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08-7666
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2008
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08-7666
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Last modified
3/6/2009 4:46:26 PM
Creation date
5/13/2008 10:56:53 AM
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Building Department
Building Department - Doc Type
Permit
Permit #
08-7666
Building Department - Name
K-MART
Address
7422 GALL BV
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<br />ACORDm CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDNYYY) <br />03/14/08 <br />PRODUCER 1-727-797-4190 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Arthur J. Gallagher Risk Management Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />2600 McCormick Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Suite 300 <br />Clearwater, FL 33759 <br /> INSURERS AFFORDING COVERAGE NAIC# <br />INSURED INSURER A: Zurich American Ins Co 16535 <br />A-l Contract Staffing Group <br /> INSURER B: <br />3829 Coconut Palm Dr. INSURER C: <br />Tampa, FL 33619 INSURER D: <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~.k+~~~~~6g;V~~ Pgkif:I~~6~~!gN <br />LTR POLICY NUM BER L1M ITS <br /> ~NERAL LIABILITY EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY ~~~~~~ YE~~~~nce) $ <br /> f-- ~ CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ <br /> I-- PERSONAL & ADV INJURY $ <br /> f-- GENERAL AGGREGATE $ <br /> ~]'L AGGREnE LIMIT APn PER: PRODUCTS - COMP/OP AGG $ <br /> POLICY P,~,9T LOC <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> f--' $ <br /> ANY AUTO (Ea accident) <br /> -, <br /> -, ALL OWNED AUTOS BODILY 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 /> ~rAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> ~i?ESS/UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> _J OCCUR 0 CLAIMS MADE AGGREGATE $ <br /> $ <br /> =l DEDUCTIBLE $ <br /> RETENTION $ $ <br />A WORKERS COMPENSATION AND WC343478605 01/01/08 01/01/09 X I fnfSTAT~!: I X IOJ~- <br />T RY LIMIT <br /> EMPLOYERS' LIABILITY $1,000,000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT <br /> OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $1,000,000 <br /> ~P~~~ec';,r~6~~gNS below EL DISEASE - POLICY LIMIT $1,000,000 <br /> OTHER <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />Sean ~atrick Enterprises Inc. dba Alliance Fire & Safety, Ine. dba Accutech Fire Sprinklers is an alternate <br />employer. Coverage is for contracted employees of A-l Contract Staffing not subcontracted labor. <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCEL LA TION <br /> <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />City of Zephyrhills DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN <br />Contractor Licensing NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />5335 8th Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> REPRESENTATIVES. <br />Zephyrhills, FL 33542 AUTHORIZED REPRESENTATIVE ~C~ <br />USA <br /> <br />ACORD 25 (2001108) betraik <br />, 8309747 <br /> <br />@ ACORD CORPORATION 1988 <br />
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