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20-101
Zephyrhills
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2020
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20-101
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Last modified
3/2/2022 8:42:00 AM
Creation date
3/2/2022 8:41:58 AM
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Building Department
Company Name
ZEPHYR LLC
Building Department - Doc Type
Permit
Permit #
20-101
Building Department - Name
ZEPHYR LLC
Address
5953 GALL BLVD
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CERTIFICATE OF LIABILITY INSURANCEF5/21120(MM/D19 <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 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 holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: <br /> Britton Gallagher PHONEo _ aac No:21 - 1 <br /> One Cleveland Center, Floor 30 E-MAIL <br /> 1375 East 9th Street ADDRESS: <br /> Cleveland OH 44114 INSURERS AFFORDING COVERAGE NAIC# <br /> INSURER A�AXiS Surplus Ins Company <br /> INSURED INSUPiRB:Everest IndemnityInsurance Co. 0851 <br /> Galaxy Fireworks Inc. INSURER C <br /> 204 E.Martin Luther King Blvd INSURERD': <br /> Tampa FL 33603 INSURER E: <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER:1121001087 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 /> I� TYPE OF INSURANCE A L S POLICY EFF POLICY IXP LIMITS <br /> INSR WVD POLICY NUMBER MM/DD MM/DD <br /> B GENERAL LIABILITY SIBML00324-191 6/10/2019 6/10/2020 EACH OCCURRENCE S1,000,000 <br /> AGE TO RERTE-D <br /> x COMMERCIAL GENERAL LIABILITY PREMISES(S Ea occurrence) $500,000 <br /> CLAIMS-MADE a OCCUR MED EXP(Any oneperson) S <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GENERAL AGGREGATE $2 000 000 <br /> GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG S2.000.000 <br /> POLICY PRO LOC S <br /> C I AUTOMOBILE LIABILITY SIBCA00081-191 6/10/2019 6/10/2020 Ea cadent L LIMIT S1,000,000 <br /> X I ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS NUTOS <br /> ON-OWNED PROPERTY DAMAGE <br /> x HIRED AUTOS X AUTOS (Per accident) $ <br /> S <br /> A UMBRELLA LIAB OCCUR Excess binder 6/10/2019 8/10/2020 EACH OCCURRENCE $4,000,000 <br /> X <br /> X EXCESS LIAR CLAIMS-MADE AGGREGATE S4,000,000 <br /> DEO I I RETENTION$ S <br /> WORKERS COMPENSATION WC STATU• OTH- <br /> AND EMPLOYERS'LIABILITY YIN TT <br /> i ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandator- In NH) E.L.DISEASE-EA EMPLOYE $ <br /> Iles,describe under <br /> DCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. <br /> Location:5953 Gall Blvd,Zephyrhills <br /> Additional Insureds:City of Zephyrhills, Mark Ayer and all his agents, representatives and subsidiaries <br /> (Workmen Comp) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> City of Zephyrhills THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 6907 Dairy Rd ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Zephyrhills FL 33542 <br /> AUTHORIZED REPRESENTATIVE <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) 'The ACORD name and logo are registered marks of ACORD <br />
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