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18-19937
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18-19937
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Last modified
5/23/2019 10:15:56 AM
Creation date
5/23/2019 10:15:54 AM
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Building Department
Building Department - Doc Type
Permit
Permit #
18-19937
Building Department - Name
BARTLETT,DEAN E & EILEEN
Address
5421 19TH ST
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DATE(MM/DD/YYYY) <br /> ACCOR a CERTIFICATE OF LIABILITY INSURANCE <br /> 6/29/2018 <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 /> PRODUCER CONTACT <br /> NAME: Pat Verdlcann0 <br /> Arthur J.Gallagher Risk Management Services, Inc. ac°NN :225-292-3515 ac No:225 292-3893 <br /> 235 Highlandia Drive,Suite 200 E-MAIL <br /> Baton Rouge LA 70810 ADDREss: Pat Verdicanno@—ajg.com <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURER A:Great American E&S Insurance Company 37532 <br /> INSURED INSURERS:Liberty Insurance Corporation 42404 <br /> Window World of Tampa Bay, LLC 10741 Endeavour Way, Unit C INsuRERc:First Liberty Insurance Corporation 33588 <br /> Pinellas Park FL 33777 INSURERD:Hamilton Specialty Insurance Company 26611 <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:2099488116 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 CLAIMS. <br /> INSR ADDLTYPE OF INSURANCE INSD SUER POLICPOLICYNUMBER MM/DDY EFF EXP <br /> LTR MM/DD LIMITS <br /> B X COMMERCIAL GENERAL LIABILITY Y Y TB7Z91469187028 7/1/2018 7/1/2019 EACH OCCURRENCE $1.000.000 <br /> CLAIMS-MADE 7 OCCUR DAMAGE TO RENTED <br /> PREMISES Ea occurrence $100,000 <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> POLICY PRO ❑LOC PRODUCTS-COMP/OP AGG $2,000,000 <br /> JECT <br /> OTHER: $ <br /> C AUTOMOBILE LIABILITY Y Y AS6Z91469187038 7/1/2018 7/1/2019 COMBINED SINGLE LIMIT $1,000,000 <br /> Ea accident <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $1,000,000 <br /> AUTOS ONLY AUTOS <br /> X HIRED X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accdent <br /> $ <br /> A X UMBRELLA LIAB HOCCUR Y Y UM2386990 7/1/2018 7/1/2019 EACH OCCURRENCE $5,000.000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 <br /> DED F7RETENTION$ $ <br /> B WORKERS COMPENSATION Y WC7Z91469187018 7/1/2018 7/1/2019 X PER OTH- <br /> AND EMPLOYERS'LIABILITY YIN STAT UTE ER <br /> ANYPROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,000.000 <br /> OFFICERIMEMBEREXCLUDED? NIA <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 <br /> D Excess 5 x 5mil GLX100076600 7/1/2018 7/1/2019 Each Occurrence 6,000,000 <br /> Aggregate 5,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> This certificate supersedes all previous certificates issued <br /> Joseph John Pogash--License#SCC131151663 <br /> See Attached... <br /> CERTIFICATE 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 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 5335 8th Street <br /> Zephyrhills FL 33542 AUTHORIZED REPRESENTATIVE <br /> USA <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />
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