� ..i� ti��; � Li. , Y �:�t�� ,.�f; � i'L� ��k i. i �ik. i '1 � '' � 'i � �, ,��. .}�`,,. . � �� f ;��' � ' '. �� -.��,}',r.1q? �t}1�"��' ;'� �:t� ;'�� 1 ��l `y�'!�y i K�� y � .� � �� fF •l ��yr{T� t,y:i ^ f .�A1 t,,'Y`, t '� '� i I, 'J.. � � +�i � , 1 .j.4 . � �V�� — ___�i,�,�— •��•.i.�. ,f x '� .�� 7_G1F-U4-0523:25 POWERPNASEcIECTRIC 727�3884$21� � ��j� 07-'15-Z010 ALEX 51NK 57ATE Of FLORtDA CHIEF�iNANCIA40FFICEk DEPAiiTMENT OF FiNMIGfAL SERVICES DIVISIpN QF WORKERS' COMP�NSATION � * CERTIFIGATE 0� ELECTION TO BE EXEMPT FROM FLORIDA WpRKERS' COMPENBiATION LAW � � CONSTRUCTiON INDUSTRIP E.XEMPTlON This cer4ifies that the individu�l listed belnw has elected to he exernpt fir�m Florida Workers° Compansakian law. EFFECTIVE DATE: 07/1d/201d EXPIRATIpN DATE: 07/14/101Z PER&ON: KUBI3ZYN LEStEK FElN: 6936x�i��'I BUSINESS NAME ANG ADDI�ESS: POMER PMASE ELl�tRiC tMC 3aza cavinroN oa . fiDi,LDAM il 34891 scoPes o� aus�NESS oR T�►a�: 1- E�ECTRICALI ELBCTRICIAN IMPORT�NT v�reia�� a CMpler ��0 Q6fi<}, f.9.. �e ei(ie�r d � c�rpar�tiu w�� elscn usepiion fr��b tYls cbP'�r by Fill�y � car111iuir ul �lecliaa r�drr tWi uctlon �n�y �o! ree�r�r M�ellu ar cn�n�eo+n��n aM�r qb e��qK I�rw�� t� G��p�er f�0.0E1121, f.3., Certlllcrt�s q Nution ro br erMpL„ �p�ly only wIMM M� scapr oi tM• bril�u+ Qr tr�N II�w an IM� �uler ol olaUea to 10 iK��M. /r�rer ro C1�pur ��o.oWt9Y, ►.s., Nuie�t �I ■I■qioe Ia Y. raM�ot MO urllNnin M ■lalio� to ba rarspf eYdi be srb�rcl ro nroc�Nsa fl �1 ry t4n �ka dio Iilip o! tMe nat{ce or tM i�r��re d fu c�rtiituu, u� p�ru� uM,1 on �e� �e6r� o� centiiui� no �pAqu ��N� ths nqulty��nlx of t11i +atlon !ar I�wuce o} � ontN�c�te, TOe kfvt�ent �M�H nroYe � :erUlitne �� py +i�� fa luWie e! ihe peeir n�eN ar t�� NWiI+Ktt� U muo INa reall�on�reis d' thiy s�oNOn aUEST10NS7 it5Ql 4t3-1f09 DWC-152 CERTIFICA'E 4F ELECTION TO BE EXEMPT REVISE� 09-06 PLEA5E CUT OU7 TME GARD iELOW ANQ RETAIN FOR �UTURE REFERENCE BTATE Oi FLORtDA D!'ARTMENT OR RINANCIAL�tRVICLi F I MPQRTANT aivuwNCFwae�es'CdMPENSATION p��su�nt to Ch�pter 4�D,051f�), F.5„ an atticer of a corpontion who CONiYRlJ�CTLON I1�ISTRY �elects exemption frern this ch�pt�r by fi inp � ClrtifiC►t� of elac�in� ClR1'1/IC/hTL ORlLlCTION TO�E�JfEMPT FROM FLORIDA �- under this section m�y nat repoW� �l��litx ar camC�ensetion under this wOltic�lS'COM�tNiAT10N LAW D chapter. EFFECTIVE 07/1S/Z010 EXPIRAIYON DJUTE: 07/14/�O1Z pyrsusnt to Ch�pHr 440.OS{121, f.S, Ceftifir,�teS ot eiectian to be PEHSOPk LESZEK K1JfISZYN H exsmpc,. �►p1y on�y within sh� scope of the busine9s w tnde liated cn FEW: i��Zfsa1 �the nptie� of yltction to be exempt BUSINESS NAME AND AD'JFiES�: E Pursusnt to C1Npter �40,45(13), F.S., !4ot�c�x pl el�Ctipn to 6a �x�mpt POWEII