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09-9319
Zephyrhills
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09-9319
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Last modified
1/24/2011 8:26:32 AM
Creation date
1/24/2011 8:26:28 AM
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Building Department
Building Department - Doc Type
Permit
Permit #
09-9319
Building Department - Name
FLORIDA MEDICAL CLINIC
Address
38135 MARKET SQUARE DR
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ACORD <br /> T . CERTIFICATE OF LIABILITY INSURANCE ATE(M /0 9 ) <br /> PRODUCER 1 -813- 229 -8021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> M. E. Wilson Co., Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 300 W. Platt St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Ste 200 <br /> Tampa, FL 33606 <br /> INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED <br /> INSURER A: Crum & Forster Specialty Ins Co 44520 <br /> McEnany Roofing, Inc. <br /> INSURER B: CONTINENTAL CAS CO 20443 <br /> 8803 Industrial Drive INSURERC:Steadfast Insurance Co <br /> Tampa, FL 33637 INSURERD: Bridgefield Employers Insurance Co. <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 POLICY EFFECTIVE POLICY EXPIRATION <br /> LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE IMM/DD/YYl DATE (MM/DD/YY) LIMITS <br /> A GENERAL LIABILITY GL0141025 01/01/09 01 /01 /10 EACH OCCURRENCE $1,000,000 <br /> DAMAGE TO X COMMERCIAL GENERAL LIABILITY (Ea RENT $ 50,000 <br /> CLAIMS MADE X OCCUR MEDEXP (Any one person) $ Excluded <br /> X Per Proj Agg subject PERSONAL&ADVINJURY $ 1,000,000 <br /> X to Policy Agg of $5MIL <br /> GENERAL AGGREGATE $ 2,000,000 <br /> �GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS - COMP/OP AGG $2,000,000 <br /> ° POLICY X J LOC <br /> B AUTOMOBILELIABIUTY C1078958977 01/01/09 01 /01 /10 <br /> COMBINED SINGLE LIMIT <br /> X ANY AUTO (Ea accident) $1,000,000 <br /> ALL OWNED AUTOS <br /> BODILY INJURY $ <br /> SCHEDULED AUTOS (Per person) <br /> 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 <br /> OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> C EXCESS /UMBRELLA LIABILITY AUC5918026 -03 01/01/09 01 /01 /10 <br /> EACH OCCURRENCE $ 5,000,000 <br /> X OCCUR CLAIMS MADE AGGREGATE $ 5,000,000 <br /> _ $ <br /> DEDUCTIBLE <br /> X RETENTION $ 0 $ <br /> D WORKERS COMPENSATION AND 0830 - 33182 01/01/09 01 /01 /10 X I TOR V/'/CY STATUL gilt) OTH- <br /> EMPLOYERS' LIABILITY <br /> ER <br /> ANY PROPRIETOR/PARTNER /EXECUTIVE <br /> E.L. EACH ACCIDENT $500,000 <br /> OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 500,000 <br /> If yes, scribe under <br /> SPECIAL de PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br /> General Liability and Umbrella Liability policies do not contain Residential Exclusion with respects <br /> to roofing operations. <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 MAIL 3 0 DAYS WRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> 5335 8th Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> REPRESENTATIVES. <br /> Zephyrhills, FL 33542 AUTHORIZED REPRESENTATIVE <br /> USA <br /> ACORD 25 (2001/08) JMO o l © ACORD CORPORATION 1988 <br /> 12436466 <br />
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