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06-6138
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2006
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06-6138
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Last modified
3/6/2009 4:17:59 PM
Creation date
6/19/2007 11:46:58 AM
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Building Department
Building Department - Doc Type
Permit
Permit #
06-6138
Building Department - Name
ABC RESTURANT
Address
5963 GALL BV
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<br />~ 'CE'RTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY) <br />02/20/2006 <br />'RODUCER (863)688-5495 FAX (863)688-4344 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Herndon & Associates Insurance, LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />91 Lake Morton Dr. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />POBox 3608 <br />Lakeland, FL 33802 INSURERS AFFORDING COVERAGE NAIC# <br />iIISURED B Wayne Enterprises Inc INSURER A: Colony Insuance Group <br /> DBA: Commercial Fire Equipment Company INSURER B: <br /> POBox 2442 INSURER c: Bridgefield Employers Ins Co <br /> Brandon, FL 33509 INSURER D: <br /> INSURER E: <br /> <br />;OVERAGES <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />~ ~~~ lYPE OF INSURANCE POLICY NUMBER POLICY EFFECllVE POLICY EXPIRATION LIMITS <br /> GENERAL LIABILITY GL3254150 02/21/2006 02/21/2007 EACH OCCURRENCE $ l,OOO,OO(J <br /> - <br /> X J::OMMERCIAL GENERAL LIABILIlY DAMAGE ~9,,~ENTED $ 50 , OO(J <br /> I CLAIMS MADE 0 OCCUR MED EX? (Anyone person) $ 5,OO(J <br />A PERSONAL & ADV INJURY $ l,OOO,OO(J <br /> - <br /> GENERAL AGGREGATE $ l,OOO,OO(J <br /> - <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPfOP AGG $ Inc;: 1 ude(i <br /> I POLICY n ~rg: n LOC <br /> AUTOMOBILE L1ABIUlY COMBINED SINGLE LIMIT <br /> - (Ea accident) $ <br /> ANY AUTO . <br /> - <br /> ALl OWNED AUTOS BOOIL Y INJURY <br /> - $ <br /> SCHEDULED AUTOS (Per person) <br /> - <br /> HIRED AUTOS BODILY INJURY <br /> - $ <br /> NON-OWNED AUTOS (Per accident) <br /> - <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LlABIUlY AUTO ONLY - EA ACCIDENT $ <br /> R ANY AUTO OTHER THAN EA ACC $ <br /> . AUTO ONLY: AGG $ <br /> EXCESS/UMBRELLA LlABlUlY EACH OCCURRENCE $ <br /> o OCCUR 0 CLAIMS MADE AGGREGATE $ <br /> $ <br /> R. DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND 083028471 01/14/2006 01/14/2007 X I WC STATU-. I IOJ~- <br /> EMPLOYERS'LlABlUlY 100,OO(J <br />C ANY PROPRIETORlPARTNERlEXECUTIVE E.L. EACH ACCIDENT $ <br /> OFFICERlMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEI $ 100,00(: <br /> If yes, desaibe under <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,OOC <br /> OTHER <br />JESCRlPTlON OF OPERATIONS f LOCATIONS I VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS <br /> <br />~ <br />" <br /> <br /> <br />C <br /> <br /> <br />City Of Zephyrhills <br />5335 Eighth Street <br />Zephyrhills, FL 33540 <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />-1!L- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br />OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE <br /> <br />Bett <br /> <br />Newsom/BETTY <br /> <br />iJ.?e JJi.--. <br />@ACORDCORPORATION1988 <br /> <br />~CORD 25 (2001/08) <br />
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