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09-9474
Zephyrhills
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2009
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09-9474
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Last modified
1/24/2011 3:07:29 PM
Creation date
1/24/2011 3:07:28 PM
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Building Department
Company Name
FOREST VILLAS
Building Department - Doc Type
Permit
Permit #
09-9474
Building Department - Name
SHONYO,HEATHER & SMOTHERS,DANA
Address
5921 FOREST LANE
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ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID B8 DATE(AIAIIDD/YYYY) <br /> PRONwcER RONIE -1 08/26/09 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> AND Brown & Brown of Florida, Inc . HOLLDER. THICONFERS ERTIFICATE DOES NOT AMEND,, EXTEND R <br /> P . 0. Box 15519 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Tampa FL 33684 -5519 <br /> Phone: 813 - 226 -1300 Fax: 813- 226 -1313 INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED <br /> INSURER A: Bridgefield Employers Ins . 10701 <br /> Ron Ierna's Beating & Cooling, INSURER B: <br /> Inc INSURER C: <br /> 19121 US Highway 41 N INSURER D: <br /> Lutz FL 3359 <br /> INSURER E: <br /> COVERAGES <br /> THE POUCIES 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 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 CLAIMS. <br /> T1LTTR ARE TYPE OF INSURANCE POLICY NUMBER T ( M ID � D T (M UNITS <br /> DAELIIIDD <br /> GENERAL LIABLITY EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY UAMAGt I U HtN i tU <br /> PREMISES (Ea occurence) $ <br /> CLAIMS MADE OCCUR MED EXP (Any one person) $ <br /> PERSONAL & ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: - <br /> POLICY PRO PRODUCTS - COMP/OP AGG $ <br /> JECT LOC <br /> AUTOMOBILE LIABILITY <br /> ANY AUTO COMBINED SINGLE LIMIT <br /> (Ea accident) $ <br /> ALL OWNED AUTOS <br /> BODILY INJURY $ <br /> SCHEDULED AUTOS (Per person) <br /> HIRED AUTOS — <br /> BODILY <br /> accident INJURY <br /> -0 $ <br /> NONWNEDAUTOS ) <br /> PROPERTY DAMAGE <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO <br /> EA <br /> OTHER THAN ACC $ <br /> AUTO ONLY: AGO $ <br /> EXCESS/UMBRELLA LIABILITY <br /> EACH OCCURRENCE $ <br /> OCCUR CLAIMS MADE <br /> AGGREGATE $ <br /> DEDUCTIBLE - <br /> RETENTION $ — <br /> WORKERS COMPENSATION AND S fA I U- OTH- <br /> A EMPLOYERS' LIABILITY X I TO LIMITS ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE 0830 -42368 07/05/09 07/05/10 E.L. EACH ACCIDENT a 500000 <br /> OFFICER/MEMBER EXCLUDED? <br /> If yes, describe under ON E.L. DISEASE - EA EMPLOYEE $ 500000 <br /> SPECIAL PROVISIS below <br /> OTHER E.L. DISEASE - POLICY LIMIT $ 500000 <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br /> CERTIFICATE HOLDER CANCELLATION <br /> CITYZEP SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF, THE ISSUING INSURER WLL ENDEAVOR TO MAL 010 DAYS WRITTEN <br /> City of Zephyrhi l is NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> Bldg Dept IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> 5335 8th Street REPRESENTATIVES. <br /> Zephyrhills FL 33542 AUTHOR NTATIVE <br /> ACORD 25 (2001/08) ® ACORD CORPORATION 1988 <br />
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