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07-7312
Zephyrhills
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Building Department
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2007
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07-7312
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Last modified
3/6/2009 4:31:55 PM
Creation date
1/18/2008 8:45:53 AM
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Building Department
Building Department - Doc Type
Permit
Permit #
07-7312
Building Department - Name
ADVERTIST HEALTH
Address
38233 DAUGHTRY RD
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<br /> CERTIFICA TE OF INSURANCE Date: (MM/DD/YY) <br /> 12/11/2007 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Lockton Companies, LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />5847 San Felipe, Suite 320 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />Houston, Texas 77057 AI TER THE ~nvFRAr.:E AF THE POUCIES BRnw <br /> INSURERS AFFORDING COVERAGE <br />INSURED: Insurer A: Liberty Mutual Fire Insurance Company <br />General Works ofTampa. LLC Insurer 8: National Union Fire Ins Co Pittsburgh PA <br />a Tecla America Co, LlC In!'::urer C: Liberty Insurance Corp. <br />6809 North Nebraska Avenue Insurer 0: <br />Tampa, FL 33604 <br /> Insurer E: <br />COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, <br /> NOlWlTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE <br /> MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND <br /> CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY BE EXHAUSTED BY PAID CLAIMS, <br />INSR TYPE OF INSURANCE POLICY NUMBER EFFECTIVE DATE EXP1RAnON LIMITS <br />LTR DATE <br /> GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 <br />A X COMMeRCiAl GENERAL LIABILITY TB2-641-435487 -277 02/01/2007 02128/08 FIRE DAMAGE (ANYONEFIREI $ 1,000,000 <br /> X OCCURRENCE MED EXP (PER PERSON) $ 10,000 <br /> X XCUINClUDED PERSONAL & ADV INJURY $ 1,000,000 <br /> X BROAD FORM PROPERTY GENERAL AGGREGATE $ 4,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS/COMP, OP. AGG $ 4,000,000 <br /> X PROJECT Policy Aggregate $ 20,000,000 <br /> X LOCATION <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000 <br /> AS2-641-435487-287 02/01/2007 02128/08 EACH ACCIDENTl <br />A X ANY AUTO BODilY INJURY - PER PERSON $ <br /> X ALL OWNED AUTOS BODILY INJURY - PER ACCIDENT $ <br /> SCHEDULED AUTOS PROPERTY DAMAGE - PER $ <br /> ACCIDENT <br /> X HIRED AUTOS DEDUCTIBlE/COLl & OTHER $ 1,000 <br /> THAN COLLISION <br /> X NON-OWNED AUTOS <br /> X AUTO PHYSICAL DAMAGE <br /> EXCESS LIABILITY EACH OCCURRENCE $ 5,000,000 <br />8 X OCCURRENCE BE 5684381 02/28/2007 02/28/08 AGGREGATE $ 5,000,000 <br /> X RETENTION $ 10.000 PROD/COMP OPS AGG, $ 5,000,000 <br /> WORKERS' COMPENSATION WORKERS' COMPENSATION STATUTORY <br />C and EMPLOYERS LIABILITY WA7-64D-4354B7-267 (AOS) 02101/2007 02/28/08 El EACH ACCIDENT $ 1,000,000 <br />C WC7-641-4354B7-297 (WI & OR) 02101/2007 02/28/08 EL DISEASE-EA EMPLOYEE $ 1,000,000 <br /> EL DISEASE-POLICY LIMIT $ 1,000,000 <br />REMARKS: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXClUSIONS ADDED BY ENDORSEMENT PROVISIONS: <br />C~6~ [8J BLANKET WAIVER OF SUBROGATION IS GRANTED IN FAVOR OF CERTIFICATE HOLDER ON All POLICIES WHERE REQUIREO BY WRITTEN CONTRACT WHERE PERMISSIBLE BY LAW. <br /> [8J CERTIFICATE HOLDER IS NAMED AS AN ADDfTlONAllNSURED (EXCEPT FOR WORKERS' COMP/El) WHERE REQUIRED BY WRITTEN CONTRACT. <br />CERTIFICATE HOLDER: CANCELLATION: <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30' DAYS WRITTEN NOTICE <br /> TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO MAIL SUCH NOTICE <br /> SHALL IMPOSE NO OBLIGATION OR LIABiliTY OF ANY KIND UPON THE COMPANY, ITS AGENTS <br /> OR REPRESENTATIVES, 'EXCEPT 10 DAYS NOTICE FOR NON.PAYMENT <br /> City of Zephyrills <br /> 5535 8th Street AUTHORIZED REPRESENTATIVE ~-~~ <br /> Zephyrhills, FL 33542 <br />
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