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09-9069
Zephyrhills
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2009
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09-9069
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Last modified
1/13/2011 8:36:44 AM
Creation date
1/13/2011 8:36:43 AM
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Building Department
Company Name
BEALL'S OUTLET #542
Building Department - Doc Type
Permit
Permit #
09-9069
Building Department - Name
BEALL'S OUTLET #542
Address
5030 GALL BLVD
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4/27/2009 2:31 PM FROM: Alarm Insurance Alarm Insurance Agency TO: +1 (813) 780 -0021 PAGE: 002 OF 004 <br /> DATE(MMIDDNYYY) <br /> ACORD,M CERTIFICATE OF LIABILITY INSURANCE 4/27/2009 <br /> PRODUCER THIS CERTIFICATE IS ISSUEDAS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Alarm Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 125D Wappoo Creek Drive, Suite 1B ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Charleston, SC 29412 <br /> 843- 762 -6607 INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED Scarsdale Security Systems Inc. INSURER A First Mercury Ins 10657 <br /> INSURER B <br /> 132 Montgomery Avenue INSURER 0 <br /> Scarsdale, NY 10583 INSURER D Travelers 11223 <br /> 1914- 722 -2200 scarOl INSURER E. <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTEDBELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDCATED. 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 %DO'L - POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br /> LTR MW TYPE OF INSURANCE POLICY NUMBER DATE NM/DID/1'Y) DATE (MMIDDIYY) <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> RJNMNUC 1 V KCII 1 CU <br /> X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) $ _ 100 , 000 <br /> CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5000 <br /> A X Errors & FM41009873 3/02/09 3/02/10 PERSONAL &ADVINJURY $ 1,000,000 <br /> X Omissions GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPUESPER PRODUCTS - COMP /OP AGG $ 2,000,000 <br /> PRO - <br /> _ POLICY ©JECT LOC <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> ANY AUTO (Ea accident) <br /> ALLOWNED AUTOS BOOLY INJURY $ <br /> SCHEDULED AUTOS (Per person) <br /> HIRED AUTOS BODLY INJURY $ <br /> NON -OWNED AUTOS (Per accident) <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> —I ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY. AGG $ <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000 <br /> X I OCCUR n CLAIMS MADE AGGREGATE $ 5,000,000 <br /> _ CUMI000312 03/02/09 03/02/10 $ <br /> A DEDUCTIBLE $ <br /> X RETENTION $ 10,000 $ <br /> WORKERS COMPENSATION AND X ITORY LIMITS 1 IU - <br /> EMPLOYERS'LIABILITY UB- 9188Y38 -9 -08 03/02/09 03/02/10 E L. EACH ACCIDENT $ 1,000,000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> D OFFICERNEMBER EXCLUDED, excludes NYS E.L.DISEASE - EAEMPLOYEE $ 1,000.000 <br /> !Nes. describe under <br /> SPECIAL PROVISIONS below E.L. DSEASE- POLICY LIMIT $ 1,000,000 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br /> UB- 9188Y38 -9 -08, Worker's Compensation policy is valid in FL. <br /> This Acord Certificate is a three page document. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> City of Zephyrhills - Building Dept DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 15 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 REPRESEIJTATIV. EJ�'� <br /> L <br /> 1 <br /> ACORD25 (2001108) ©ACORD CORPORATION 1988 <br />
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