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16-17959
Zephyrhills
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Building Department
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2016
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16-17959
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Last modified
7/20/2017 2:04:12 PM
Creation date
7/20/2017 2:04:11 PM
Metadata
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Building Department
Company Name
TYSON
Building Department - Doc Type
Permit
Permit #
16-17959
Building Department - Name
GOD'S SHARE PROGRAM INC
Address
38435 NORTH AVE
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i <br /> . . � <br /> � <br /> li i <br /> � 1�128'/2Fi16 61:46PM 8137832336 A�L—TECH PAGE 01101 , <br /> i <br /> �; i <br /> i <br /> ��°►c�� GERTIFICp►TE QF �IABfL1TY INSURANCE ��`�""'°°"�"�' ' <br /> II 7HIS CERTtFICATE IS ISSUEO A5 A oIATTER OF INFORMATiON bNLY ANR CONF�RS NO itIGHTS UPON THE CER77FtCA7�HOLDER.TH13 <br /> �� CERTIFICATE DOES NOT AFFIRMATiYELY QR N�C,ATNELY AMENR,EXTEND QR AI.TER THE COVERAGE APFflRt7ED SY THE POtiClES <br /> BELbW. Tt{15 CERTlflCATE OF IPE5URANGE DOES NDT CONSTI'i'U'fE A GOi+iTRACT B�iWEEN THE ESSUINCs I[�,SURER(S),AUTF30FJZE� <br /> I REPRESENTA7NE OR PRODiICER,AEVD THE CERTIFlCATE HOLb�R. <br /> � IMP�RTArIT: lf the aerUfleate holder is an ADD1710NA!INSURED,the policy{ias�must have ADDlTlONAL INSURED prov[sians or be endorsed. <br /> � tf SUBf2bGA'(IOI�1S WANED,sub]ee#tc the fcrms and condit3ons of the pottcyr certaia poticies may requirc en endat�semett#. A statemenE an <br /> � this cerkificate does nat confer rtghts to the certiRcete holder in Ileu of such endorsemeet s. <br /> ��,��� GONTA s�,wa aawicz <br /> � Ghris E1aek insurance r►{or� F� <br /> 7868 tiighland Oaks B(v8,Ste A � : 1ei3 7az-�nr r�.�,�:tsiaj�s2-aaas <br /> Lutx,FL 33559 aoonEs� ryan(�cfidsblacki�urartse.com <br /> Liaense#:E'{83481 tHsvR aFFot�raa cov�noE ruuc� <br /> � INSURERA: @Ti1 ers Insu 1 <br /> i�� iNsurt�x e: OdEtE33 iN �MPA <br /> ALU7ECH AIR 8�FII.'T32A7IQN,LLC INstfffstc: rida C 8�tnd es Fun <br /> 35946 State Road 54 �sur�o� ; <br /> Zephyrhills,FL 3354t-x243 wsu�E: <br /> tttsent�F: � <br /> IICOVERAGES CERi1FiCATE NUMBER: o0000QOQ-29966 REVifiION NUM1lIgER: 12 <br /> _ � TttiS tS TO t;�RTtFY THAT?k1E POI.IGIES QF INSURANGE LISTED HELOW htAVE BEEN ISSUED TO T3iE INSUR�D NAAAED ASOVE FOR TN�POLtCY PERf00 <br /> iNDlCATED. NO'TIMTH8TAND1lSt3 ANY REQL1tREhAENT,3EE2M OR GOND1TtOM 4F ANY COMRACT QR dtHER DOCUMENT WfTH tiLSPECTTO WH1CH THIS <br /> CERTIFICATE MAY 6E ISSU�D OR MAY AERTAIN,THE INSURANGE AFFaR�ED 6Y THE POLICfES DESCRIBEd HEREIN fS SUBJ�GTTO ALL THE TERMS, <br /> EXCWSIONS ANp CONDI7'IONS OF SUCH POUCIE&.LIMITS SHONM MAY HAVE 6EEN REDUCFD BV PAI�CLAIMS. <br /> INSk TYP&OPNSttRANCE PtllECYHUERBER l�tOG PdllCYE%F � <br /> A X �TM+�C��^�+��WTM 20519889 iof3o12o1s 70l3012017 �occuR�rtce a 1 000 Q00 <br /> cutras.tanoe �X oeeua E TO a oanrtrnee} s 300 OUQ <br /> tdEp EXP tArN c�m oerson) f ���� <br /> PER6CSNAL6ADVINJURY 5 � OOO OOO <br /> s�xw.,���teurarratrnc�s��a: ��as�rtE�rE s 2 OOQ 000 <br /> X Poucr❑j�7 ❑�oc PRODl1CTS-CpMpIOPAGCi a 1�00 000 � <br /> OTHER: a <br /> g Auroans��uae�z� 03879409-0 �stosr2a�ss oe�osr,eaiT °°�,� � ,,,_ � <br /> aNvauro BOOILYINJURY(Pe�person) s 5D000 ' <br /> AU7 ONLY X ��L� �ILY lNSUAY(Per acddCaQ S j Q(� <br /> }ii�RF.o�oNtY �nusaSvu�tio, �o��orasnGE s 26 OOO � <br /> t <br /> � wea�cwuns _oceuR excwoccu�� s ; <br /> occEssuag cuuNsa�an� ncGtzEca� a i <br /> pEv �T�rioas s � <br /> (M ndaOPRinEI'Oi71PARii�f'JDfECVfNE Q E.k,F.�A . § ��O�Dd� ' <br /> � oFFICERHYIEMBH3EXCLUDEi7? YIH NIA �a�•�� 1'1119l26S$ 4il19t2017 X S°SEA9E-EAE1EPlOY�� ����� ��0 <br /> tM1bRK�R9 GQTkPENSA'tS�NN <br /> AND�ttlPL4YER8'GlA8�17Y <br /> GH ACGIOENT <br /> != <br /> It deaata wder <br /> o�°°�°scR�artoN oF o�au-�oHs��w E.L.Dt6EA6E-PdLiCY LIMtT a 4 000 000 �- <br /> ( � <br /> I pE8CR1PT10N OF OPERA"[ioNS 1 LOCATIONS!VENIa1..F,9(ACQRD tOt.AddieWnal Remorka 6eh�q myr be anached 8 moce s{uoe i�required� � � <br /> I � <br /> I <br /> E <br /> I)CERTtFlCATE HOLDER GAHCEI.tAT10N <br /> SttOt}W ANY OF TNE A$OVE DESCRIBED POLtGiES BE CAHCFt.S.�G BEFORE � <br /> CITY OF ZEPHYRHlLLS 'EHE EXPiRATtON DA7E THEREOF,N0710E WlLL HE OECtVEREd IN , <br /> SUILDING LIEPARTMENT AaQ�NCEWITHTNEPOLICYPROViS10NS. � <br /> 6335 8TH ST ' � <br /> Zephyrhilts,�L 33542 nun+o�nt�r���mr� , <br /> RS <br /> 1S ACORG CORPORATtOt�,. AIt rights reserved. � <br /> �pCpRb 25(20161p3) The ACORD name and logo are reglstered marks of ACORD � <br /> , Ptinted by RSW on tlovember23,2416 at 08_58AM � <br />
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