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19-22154
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19-22154
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Last modified
2/17/2021 10:29:00 AM
Creation date
2/17/2021 10:29:00 AM
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Building Department
Company Name
MAJESTIC OAKS
Building Department - Doc Type
Permit
Permit #
19-22154
Building Department - Name
NHC-FL 115 LLC ATTN: TAX DEPARTMENT
Address
3751 LAUREL VALLEY BLVD
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'4� �"CERTIFICATE OF LIABILITY INSURANCE 1 <br /> ,7J09f2019 <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 BELOW.THIS <br /> CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR <br /> 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. It <br /> SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this <br /> certificate does not confer rights to the certificate holder In lieu of such endorsements. <br /> PRODUCER CONTACT <br /> FEDERATED MUTUAL INSURANCE COMPANY N E: CLIENT ONTACT CENTER <br /> HOME OFFICE:P.O.BOX 328 PA/ONNo E.:888-3334949 FA c xo:507 446 4664 <br /> OWATONNA,MN 55060 aooeess:C IENTCONTACTCENTER FEDINS.COM <br /> INSURER(S)AFFORDING COVERAGE NAIC k <br /> INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 <br /> INSURED 248-562-1 INSURER B: <br /> TARANTO ELECTRIC,INC. INSURER C. <br /> 2560 W TULSA DR <br /> DELTONA,FL 32738-2582 INSURER 0: <br /> INSURER EI <br /> IN3URER F: <br /> COVERAGES CERTIFICATE NUMBER:124 REVISION NUMBER:0 <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,EXCLUSIONS <br /> AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR DL SUBR POLICY EFF POLICY EXP <br /> LT TYPE OF INSURANCE INS POLICY NUMBER MI D/ YVY MM/DD LIMITS <br /> COMMERCIAL GENERAL LIABILITY _ EACH OCCURRENCE $1,000,0D0 <br /> CLAIMS-MADE ❑X OCCUR DAMPREM ESORENTED $100,000 <br /> X BUSINESS OWNER'S LIABILITY <br /> MED EXP(Any one person) <br /> A N N 6111097 11/30/2019 11/30/2020 PERSONAL S ADV INJURY $1,000,000 <br /> OEM1 AOOR42A1E LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> X POLICYLJ JECT LOC PRODUCTS-COMPIOP AGO $2,000,000 <br /> OTHER: <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,�0,000 <br /> Ea a den <br /> X ANY AUTO BODILY INJURY(Per person) <br /> A OWNED AUTOS ONLY AUTO8UlED N N 6111098 11130/2019 11/30/2020 BODILY INJURY(Par aaldent) <br /> HIRED AUTOS ONLY NON-OWNED PROPERRTY DAMAGE <br /> AUTOS ONLY r dd <br /> X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $1,000,0D0 <br /> A EXCESS LIAB CLAIMS-MADE N N 6111099 11/30/2019 11/30/2020 AGGREGATE $1,000,000 <br /> DED I I RETENTION <br /> WORKERS COMPENSATION PER STATUTE I OER- <br /> AND EMPLOYERS'LIABILITY YIN <br /> ANY PROPRIETORIPARTNERIEXECUTIVE E E.L.EACH ACCIDENT <br /> OFFICERIMEMBER EXCLUDED? NIA <br /> (Mmdslory In NHI E.L.DISEASE-EA EMPLOYEE <br /> ea,1t y describe under <br /> DESCRIPTION OF OPERATIONS below E.L DISEASE•POLICY LIMIT <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Additional Remarts Schedule,may be eUached it more Space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> 248-562-1 1240 <br /> CITY OF ZEPHYRHILLS BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 5335 8TH ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ZEPHYRHILLS,FL 336424312 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> 6 <br /> O 190-2018 ACORD CORPORATION.All rights reserved <br /> ACORD 26(2018M) The ACORD name and logo are registered marks of ACORD <br />
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