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16-17987
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2016
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16-17987
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Last modified
7/20/2017 2:28:33 PM
Creation date
7/20/2017 2:28:32 PM
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Building Department
Company Name
CITY OF ZEPHYRHILLS
Building Department - Doc Type
Permit
Permit #
16-17987
Building Department - Name
CITY OF ZEPHYRHILLS
Address
38122 HENRY DR
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Aco'� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> `� � 4/5/2016 <br /> THIS CERTIFMCATE 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. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSllRER(S), AUTHORIZED <br /> REPRFSENTbTIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT:I If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate ho`der in lieu of such endorsement s . <br /> PRODUCER NAMEACT Tricia Hushmire <br /> Insurance Offic�e of America, IIIC. PHONE ']']O-Z�JO-O�T7 FAX 678-450-9180 <br /> 854 Washington Street NW A/C No: <br /> Suite200 EpA'� .Tricia.Hushmire@ioausa.com - <br /> Gainesville G 30501 INSURER S AFFORDING COVERAGE NAIC# <br /> iNsuReRa:Zurich American Insurance Com an o 27855 <br /> INSURED NEWTECH-02 INSURER B: <br /> New Tech Co StfUCtlOfl COfp. INSURER C: <br /> 1579 Barber d. <br /> Sarasota FL 3�Z�FO INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:221433728 REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED �JOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATEI MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS ND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR YPE OF INSURANCE POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD POUCY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> COMM RCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> CLpIMS-MADE �OCCUR DAMAGE TO RENTED <br /> I PREMISES Ea occurrence $ <br /> MED EXP(Any one person) $ <br /> PERSONAL 8 ADV INJURY $ <br /> GEN'L HGGI��EGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY�PR� �LOC PRODUCTS-COMP/OP AGG $ <br /> JECT <br /> OTHER $ <br /> AUTOMOBIL�LIABILITY COMBINED SINGLE LIMIT $ <br /> I Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> AUTOS�E� AUTOSULED BODILY INJURY(Per accident) $ <br /> HIRED UTOS NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS Per accident <br /> $ <br /> UMBR LLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCES LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> q WORKERS OMPENSATION WC0114356-01 4/20/2016 4/20/2017 X STATUTE ER <br /> AND EMPLO ERS'LIABILITY <br /> ANY PROPRI TOR/PARTNER/EXECUTIVE Y� N�A E.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/ME BER EXCLUDED7 <br /> (Mandatoryf NH) E.L.DISEASE-EAEMPLOYE $1,000,000 <br /> If yes,descri e under <br /> DESCRIPTI N OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 <br /> DESCRIPTION OFIOPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedute,may be attached if more space Is required) <br /> Blanket Waiv r of Subrogation in favor of certificate holder is included when required by written contract. <br /> ,�3 - �.��-�C� �I <br /> � <br /> CERTIFICATIE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> CITY OF ZEPHYRHILLS BUILDING DEPT ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 5335 8TH STREET <br /> ZEPHYRHILLS FL 33542 AUTHORIZED REPRESENTATIVE , <br /> �r��� ' " __— "`"" <br /> O 1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25 �2014/01) The ACORD name and logo are registered marks of ACORD <br />
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