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16-17951
Zephyrhills
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2016
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16-17951
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Last modified
7/20/2017 1:00:21 PM
Creation date
7/20/2017 1:00:20 PM
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Building Department
Company Name
HAZEL HEIGHTS
Building Department - Doc Type
Permit
Permit #
16-17951
Building Department - Name
ADAMES,ADONIS & AYALA, VIRGEN
Address
5510 24TH ST
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�i <br /> ACORt�� DATE(MM/DD/YYY� <br /> L..�� II CERTIFICATE OF LIABILITY INSURANCE 11/17/2016 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. TF�IS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENT�4TIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. � <br /> IMPORTANT' If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGA�ION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this certifcate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER I NAMEACT Jeff Lampert <br /> Presidential�nsurance Services, LLC ac"o EXs: 305-423-0350 �� No;305-423-0351 <br /> 2665 South ayshore Drive#707 a oR�ess: jeff@insurancequotelive.com <br /> Miami, FL. 3ifi133, INSURER S AFFORDING COVERAGE NAIC# <br /> iNsuRERa: Preferred Contractors Insurance Com an <br /> INSURED I INSURER B: <br /> Sun Coast oofing Services, II1C. INSURERC: <br /> 843 North D xie Freeway INSURER D: <br /> New Smyrn Beach, FL.32168 INSURER E: <br /> LIC# CCC�329155 <br /> INSURER F: <br /> COVERAGES� CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO�ERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. IINOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATL MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSION AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR TYPE OF INSURANCE POLICY NUMBER MM/DD MM/DD/YYYY <br /> X COM i RCIAL GENERAL LIABILITY EACH OCCURRENCE $ 'I.00O.00O <br /> DAMAGE TO RENTED rjO,OOO <br /> C IMS-MADE � OCCUR PREMISES Ea occurrence � <br /> MED EXP(Any one person) S 5,��0 <br /> q I PC-78674-06 2/15/2016 2/15/2017 <br /> PERSONAL&ADV INJURY $ �,OOO,OOO <br /> GEN'LAGG EGATELIMITAPPLIESPER: GENERALAGGREGATE $ 2,000,000 <br /> X POLICI �jE� � LOC PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> OTHER: § <br /> AUTOMOBI ELIABWTY COMBINED SINGLE LIMIT � <br /> Ea accident <br /> ANY PIUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTO$ONLY AUTOS <br /> HIREQ NON-OWNED PROPERTY DAMAGE $ <br /> AUTiS ONLY AUTOS ONLY Per accident <br /> $ <br /> UMB I LLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB AGGREGATE $ <br /> CLAIMS-MADE <br /> DED RETENTION$ $ <br /> WORKERSi�COMPENSATION STATUTE ERH <br /> AND EMPLbYERS'LIABILITY <br />' ANYPROP�IETOR/PARTNER/EXECUTIVE Y� N/A E.L.EACH ACCIDENT 5 <br /> OFFICER/ EMBEREXCLUDED? <br /> (Mandato ' in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,desc'be under <br /> DESCRIPT ON OF OPER4TIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Zephyrhills <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 5335 8th Street ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Zephyrhills, FL 33542 AUTHORIZEDREPRESENTATIVE <br /> � � <br /> II O 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br /> l II <br />
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