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09-9991
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2009
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09-9991
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Last modified
1/11/2011 2:39:39 PM
Creation date
1/11/2011 2:39:36 PM
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Building Department
Company Name
ADVENTISH HEALTH SYSTEM SUNBELT
Building Department - Doc Type
Permit
Permit #
09-9991
Building Department - Name
ADVENTIST HEALTH SYSTEM SUNBELT
Address
38005 ARBOR RIDGE DR
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Client#: 4424 RODDCON <br /> ACORDrM CERTIFICATE OF LIABILITY INSURANCE DATE ( 09 D ) <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Lanier Upshaw, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 1115 US Hwy 98 South HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> P.O. Box 468 <br /> Lakeland, FL 33802 INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED INSURER A: Westfield Insurance Company 24112 <br /> Rodda Construction, Inc. INSURER B: Bridgefield Employers Insurance Comp 10701 <br /> 250 E. Highland Drive <br /> INSURER C: <br /> Lakeland, FL 33813 <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 /> INSR AMYL POLICY EFFECTIVE POLICY EXPIRATION <br /> LTR INSRC TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS <br /> A GENERAL LIABILITY CMM4641613 12/31/09 12/31/10 EACH OCCURRENCE $1,000,000 <br /> DAMAGE TO RENTED <br /> X COMMERCIAL GENERAL LIABILITY PREM SFS Ea occu encel $150,000 <br /> CLAIMS MADE X OCCUR MED EXP (Any one person) $10,000 <br /> X PD Ded:1,000 PERSONAL &ADVINJURY $1,000,000 <br /> GENERAL AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $2,000,000 _ <br /> 7 POLICY n JECT n LOC <br /> A AUTOMOBILE LIABILITY CMM4641613 12/31/09 12/31/10 COMBINED SINGLE LIMIT <br /> X ANY AUTO (Ea accident) $1,000,000 <br /> ALL OWNED AUTOS <br /> BODILY INJURY $ <br /> SCHEDULED AUTOS (Per person) <br /> X HIRED AUTOS <br /> BODILY INJURY <br /> X NON -OWNED AUTOS (Per accident) $ <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT _ $ <br /> - <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> A EXCESS /UMBRELLA LIABILITY CMM4641613 12/31/09 12/31 /10 EACH OCCURRENCE $10,000,000 <br /> OCCUR ( CLAIMS MADE AGGREGATE $10,000,000 <br /> _ $ <br /> DEDUCTIBLE <br /> _ $ <br /> X RETENTION $ 10000 $ <br /> B WORKERS COMPENSATION AND 83037282 01/01/10 01/01/11 X I TORY I IMIT WC STATUS ER - I I OTH- <br /> EMPLOYERS' LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDED? <br /> If yes, describe under <br /> E.L. DISEASE - EA EMPLOYEE $1,000,000 <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br /> 10 Days notice of Cancellation applies for non payment of premium. <br /> ** Supplemental Name ** <br /> Rodda Construction, Inc. <br /> Rodda Construction Multi Family, LLC <br /> (See Attached Descriptions) <br /> CERTIFICATE HOLDER CANCELLATION <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 311 DAYS WRITTEN <br /> 5335 8th Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> Zephyrhills, FL 33542 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> REPRESENTATIVES. <br /> AUTHORIZED REPRE ENTATIVE . <br /> a . <br /> ACORD 25 (2001/08) 1 of 3 #S139501/M139313 ALM 0 ACORD CORPORATION 1988 <br />
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