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09-9305
Zephyrhills
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2009
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09-9305
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Last modified
1/20/2011 12:55:09 PM
Creation date
1/20/2011 12:55:08 PM
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Building Department
Company Name
DRIFTWOOD
Building Department - Doc Type
Permit
Permit #
09-9305
Building Department - Name
THOMAS,EARL & EVELYN
Address
6639 JUNIPER CT
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Jun. 30. 2009 9:38AM No. 6686 P. 1/1 <br /> A CORD CERTI OF LIABILITY INSURANCE D AT 06/ 3 0 2 0 09 Y) <br /> TM. <br /> PRODUCER Phone: (813) 988 - 1234 Fax 813 988 - 0989 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> - ASSO6IATES AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> PO BOX 16190 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 11470 N. 53RD ST. Al TFR THE COVERAGE AFFORnFr BY THE POI ICIFS RFI OW <br /> TEMPLE TERRACE FL 33687 <br /> INSURERS AFFORDING COVERAGE NAIC # <br /> Agency Licit' R001766 <br /> INSURED INSURER A: SOUTHERN OWNERS INSURANCE CO. 10190 <br /> OWENS AIR CONDITION AND HEATING INC. INSURER B: AUTO OWNERS INSURANCE CO. 18988 <br /> 5837 TURKEY TREE LANE . <br /> INSURER C: <br /> PLANT CITY FL 33567 <br /> 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 POLICY NUMBER POLICY EFFECTIVE POUCY EXPIRATION LIMITS <br /> LTR INSRD DATE IMM/DD /YY1 DATE (MM/DO /YYI <br /> GENERAL LIABILITY 20631995 04/03/09 04 /03/10 EACH OCCURRENCE $ 1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 <br /> PREMISES (Ea occurence) r <br /> CLAIMS MADE I )(I OCCUR MED. EXP (Any one person) $ 10,000 <br /> A PERSONAL & ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS- COMP /OP AGG $ 1,00%000 <br /> — PRO - <br /> 7 POLICY JECT n LOC <br /> AUTOMOBILE LIABILITY 9670194001 04/03/09 04/03/10 COMBINED SINGLE LIMIT <br /> X ANY AUTO (Ea accident) $ 250,000 <br /> ALL OWNED AUTOS BODILY INJURY <br /> (Per person) $ <br /> SCHEDULED AUTOS _ <br /> B X HIRED AUTOS <br /> BODILY INJURY $ <br /> X NON -OWNED AUTOS (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 1 UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> I OCCUR CLAIMS MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND WC STATU OTHER TORY LIMITS <br /> EMPLOYERS' LIABILITY <br /> E.L. EACH ACCIDENT $ <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EMPLOYEE $ <br /> N yes, describe under <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ <br /> OTHER: <br /> D OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <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 10 DAYS <br /> WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO <br /> City of Zephyrhills DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS <br /> 5335 8th Street AGENTS OR REPRESENTATIVES. <br /> Zephyrhills, FL 33542 AUTHORIZED REPRESENTATIVE <br /> Attention: 780 -0021 J ason Farquhar <br /> ACORD 25 (2001/08) Certificate # 180191 @ACORD CORPORATION 1988 <br />
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