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09-9167
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09-9167
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Last modified
1/13/2011 3:40:34 PM
Creation date
1/13/2011 3:40:33 PM
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Building Department
Building Department - Doc Type
Permit
Permit #
09-9167
Building Department - Name
PEARSON,PHYLLIS & JULIE
Address
6118 18TH ST
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AC tir 27. utk u u - i CA 'i t OF LIABILITY INSURANCE N° 97E7 `P' I / <br /> 05/27/009 <br /> PRODUCER (813)637. - 8877 FAX (813)637 -8484 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Insurance Office of America, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 4915 W. Cypress Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Tampa, FL 33607 <br /> Susan Kamburoff INSURERS AFFORDING COVERAGE NAIC a <br /> INSURED Doradus Corp. INSURER A: Bridgefield Employers Ins. Co. 10701 <br /> DBA: Alvarez Roofing INSURER B: <br /> 10825 Tom Folsom Road INSURER C: <br /> Thonotosassa, FL 33592 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 ADD'L TYPE OF INSURANCE POUCY NUMBER POLICY EFFECTIVE POLICY EXPIRATION <br /> I TR Kan DATE IMMJADM11 DATF NM /0D/W1 UMITb <br /> GENERAL LIABILITY EACH OCCURRENCE S <br /> COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 1 <br /> PREMISES /FA ,vv„mrra) <br /> 1 CLAIMS MADE Q OCCUR MED EXP (Any one person) $ <br /> PERSONAL b ADV INJURY $ <br /> GENERAL AGGREGATE 1 <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS • COMP /OPAGG 1 <br /> POLICY n 2e LOC <br /> AUTOMOBILE LIABILITY <br /> ANY AUTO <br /> (Ea accident) <br /> ANY LIMIT <br /> ALL OWNED ALTOS <br /> BODILY INJURY <br /> SCHEDULED AUTOS (Per person) <br /> HIRED AUTOS BODILY INJURY <br /> NON-OWNED AUTOS (Per accldenI) <br /> PROPERTY DAMAGE 1 <br /> (Par arcidenl) <br /> OARAOE UABIUTY AUTO ONLY • EA ACCIDENT i <br /> ANY AUTO EA ACC 6 <br /> OTHER THAN <br /> AUTO ONLY: AGG 1 <br /> EXCESSUUMBRELLA UABILTY EACH OCCURRENCE 1 <br /> 7 OCCUR n CLAIMS MADE AGGREGATE <br /> DEDUCTIBLE <br /> RETENTION 1 1 <br /> WORKERS COMPENSATION AND 0830 -31684 03/24/2009 03/24/2010 X I TWRYlATU- 1 I <br /> EMPLOYERS' LIABILITY <br /> A ANY PROPRIETOR/PARTNERJEXECUTNE E.L EACH ACCIDENT S 1,000,000 <br /> OFFICER/MEMBER EXCLUDED"? E.L. DISEASE • EA EMPLOYEE 1 1,000,000 <br /> Wyss, O9e ,Tbe under <br /> SPECIAL PROVISIONS below E DISEASE • POLICY LIMIT 1 1,000,000 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT l SPECIAL PROVISIONS <br /> 10 day notice of cancellation for non payment of premium <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br /> 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br /> City of Zephyrhi 11 s Building Department BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br /> 5335 8th Street OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br /> Zephyrhills, FL 33542 AUTHORILEDREPRESENTATIVE <br /> Bruce Johnson /KAMBUS <br /> ACORD 25 (2001108) @ ACORD CORPORATION 1988 <br /> • <br />
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