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09-9192
Zephyrhills
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09-9192
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Last modified
1/14/2011 8:33:28 AM
Creation date
1/14/2011 8:33:25 AM
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Building Department
Building Department - Doc Type
Permit
Permit #
09-9192
Building Department - Name
ZEPHYR LLC
Address
5953 GALL BLVD
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A c ® CERTIFICATE OF LIABILITY INSURANCE DATE I O 3 IDONY) <br /> PRODUCER Bauer 8 Associates THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> 12210 US Highway 301 ONLY AND CONFERS NO RIGHTS UPON THE CERTFICATE <br /> HOLDER. THIS CERTFICATE DOES NOT AMEND, EXTEND OR <br /> Dade City, FL 33525 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Phone (352)567 -3702 Fax (352)523 -0434 INSURERS AFFORDING COVERAGE NAIC I1 <br /> INSURED JOHN SMITH DBA/ INSURER A: AUTO OWNERS INSURANCE <br /> INSURER B: <br /> JOHN L. SMITH CONSTRUCTION INSURER C: <br /> 4240 COATS ROAD INSURER D <br /> ZEPHYRHILLS, FL 33541 INSURER E: <br /> COVERAGES INSURER F: <br /> THE POLICIES OF INSURANCE USTED 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. <br /> INSR ADO'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br /> LTR INSRD DATE (MMIDDNY) DATE (MWDDIYY) <br /> GENERAL LIABILITY EACH OCCURRENCE 300,000 <br /> [J COMMERCIAL GENERAL LIABILITY 20632794 05/01 /09 05/01 /10 PRawSESEaErrerce) 50,000 <br /> Ci ❑ CLAMS MADE [r] OCCUR MED EXP (Any one person) 5,000 <br /> A ❑ ❑ PERSONAL 8 ADV INJURY 300,000 <br /> GENERAL AGGREGATE 600,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG 600,000 <br /> [I POLICY ❑ PROJECT ❑ LOC <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> O ANY AUTO (Ea accident) <br /> ❑ ALL OWNED AUTOS BODILY INJURY <br /> ❑ 10 SCHEDULED AUTOS (Per person) <br /> ❑ HIRED AUTOS <br /> ❑ NON OWNED AUTOS BODILY INJURY <br /> (Per accident) <br /> �� — -- PROPERTY DAMAGE <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT <br /> ❑ ❑ ANY AUTO OTHER THAN EA ACC <br /> AUTO ONLY: AGG <br /> EXCESS/UMBRELLA LIABIUTY EACH OCCURRENCE <br /> El • OCCUR E.:1 CLAIMS MADE AGGREGATE <br /> ❑ DEDUCTIBLE <br /> ❑ RETENTION $ <br /> WORKERS COMPENSATION AND ❑ WC STATU- ❑ OTH- <br /> EMPLOYERS' LIABILITY TORY LIMITS ER <br /> ANY PROPRIETOR / PARTNER / EXECUTIVE E.L. EACH ACCIDENT <br /> OFFICER / MEMBER EXCLUDED? <br /> It yea, describe under E.L. DISEASE - EA EMPLOYEE <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY UMIT <br /> OTHER <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br /> BUILDING CONTRACTOR <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 /> CITY OF ZEPHYRHILLS 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO <br /> BUILDING DEPT. THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY <br /> 5335 8TH STREET OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br /> Au p <br /> ZEPHYRHILLS , FL 33542 <br /> 1 FAX @813- 780 -0021 TH EPR TAT <br /> ` / NNE dr y / 7 <br /> 3 O <br /> ACORD 26 (2001/08) QF ®ACORD CORPORATION 1988 <br /> T00 21 '3NI 'DOSSV '8 HafIVEI t£60EZSZSE XVd L£:ST 600Z/£0/90 <br />
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