PMASE £LEtTXI[ IMC end cerrifiuees ef •qetiqn tp b� eRempt Sh�II bt subj�ct to nvoc�t�on 3l13 [OVIN1qN QR if, n rry rim� �ft�r tht tirinq of tAe notiee ar the issu�ce of the No�aNr, F� a•�y, c�rtilicet�, the perion rs�med on tt►e notice or eertificat� no Ipnplr meets �� rlquir�mMtS of this �ectbrs }or ieswnce ot a certNionr. TM d�p�rtm�nt ihall reroke � ce►tifieete at �ny time fDr 1Nlure of tha SCOPE dF BU51NE55 OR TFiADE: persan n�med en tht eartit;ptR to mee� the Y04�+�Om�ntS �f Mis i• ELECTIUGAL/ ELErTRKWH eaeti�n. OUESTIQNSI (i6�! d13�1$09 cur �� M Grry bottorn pvrtion on thv job, ks�p uppr�r portion fo� your raoords. owc-2s2 cEpriFfcnr� 4F EIEC?!ON TO pE EXEMPT REViSED 09-06 20r2-�b-iG OB.F4 AO�VER�'�R5�ELFCT t;lC i 27938S4Ri�;» p�)1 z � � �� l � " �' • �� • a � Ui ti � L� � ." � I � �� W�i � �a�' � � Gd1 � �� Wffi� � - � d � ¢ � , � � � � a � � � } � � � ~ �� o I , � �o ` � � � ��U � ~ t � � ~�`� s Oa. �E m . x ,�� < �� o � � � °� � �111 � �� r � � �� -' _ � � � � . � � N w � o � � � U �f! Y � � � � � � � Q ! � � � �t� � � : z � W� Q � a J J t x� 2 � � �� a�� r� .. ,� .. � °a � ........�..._ ---�...,....._..,.�..� .�.,.W _, �� =��"'�'-05-�G�1� 1�'`"' F.i�=,��.�"F,p, I.J��IRANCE N_7E��C1` =13 �81. _,-,�:+E, � --.. c'�. �.�c�c�►r�ri7, C�RTIF1Cp►�'E CIF LIAE31L1TY 1NSURANC� o�0�,�3, ' �......- �-�'- - .. THIS C�R7I�ICA7� j8 18SUEl AS A MATTER OF INFOitM1ATi�ON �NLY AND CQNFEM�S NO RICsMTS UPt7N 7HE C�RTIFICIA'"F I�GI_UGR YM� CEC1TIFtCA7E DQES NOT AFFIRMSTIVEt�f OR NE�a3'�V�+�Y AMEND, �XTEhID Cli� ALT�R TN� CQV�RACiE pRFORDECI �Y THE ��i.I�t�S , 9ELOV1'. Th91$ CEfiT1FICA'ff� t�F IN3URANCE �U�B P30T C;ON$TITUTE A CdF)TRACT BETWEEN TF�1E �SSUIlVG 1N.�c�R�Rl�a1� �U7��i2�D R��R�,ENTATIVE 4R PRODUrER,AND TH�G8itvlf iCATE N(7LDER• MI�ppR'!'ANY' 8F thr cerfJfi�h01d�r is 1n ADt31FIC�NAL INSURE.D, tne poticy(les) must ba endorsed. If SUBROGATlOM tS �hJAtVE[3.arsb{ect ta ' „ M �e��.and co�aitC6are of the Poticy,certain poqcl�x rnay rdquire an endoraement A atatem�nt c,n thls certlflGate does not ca��r rtght��tha! , � COrf3flC8t�s ha'�d��n fi+u Of suGh 9ndaPSemont S� ,M., r�cr � �ooucwe $1�-636�4Q00 �►a,�• .. ----.. ..—_ F _— , „ iockman insurunce Ayency;ir�c. 813-281-10R on� ____., _, .,_�._._N�L._ _._._.._--. t38 Colwei!Avenua � `�_ .�„ � �mp6,FL 33b�4 Aoo'��s�- __ , ...+�._.�.._...Y ___.__,_�—. 3oeklr+an�nsu�nc�A�enc�r��G. INOUR�)JhPrORDINQ COVEMGE�.^�_ _�_Nl�q � ir+su a��:Hanover In�urance Com an '�� , _.,._L'L—M...�. �uuseo �p�wcr Phase EleCtrlc�IS1C.V ._._._�_�-- INSURER9: �-- . __. _��_.-,. � Leszek K�eblssyn �NSV+ceN c�,�. . . . --.—• --; ' ' P.C?.@ox 3219 iNSUata o: _ ..�_, �_� . _�-__. HQ�ld�y,FL 3�692 ' � �NSURik e: �^-�_ �—�,.----- °� .. ,_ �.`_�_�..