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09-9171
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09-9171
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Last modified
1/13/2011 3:45:33 PM
Creation date
1/13/2011 3:45:32 PM
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Building Department
Building Department - Doc Type
Permit
Permit #
09-9171
Building Department - Name
MATHEW,GEVVARUGHESE & ANNAMMA
Address
4749 5TH ST
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MAY -27 -2009 WED 03:36 PM COMMERCIAL INS SPECIALST FAX NO. 1 813 949 5583 P. 01 <br /> DATE (MM(DDP( 1Y) <br /> ACORQ,. CERTIFICATE OF LIABILITY INSURANCE 5/27/2009 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> COMMERCIAL INS SPECIALISTS INC HOLDER. THIS CERTIFICATE NOT AMEND, EXTEND CERTIFICATE <br /> PO8 17738 ALTER THE COVERAGE AFFORDED EY THE POLICIES BELOW. <br /> Tampa, FL 33682 NAIC� <br /> (813) 949 - 0481 INSURERS AFFORDING COVERAGE <br /> INSURED MARK WILLIAMS & INSURER A: p,�]Tp- WNERS INSURANCE CO. <br /> ABOUT TIME PLUMBING & DRAIN INSURER B SOUTHERN-OWNERS INS . CO . __ <br /> CLEANING, INC . INSURER C: — <br /> 26312 TWIN PINES CT. INSURER D. <br /> I ZEPHYRHILLS , FL. 33544 INSURER E' <br /> COVERAGES <br /> THE ANY REQUIREMENT, TERM OR CONDITION OF BEEN A ANY CONTRACT OR OTHER DOCUMENT WITH WITH RESPECT WHICH THIS CERTIFICATE MAY BE NOTWITHSTANDING 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. LIMITS <br /> PO ICy EFf`EC77IVE POLI�YEXPIR <br /> II p'L POLICY NUMBER DA�E(MMIDD/YY1 DATEIMMIOD NY <br /> LTII INBRD EACH OCCURRENCE s 1,000,000 <br /> 1 GENERAL LIABILITY ' DAMAGk (O RENT tU <br /> PREMISE iEa o urencc) $ 50,000 <br /> X COMMERCIAL GENERAL LIABILITY MED EXP (Any One Person) S 5,000 <br /> I CLAIMS MADE OCCUR <br /> B 062312 20715113 01 °18 -09 01 -18 -10 GENE>� AGGREGATE $ 2 , 000 , 000 <br /> PRODUCTS - COMPIOP $ 2,000,OOO <br /> GEN'L AGGREGATE LIMIT APPLIES PER <br /> J l POLICY I X jfC EI LOC <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 500,000 <br /> X ANYAUTO (Ea accident) <br /> ALL OWNED AUTOS BODILY INJURY <br /> (Perperzon) <br /> SCHEDULED AUTOS <br /> A HIRED AUTOS 46- 677-563 -00 01 -18-09 01 -18 -10 BQ0LVINJURY $ <br /> (PomoWent) <br /> NON-OWNED AUTOS <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> AUTO ONLY- EAACCIDENT S <br /> GARAGE LIABILITY EA ACC $ <br /> OTHER THAN — <br /> � ANYAUTO AUTO ONLY' A GO $ <br /> ` — EACH OCCURRENCE S <br /> EXCESSrt1MBRELLA LIABILITY AGGREGATE S <br /> 7 OCCUR — CLAIMSMAPE S <br /> $ <br /> • <br /> DEDUCTIBLE s <br /> RETENTION S WGS ATU- R l F <br /> 1 IDTH- <br /> TORVIIMI1' <br /> WORKERSCOMPENSATIONANO E.L. EACH ACCIDENT $ <br /> EMPLOYERS' LIABILITY <br /> ANY aOP <br /> vR1ETORa' E vE E.L. DISEASE - EA EMPLOYEE $ <br /> OFFIC IX� AITNER E <br /> Ilyes describe 6, L. DISEASE •POLICY LIMIT $ <br /> SPECIAL PROVVISIO ISIONS below <br /> OTHER <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES I EXCLU SIONS ADDEO BY ENDORSEMENT! SPECIAL PROVISIONS <br /> MARK WILLIAMS LIC# CFC1426963 <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 MAiO DAYS WRITTEN <br /> 5335 8TH STREET NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> 2EPHYRHILLS, FL. 33540 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR <br /> REPRESENTATIVES. <br /> AUTHORIZED REPRESENTATIVE A il <br /> FAX 813 - 780 -002 <br /> ( ®ACORD CORPORATION 1988 <br /> ACORO2$(2001108) <br />
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