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08-7532
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2008
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08-7532
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Last modified
3/6/2009 4:47:09 PM
Creation date
5/13/2008 9:03:54 AM
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Building Department
Building Department - Doc Type
Permit
Permit #
08-7532
Building Department - Name
FL MEDICAL CLINIC
Address
38135 MARKET SQ DR
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<br />ACOR~" CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) <br />02/28/07 <br />PRODUCER 1-813-229-8021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />M. E. W.iflson cOr Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />300 W. Platt St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Ste 200 <br />Tampa, FL 33606 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED INSURER A: Travelers Prop Cas Ins Co 36161 <br />Rodan Fire Sprinklers, Inc. <br /> INSURER B: Bridgefield Employers Ins Co 10701 <br />2501 N. 70th Street INSURER C: I <br />Tampa, FL 33619 INSURER 0: <br /> INSURER E: <br /> <br />COVERAGES <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 />INSR ~~~~ P~NCY EFFECTIVE POLICY EXPIRATION <br />TR POLICY NUMBER LIMITS <br />A ~NERAL LIABILITY DTC00300L66AIND07 03/02/07 03/02/08 EACH OCCURRENCE $1,000,000 <br /> X OMMERCIAL GENERAL LIABILITY PREMISES lEa occureneel $ 300,000 <br /> - CLAIMS MADE 0 OCCUR <br /> f---- MED EXP (Anyone person) $5,000 <br /> '-- PERSONAL & ADV INJURY $1,000,000 <br /> - GENERAL AGGREGATE $ 2,000,000 <br /> n'LAGGREME LIMIT APnS PER: PRODUCTS - COMP/OP AGG $2,000,000 <br /> POLICY X ~~g: LOC <br />A ~TOMOBILE LIABILITY DT8100300L66ATIL07 03/02/07 03/02/08 <br /> COMBINED SINGLE LIMIT $1,000,000 <br /> X ANY AUTO (Ea accident) <br /> - <br /> - ALL OWNED AUTOS BODILY INJURY <br /> (Per person) $ <br /> - SCHEDULED AUTOS <br /> X HIRED AUTOS <br /> - BODILY INJURY $ <br /> X NON-OWNED AUTOS (per accident) <br /> - <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> I~RAGE LIABILITY AUTO ONLY. EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EAACC $ <br /> AUTO ONLY: AGG $ <br />A EXCESS/UMBRELLA LIABILITY DTSMCUP0300L66ATIL07 03/02/07 03/02/08 EACH OCCURRENCE $ 2,000,000 <br /> ~ OCCUR D CLAIMS MADE AGGREGATE $2,000,000 <br /> $ <br /> I~ DEDUCTIBLE $ <br /> X RETENTION $ 10,000 $ <br />B 83030080 04/01/07 04/01/08 I WCSTATU. I !OTH- <br />WORKERS COMPENSATION AND X TORY LIMITS ER <br /> EMPLOYERS' LIABILITY $500,000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE X EL EACH ACCIDENT <br /> OFFICER/MEMBER EXCLUDED? E,L. DISEASE - EA EMPLOYEE $500,000 <br /> If yes, describe under $500,000 <br /> SPECIAL PROVISIONS below E,L. DISEASE. POLICY LIMIT <br /> OTHER <br />DESCRIPTION OF OPERATIONS' LOCATIONS 'VEHICLES' EXCLUSIONS ADDED BY ENDORSEMENT' SPECIAL PROVISIONS <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCELLATION <br /> <br />5335 8th Street <br />IZePhyrhil1S, FL 33540 <br /> <br />ACORD 25 (2001/08) adickey <br />5734025 <br /> <br />USA <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES, <br />AUTHORIZED REPRESENTATIVE a <br />~"'-~ <br /> <br />@ACORDCORPORATION 1988 <br /> <br />City of Zephyrhills <br />Building Department <br />
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