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10-10004
Zephyrhills
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2010
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10-10004
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Last modified
1/26/2011 8:18:42 AM
Creation date
1/26/2011 8:18:41 AM
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Building Department
Company Name
TYSON
Building Department - Doc Type
Permit
Permit #
10-10004
Building Department - Name
HALL,DANNY & JOA
Address
6135 9TH ST
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Sent by: A Community Insurance of CFL (813)779 7183 1/19/2010 10:28:49 AM Page 1 of 1 <br /> ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (IIM/DD/YYYY) <br /> 1 /19 / <br /> 1 /19/2010 <br /> PRODUCER Phone# (813) 779 8802 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> A Community Insurance of Central FL, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 38336 5th Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Zephyrhills, FL 33541 INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: AMERICAN VEHICLE <br /> AIR TECH SERVICES, INC INSURER B: <br /> P.O. BOX 1120 INSURER C: <br /> Zephyrhills, FL 33549 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 ALKYL POLICY EFFECTIVE POUCY EXPIRATION <br /> LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM /DD /YY) DATE IMM/DD/YYI LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO RENTED <br /> COMMERCIAL GENERAL LIABILITY <br /> PREMISES (Ea occurence) $ 100,000 <br /> A CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000 <br /> 11182009A_647783 11/18/09 11/18/10 <br /> PERSONAL& ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 <br /> — 7 POLICY PRO— <br /> JFCT <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT $ <br /> ANY AUTO (Ea accident) <br /> ALL OWNED AUTOS <br /> BODILY INJURY $ <br /> SCHEDULED AUTOS (Per person) <br /> HIRED AUTOS <br /> BODILY INJURY $ <br /> NON•OWNED AUTOS (Per accident) <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE UABILITY AUTO ONLY- EA ACCIDENT $ <br /> ANY AUTO <br /> OTHER THAN EA ACC $ <br /> AUTO ONLY: <br /> AGG $ <br /> EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ <br /> OCCUR CLAIMS MADE AGGREGATE $ <br /> DEDUCTIBLE <br /> $ <br /> RETENTION $ $ <br /> WC STATU- OTH- <br /> WORKERS COMPENSATION AND TORY LIMITS ER <br /> EMPLOYERS' LABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> E.L. EACH ACCIDENT $ <br /> OFFICER /MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ <br /> If yes, describe under <br /> SPECIAL PROVISIONS bebw E.L. DISEASE • POLICY LIMIT _ $ <br /> OTHER <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br /> Air conditioning <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION <br /> Zephyrhills Building Department GATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br /> 5335 8th Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL <br /> Zephyrhills, FL. 33542 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> ATTN: Jackie REPRESENTATIVES. <br /> fax 813 780 0021 AUTHORIZED REPRESENTATIVE <br /> Tatyana Midili <br /> ACORD 25 (2001/08) © ACORD CORPORATION 1988 <br />
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