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09-9875
Zephyrhills
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2009
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09-9875
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Last modified
1/11/2011 9:03:53 AM
Creation date
1/11/2011 9:03:40 AM
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Building Department
Company Name
ASPEN DENTAL
Building Department - Doc Type
Permit
Permit #
09-9875
Building Department - Name
ASPEN DENTAL
Address
7715 GALL BLVD
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Powered by GoldFax 1/11/2010 09:43 Advanced Insurance Underwriters Page 2/3 <br /> Client*: 83129 ALLCO9 <br /> ACORD,. CERTIFICATE OF LIABILITY INSURANCE 1/11/201 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Adv. Ins. U/W - Ocala ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> P.O. Box 6 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> % Scot Brown ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Ocala, FL 34478 INSURERS AFFORDING COVERAGE NAIC 1K <br /> INSURED INSURER A: Tower Insurance Company of New <br /> All County Plumbing Services, Inc. _INSURER B: FCCI Insurance Company <br /> 2875 SE 58th Ave. INSURER C: Delos Insurance Company <br /> Ocala, FL 34480 <br /> INSURER D: <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. 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 /> INSWADO'L- - POLICY EFFECTIVE - POLICY EXPIRATION <br /> LTR NSRC TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYYyY1 DATE MMIOOIYyyyI LIMITS <br /> A GENERAL UABILITY LA9025214309 02/26/2009 02/26/2010 EACH OCCURRENCE S1,000,000 <br /> COMMERCIAL GENERAL LIABILITY PRFMI3 $100.000 <br /> CLAIMS MADE LI OCCUR MED EXP (Any one person) 55,000 y <br /> PERSONAL & ADV INJURY 51,000,000 <br /> _ GENERAL AGGREGATE $2. 000,000 <br /> GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 <br /> POLICY El JF n LOC <br /> C AUTOMOBILE LIABILITY DBB1013500 10/19/2009 04/28/2010 COMBINED SINGLE LIMIT <br /> ANY AUTO (Ea accident) $1,000,000 <br /> `— ALL OWNED AUTOS <br /> BODILY INJURY S <br /> X SCHEDULED AUTOS (Per person) <br /> X HIRED AUTOS _ —� <br /> BODILY INJURY S <br /> X NON -OWNED AUTOS (Per accident) <br /> — PROPERTY DAMAGE S <br /> (Per node") <br /> ` GARAGE LIABILITY <br /> AUTO ONLY - EAACCIDENT S <br /> R ANY AUTO , <br /> OTHER THAN EAACC S <br /> AUTO ONLY: AGG S <br /> EXCESS /UMBRELLA UABIU TY _EACH OCCURRENCE S _ <br /> OCCUR 0 CLAIMS MADE AGGREGATE S <br /> S _ <br /> DEDUCTIBLE <br /> S <br /> _ RETENTION S $ <br /> B WORKERS COMPENSATION AND 001WC10A63111 01/01/2010 01/01/2011 wcsTATU- OTII- <br /> EMPLOYERS' LIABILITY I TnRY J IMITR I I FR <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $500,000 <br /> Qi NHR EXCLUDED? N <br /> If yes. describe under <br /> E.L. DISEASE - EA EMPLOYEE $500,000 <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT _ $500,000 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS/ VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT, SPECIAL PROVISIONS <br /> CERTIFICATE HOLDER CANCELLATION 10 Days for Non <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> City ofZephyrh ills Deparbnent DATE NEREOF, T1IE ISSUING INSURER WILL ENDEAVOR TO MAIL ._jQ DAYS WRITTEN <br /> 5335 8th Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL <br /> Zephyrhllls, FL 33542 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> REPRESENTATIVES. <br /> AUTHORIZED REPRESENTATIVE <br /> a k10 ,4-1 <br /> ACORD 25 (2009101) 1 of 2 #S6032021M600424 0 1988 -2009 ACC/RD CORPORATION. All rights reserved <br /> The ACORD name and logo are registered marks of ACORD SBR1 <br />
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