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18-19713
Zephyrhills
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2018
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18-19713
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Last modified
9/18/2019 8:50:52 AM
Creation date
9/18/2019 8:50:51 AM
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Building Department
Company Name
PUBLIX
Building Department - Doc Type
Permit
Permit #
18-19713
Building Department - Name
SF ZEPHYR COMMONS LP
Address
7838 GALL BLVD
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' ® DATE(MM/DD/YYYY) <br /> ACORN CERTIFICATE OF LIABILITY INSURANCE <br /> 5/31/2018 <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 p CONTACT <br /> Ste hens Insurance, LLC NAME: <br /> 111 Center Street, Suite 100 PHONE o xt: 1-800-643-9691 A/C No: 501-377-2317 <br /> Little Rock,AR 72201 E-MAIL <br /> ADDRESS: <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> www.stephens.com INSURER A: Navigators Insurance Company AM Best A XI 1) 36056 <br /> INSURED INSURERS: Safety National Casualty CO A+X 15105 <br /> Red Knight Transportation LLC dba R. K. INSURERC: Liberty Insurance Corporation AM Best A X 42404 <br /> Transportation, LLC; RK Transportation <br /> R. K. Transportation INSURERD: Travelers Property Casualty Ins.Co AM Best A++XV 36161 <br /> 4216 Dewitt Avenue INSURERE: <br /> Mattoon IL 61838 <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER: 42266980 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 TYPE OF INSURANCE ADDLSUBR POLICYNUMBER POLICY/YYYY MMIDDIYWY LIMITS <br /> LTR <br /> A �/ COMMERCIAL GENERAL LIABILITY GAI8CGL1255871C 3/31/2018 3/31/2019 EACH OCCURRENCE $1000000 <br /> DAWAGE <br /> CLAIMS-MADE �✓ OCCUR PREM SESOEa oNccurrence $30O 000 <br /> MED EXP(Any one person) $0 <br /> PERSONAL&ADV INJURY $1 000 000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> ✓ POLICY 0 jE LOC PRODUCTS-COMP/OP AGG s2,000,000 <br /> OTHER: $ <br /> B AUTOMOBILE LIABILITY CAF4058384 3/31/2018 3/31/2019 (Ea accident) $1,000,000 <br /> ✓ ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> ✓ AUTOS ONLY ✓ AUTOS ONLY Per accident <br /> $ <br /> C ✓ UMBRELLALIAB �/ OCCUR TH7-691-462275-028 3/31/2018 3/31/2019 EACHOCCURRENCE $10000000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $1 O 00O 000 <br /> DED I ✓ RETENTION50 $ <br /> B WORKERS COMPENSATION LDC4052725 3/31/2018 3/31/2019 ✓ STATUTE oRH <br /> AND EMPLOYERS'LIABILITY <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1 000 000 <br /> OFFICER/MEMBEREXCLUDED? ❑N NIA <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 <br /> ,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000 000 <br /> D Motor Truck Cargo QT-660-OH82105A-TIL-18 3/31/2018 3/31/2019 Cargo $300,000 <br /> Cargo Ded $5,000 <br /> B Trailer Interchange CAF4058384 3/31/2018 3/31/2019 Trailer Interchange Limit$25,000 <br /> 5 000 deductible Comp&Collision <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Re: 7422 Gall Blvd Zephyrhills,FL <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> FOR INFORMATION ONLY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> Ted Grace <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br /> 42266980 1 2018.19 Cargo Certificate I brittney.mullaney®stephens.com 1 5/31/2018 3:35:16 PM (CDT) Page 1 of 1 <br />
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