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18-20260
Zephyrhills
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2018
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18-20260
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Last modified
3/4/2019 11:19:49 AM
Creation date
3/4/2019 11:19:45 AM
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Building Department
Company Name
EMERALD POINTE RV RESORT
Building Department - Doc Type
Permit
Permit #
18-20260
Building Department - Name
CISNEROS,JEANNE M
Address
3433 PERIDOT LN LOT 220
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�•� CHARMWA-01 __LAL!EN <br /> ACORO CERTIFICATE OF LIABILITY INSURANCE DATE 08/31/201 YY) <br /> 08131/2017 <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. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED <br /> REPRESENTATIVE 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 SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on ' <br /> this certificate does not confer rights to the certificate holder_in lieu of such endorsement(s)` _ <br /> i PRODUCER CONTACT Judy-Wagner,AA),AU,AIS,CPIW <br /> NAME: <br /> Florida Insurance Center,Inc. FAX <br /> 414 N Alexander St PHONE E:t): (A/C,No): <br /> Plant City,FL 33563 ADDRESS:jwagner@floridainsurancecenter.com i <br /> 1 <br /> INSURER(S)AFFORDING COVERAGE NAIC 0 <br /> INSURER A:United Fire 8.Casualty Company 13021 <br /> INSURED INSURER B: <br /> Charles M Watts Air Conditioning Inc <br /> INSURER <br /> Conditioning Inc : <br /> 803 Nilsen St INSURER D: <br /> Haines City,FL 33844-3716 INSURER E: <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER: _ 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. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CL <br /> INSR ADDL SUDR 'POLICY EFF_ .P CY EXP- <br /> TYPE OF INSURANCE INSD LYVD POLICY NUMBER LIMITS <br /> A X COMMERCIAL GENERALLJABt1JTY _(h1MfOD1YYYY - 1M(gOi7.YYY - 1,000,000 <br /> EACI i CC RRENCC- S <br /> CLAIMS-MADE X OCCUR 60395411 0 112017 08/3112018 DAMAGE O RENTED 100,000 <br /> PREMIS (Ea occurrence) S <br /> MED E (Any one person) S 5,000 <br /> PE ONAL&ADV INJURY S 1,000,000 <br /> GEN'L AGGREGATL:LIM1r APPLIES PER, -NERAL AGGREGATE S 2,000,000 <br /> POLICY X JECT X LOC PRODUCTS-COMPIOP AGG S 2,000,000— <br /> t <br /> _-OTI iEP_ - z_ <br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ` 1,000,000 <br /> (Ea accident) S <br /> X ANY AUTO 60395411 08/31/2017 0813112018 BODILY INJURY(Per person) S <br /> OWNED SCHEDULED <br /> AUTOS ONLY .AUl OS BODILY INJURY(Per accident) S <br /> X HIRED X NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY AUTOS ONLY (Per accident) S <br /> X H edagCarPhys PIP S 10,000 <br /> am <br /> A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE _ 1,000,000 <br /> EXCESS LIAR CLAIMS-MADE 60395411 06/31/2017 0813112018 AGGREGATE 5" 1,000,000 <br /> DED X RETENTIONS 10,000 <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER <br /> ANY PROPkir-[OR+PARTNER]EXECUTIVE E.L.EACH ACCIDENT S <br /> OFrICErWAEW.BER EXCLUDED? N I A <br /> .(Mandatory in NI I) <br /> E.L.DISEASE-E4 EMPLOYEE S <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below ..__ _._,..�E,L._DISEASE=POLICY LIMIT S <br /> A Installation/Build �+ 60395411 08/3112017 08/31/2018 Limit: 10000, } <br /> A Leased/Rented Equip 60395411 08/3112017 08/31/2018 Limit: 100:000� <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it mom space is required) <br /> i <br /> CERTIFICATE HOLDER CANCELI:ATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> City ofZephyrhills Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I <br /> 5335 8th Street ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Zephyrhills,FL 33542 -._.__. <br /> AUTHORIZED REPRESENTATIVE <br /> I <br /> ACORD 25(2016103) 01988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />
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