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09-9193
Zephyrhills
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2009
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09-9193
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Last modified
1/14/2011 8:34:54 AM
Creation date
1/14/2011 8:34:53 AM
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Building Department
Company Name
SUPER WALMART
Building Department - Doc Type
Permit
Permit #
09-9193
Building Department - Name
SUPER WALMART
Address
7631 GALL BLVD
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C ERTIFICATE OF INSURANCE ISSUE DATE <br /> ACORD 11/04/2008 <br /> PRODUCER This certificate is issued as a matter of information only and confers no rights <br /> F, SEIBELS & WILLIAMS, INC. upon the Certificate Holder. This Certificate does not amend, extend or alter the <br /> MCGRIFF, <br /> Box F, SEI coverage afforded by the policies below. <br /> Birmingham, AL 35202 <br /> 205-252-9871 COMPANIES AFFORDING COVERAGE <br /> Company Columbia Casualty Insurance Company <br /> INSURED Company James River Insurance Company <br /> American Promotional Events, Inc. <br /> dba TNT Fireworks <br /> P.O. Box 1318 Company <br /> Florence, AL 35631 C <br /> Company <br /> D <br /> Company <br /> E <br /> This is to certify that the policies of insurance described herein have been issued to the Insured named herein for the policy period indicated. Notwithstanding <br /> any requirement, term or condition of contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by <br /> the policies described herein is subject to all the terms, conditions and exclusions of such policies. Limits shown may have been reduced by paid claims. <br /> CO TYPE OF INSURANCE POLICY NUMBER EFFECTIVE LIMITS OF LIABILITY <br /> LT EXPIRATION <br /> A GENERAL LIABIUTY PCL0223304725 11/01/2008 EACH OCCURRENCE $ 1,000,000 <br /> ® Commercial General Liability 11/01/2009 FIRE DAMAGE $ 100,000 <br /> ❑ Claims Made ® Occurrence MEDICAL EXPENSE $ EXCLUDED <br /> ❑ Owners' and Contractors' Protection <br /> ® $5,000 Deductible Per Occ PERS. AND ADVERTISING INJURY $ 1,000,000 <br /> ❑ GENERAL AGGREGATE $ 2,000,000 <br /> General Aggregate Limit applies per: PRODUCTS AND COMP. OPER. AGG. $ 2,000,000 <br /> ❑ Policy ❑ Project MI Location <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> ❑ Any Automobile BODILY INJURY (Per person) $ <br /> ❑ All Owned Automobiles <br /> ❑ Scheduled Automobiles BODILY INJURY (Per accident) $ <br /> ❑ Hired Automobiles PROPERTY DAMAGE (Per accident) $ <br /> ❑ Non-owned Automobiles COMPREHENSIVE <br /> ❑ COLLISION <br /> WORKERS' COMPENSATION WC Statutory Limit 1 1 Other 1 <br /> AND EMPLOYERS' LIABILITY EL EACH ACCIDENT $ <br /> EL DISEASE (Each emolovee) $ <br /> EL DISEASE (Policy Limit) $ <br /> EXCESS LIABIUTY EACH OCCURRENCE $ <br /> ❑ Occurrence ❑Claims Made AGGREGATE $ <br /> B EXCESS UMBRELLA POLICY 000346920 11/01/2008 Excess of Underlying $5,Million $ 5,000,000 <br /> Per Occurrence 11/01/2009 $ <br /> This certificate only applies to State Approved Sparkler Sales at Wal -Mart #706 located at 7631 GALL BOULEVARD in ZEPHYRHILLS FL, 33541. <br /> The Certificate Holder is named as Additional Insured with respect to General Liability as required by written contract subject to policy terms, conditions, and <br /> exclusions. <br /> CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO <br /> MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE <br /> LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF <br /> ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br /> CITY OF ZEPHYRHILLS Authorized Representative <br /> 5335 8th Street <br /> ZEPHYRHILLS, FL 33542 <br /> USA (1;46411 <br /> Page 1 of 1 Certificate ID# 1653K61H <br />
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