�... i SURER F � �'C�Y�FtAG��_ �ERTi ICAT�NUINSER: -- REViSIOk N MBE ; , THI$fS TO GER?iFY THAT THE POL�C�ES OP �NSUPAwCE I.tSTED BEt�Ow MAVE BEEN�S5UE0 =b TH�iN�SURE� NAMED ABt7L'E FS7R THE PO�iC'�' pF�taD;' ', • INR�CATEO. NO'�tM7HS7ANDING AN�' REQUIFIEM�NX, TENM OR CflNDITION OF ANY COhiTRRC�� oR QTHER DOCUNEIdT'wlTli R�.SPECf T;7 tNHlCH Tt{I� CER71F1CAY£ A�IA4' BE �55UED OR hAAy P�#iT�IN, THE iNSUftANCE AFFOflG£p �Y THE POUC�ES OESGRIeED HER�� i8 SU��CT �D kL'_ TME TERM$, EXCLiJSION$�ND CC7NDlTIONS Of SUCN POltC1E8.LlM17S SH031JN PMY NAV�B��N REDUCE�BY RqID CLAIMS . �_�„.__V _____. ,"' �� TYPE OF INSUMq� yV--POLICV N M9�1 � Wf IM��ODfYY'1�T1�� ^ L',MITS_�w ('�pA�{ALL1ABIlITY � � � I °aCMG'QC:IRRENGE I 3 �� ''—� i LNJA1011M101 � i➢ut107/12 j 04107t13 �'��J �.�s _1�.,,;,_ A I aC CGMMERCIAI GENffR�.A�l.�IABI_trY I, i ` F P�`��5��`��``--�' F_�~� CtAlMlS-k�DE �,A 1 OCGUR j I � tmEO FJt�4n5 a*�e p�,rc?^_.._r� � . �" �---�� I I II PER30NRL 8 Afay li�'.iVRr I S '� � � .w.�_�. .., i � �RAI A�GrtE�arE �� -.._..— ,' '1� � --° � I I I PYROO't1CT$'C13MPPIOP AGIi I S '{^i pQ �: � 3F,N'LAGGP.�IG�T£LiMf7"APPI.iESPEF' I I j , -.•-._�•�- --�_.�.3 —� - �� - INED SIN�LE IMI .,v�� -.�.��-� P4�I,ICY 1�,�i��^,�f I � LOC - I I�r�g ntY __��,.---__ I AUTGIIIOBII.6 U�L17Y � ' I � r i � � i BGCI' LY!NJ�}Rl�Pvpn�deN %_ _.. I �M7Y AUTt) � � � � � „-�..-.��.. ALi.QWNEQ SCt1C0U'.ED � � BO�ILYlWUR�'(peracGaani1; � 'AUTGIS �A1JT09 I � � PROP� TYOAAW E�.:b--... ., � ��NON-OW1vGD � i i �{?ar acm�enU_ ----i-S , , M RGa AU708 � AU70£ — � ___ � �..�.--�� --- - ' UMYR6LLA LLiB !OCCUR � i��ACrI�CCURFiENC6 , �S ,__._. AGGREGnT� ---�,.�S _ -- EXCiiS L1A0 �CLAI�.MAD�, I � � - --'---'-_� � , 4.� R TION � � - -- -' y ATU. � OTW ^ � NlORKL'M COYPEN3ATIGM i � {AN��EMr601�f'iRt'4wpL,A'� YIN I ` J F.LIEACHI�CCIOGNT�$' .V r ,, �o,av PROac+t�TORmnan:en�6wecu-r�vE r-1�r r r! � � C�GiCCRMBMmEII CKGLUOEO7 �J I i � � DISEASE-tA EMP:O'"!EEj� __ ', t y, �Y�ndr��Y M NFi} I '" K p,tlrr�ri00 untlar � � I E 1. C�IBEA.��O_ICY�.t,tlT � �. p RIFTiON F P FQATIDNS bac --r-�°"'� , � � , I I � ! ; ` _ Ip�lGAIP11dN OF OPERA7f0�1 LCYCAiION$I YENiCL�3(dtfeCh ACOp�1b�.AddiUauii R�m�rks SdteM�ia,H mon spa�e M nW�{+d1 Fsx: ei3-�5a-ao59 t �� ` ;" � �; �CERTIFICA'T!'N LqER CANC 1.LATIQN �_.. ----- ,. ° r �,, � SERV PR ! 5HOULD ANY OF TME A�CVE DESGRI�ED�OLICIES�E CANGE�.LFO lI�F�I�;t�.:fl'" '*HE E7tPIpAT10N DAT� TIiE!lEOF, NQ"�iCE 1MLL 6E. DP.LAV[I�D'N'fix;k��: �ry�p RCCOROANCE YVITFI THL POLICY PRQVi�1A1�. � ''C'' 11266 W Hil�sborough Ave --...-____- ; � : Tampa,�L kurwo�o r�&PaG:ru�rATrve � ,, �., ;�►, �'�.�..,.� `' � � .�:,� �1938•2010 ACORq CORFPRA71Qhi. Ati rigbri rrss�r °, ....,s„'e ron�nrrex► The ACtaRD name And togo are rogisterod marks of A�ORD 'T`�J7R� P.�1