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09-9188
Zephyrhills
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2009
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09-9188
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Last modified
1/18/2011 1:53:38 PM
Creation date
1/18/2011 1:53:36 PM
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Building Department
Company Name
ALPHA VILLAGE
Building Department - Doc Type
Permit
Permit #
09-9188
Building Department - Name
JONES,DOLORES
Address
7204 OMEGA CT
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06/10/2009 14:52 3525679638 PASCO FARM BUREAU PAGE 01 <br /> A ® <br /> C ERTIFICATE OF LIABILITY INSURANCE 1 DATE MIDDm <br /> 06/09/2009 <br /> PRODUCER Pax, PAPPAS THIS CERTIFICATE IS IS AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> Allen Altman Agency Pasco Co Farm Bureau ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. <br /> 12445 US 301, Dade City, FL 33525 <br /> FL INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED Roll Phonon INSURER A: F FVA <br /> Bahr' Aluminum, Inc. IN9URERa: <br /> 6440 Fort King Rd INSURER C: <br /> Zephyrhills, FL 33541 INSURER D: �• <br /> J 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 AY PERTAIN, THE REQUIREMENT, CE AFFORDED BY THE POLICIES DESCRIIBED HEREIN I DOCUMENT B ECT TO ALL THE TERMS, EXCLUSIONS AND CON I11ONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> WEIR AOD•L POLICY EFFECTrvE POLICY DIPIRATION LIMITS isI• . _ . POLICY NUMBER w <br /> BI rID BITaI RXr /MMe]DPr0:L <br /> EACH OCCURRENCE S <br /> GENERAL LIABILITY EACH TO RbNTED <br /> COMMERCIAL GENERAL LIABILITY PREMISES (F t>LcurinQq) $ <br /> 1 CLAIMS MADE E OCCUR , MED EXP (Any one person) $ <br /> PERSONAL & ADV INJURY _. $ <br /> GENERAL AGGREGATE $ <br /> GEN 'L AGGREGATE L!M(T APPLIES PER PRODUCTS • COMPIOP AGG $ _, <br /> POLICY PR ti • ■ LOC <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ee neolnent) <br /> ANY AUTO <br /> — <br /> ALL OWNED AUTOS BODILY INJURY S <br /> (Perpnraon) <br /> _ <br /> SCHEDULED <br /> AUTOS BODILY INJURY (Pet occident) <br /> $ <br /> -r <br /> NON •OWNED AUTOS ' <br /> — PROPERTY DAMAGE $ <br /> (Per aedtlenl) <br /> AUTO ONLY • EA ACCIDENT S <br /> GARAGE LIABILITY - <br /> OTHER THAN EA ACC S <br /> ANY AUTO AUTO ONLY AGG S <br /> EXCESS 1 UMBRELLA LIABILITY EACH OCCURRENCE - $ <br /> E OCCUR E CLAIMS MADE AGGREGATE S <br /> S <br /> R_ DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION 1 TORY TATU I J <br /> AND EMPLOYERS' LIABILITY Y I N E L EACH ACCIDENT $ 500,000 <br /> a ANY PROPRIETOR <br /> IVARTNER�EXECW1VE 0 Wc840- 0021343 -2009A 01/01/09 /09 01 /01 /10 <br /> (mammon NH) I7rCLUDlD? EL, • EA EMPLOYEE $ 500,000 <br /> (Man In NH) <br /> SPE ye CIAL tleePROVI,riID un der NS below E.L. DISEASE • POLICY LIMIT S 500,000 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br /> SHEET METAL WORK <br /> CERTIFICATE HOLDER Fax# Phone# CANCELLATION <br /> SHOULD ANY OF THE AnOV! DESCRIBED POLICIES BE CANCELLED BEFORE TEE EXPIRATION <br /> CITY OF ZEPHYRHILLS DATE THEREOF, 7145 ISSUING INSURER WILL ENDEAVOR TO MAIL _IQ_ DAYS WRITTEN <br /> 5335 8th Street NOTICE 10 THE CERTIFSCATE HOLDER NAMED TO TN! LEFT, BUT FAILURE TO DO SO SHALL <br /> Zephyrhills, FL 33541 IMPOSE No OBLIGA •� 0 LIABILITY OF ANY KIND UPON TN USURER; ITS AGENTS OR <br /> fax#813 -780 -0021 t(;�P - ATIVES• 1 <br /> / A • -•,• REP - 0' • <br /> f! , <br /> ACORD 25 (2009/01) 988 -2009 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo , e registered marks of ACORD <br />
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