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01-0149
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2001
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01-0149
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Last modified
3/6/2009 2:43:16 PM
Creation date
10/13/2006 8:58:27 AM
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Building Department
Building Department - Doc Type
Permit
Permit #
01-0149
Building Department - Name
NEWCOMBE,HELEN
Address
5TH AV
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<br />-. FRSA-SIF I Above the Rest' <br /> <br />. . <br /> <br /> <br />CERTIFICATE OF INSURANCE <br /> <br />ISSUED TO: <br /> <br />COPY PROVIDED TO: <br /> <br />Zephyrhills. City of <br />Building Dept. <br />5335 8th Street <br />Zephyrhills FL 33540 <br /> <br />MilBar Construction, Inc. <br /> <br />15911 U.S. Hwy. 301 <br />Dade City FL 33523 <br /> <br />ATTN:To whom it may concern <br /> <br />Date: 02/12/2001 <br /> <br />This is to certify that <br /> <br />MilBar Construction. Inc. <br />15911 U.S. Hwy. 301 <br />Dade City FL 33523 <br /> <br />being subject to the provisions of the Florida Workers' Compensation Act, has secured the payment of <br />compensation by Insuring their r1sk with the FLORIDA ROOFING, SHEET METAL & AIR CONDITIONING <br />CONTRACTORS ASSOCIATION SELF INSURERS FUNO. <br /> <br />EXPIRATION DATE: <br /> <br />870-032597 <br />01/0112001 <br />01/01/2002 <br /> <br />LIMID <br />Workers' Compensation Statutory. state of Florida <br /> <br />COVERAGE NUMBER: <br /> <br />EFFECTIVE DATE: <br /> <br />Employers' Liability <br /> <br />$100,000 . Each Accident <br />$100,000 . Disease, Each Employee <br />$500,000 . Disease, Policy Limit <br /> <br />REMARKS: Non<ancelable without 30 days prior written notice. <br /> <br />This certificate Is not a policy and of Itself does nat afford any Insurance. Nothing contained In this certificate shall be <br />constructed as extending coverage not afforded by the pollcy(les) shown above or as affording Insurance to any <br />insured not named above. This provides coverage for Florida policyholders and Florida domicile employees only. <br /> <br />&p'~~ <br /> <br />Tom Dralle, Administrator <br />FRSA-8lF <br /> <br />B~~~ <br /> <br />Debbie Kemmerer. S1F Accounts Ihpre".ntative <br />FRSA.S1F <br />
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