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10-10064
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10-10064
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Last modified
1/27/2011 8:27:07 AM
Creation date
1/27/2011 8:27:05 AM
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Building Department
Company Name
PINECREST MOBILE HOME CLUB HOUSE
Building Department - Doc Type
Permit
Permit #
10-10064
Building Department - Name
PINECREST MHP CLUBHOUSE
Address
6043 HARRIET ST
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DATE (MM/DDmYY) <br /> Rbe CERTIFICATE OF LIABILITY INSURANCE OP ID FRSU <br /> 4 <br /> JWHCO - 1 01120/10 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTE OF INFORMATION <br /> Dick, Johnson & Jefferson, Inc HOLDER. TH S CONFERS NO CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 1429 60th Ave W Suite 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW <br /> Bradenton FL 34207 <br /> Phone: 941- 758 -3861 Fax: 941- 756 -5788 INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED <br /> INSURER A: Southern-Owners Insurance Co 10190 <br /> wn <br /> JWH Contracting Svcs Corp INSURER B: <br /> dba MBC Construction Services INSURER C: <br /> PO Box 4772 INSURER D: <br /> Plant City FL 33563 <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 /> INS( AUU•C POLICY EFFEC/DD/YTIVE POLXPIR <br /> LTR INSRC TYPE OF INSURANCE POLICY NUMBER DATE (MM YYY) DATE IC (Y MM YYYY) LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1000000 <br /> A X COMMERCIAL GENERAL LIABILITY 20700784 09/04/09 09/04/10 PREMISES (Ea occurence) $ 50000 _ <br /> CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5000 <br /> PERSONAL &ADV INJURY $ 1000000 <br /> GENERAL AGGREGATE $ 2000000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS - COMP /OP AGG $ 1000000 <br /> - X - 1 POLICY JEC7 LOC <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 /> NON-OWNED AUTOS BODILY INJURY $ <br /> (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 /> EXCESS / UMBRELLA LIABILITY <br /> EACH OCCURRENCE $ <br /> OCCUR CLAIMS MADE AGGREGATE $ <br /> DEDUCTIBLE <br /> RETENTION $ <br /> WORKERS COMPENSATION $ <br /> WC S <br /> AND EMPLOYERS' LIABILITY X TORY LIMITS O E R <br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE 20005049 01/05/10 01/05/11 E.L. EACH ACCIDENT $ 500000 <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) <br /> If yes, describe under E.L. DISEASE - EA EMPLOYEE $ 500000 <br /> SPECIAL PROVISIONS below <br /> OTHER <br /> E.L. DISEASE - POLICY LIMIT $ 500000 <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> ZEPHYO 1 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> Zephyrhills Building Dept REPRESENTATIVES. <br /> 5335 8th St AUTOO D REPRESENTATIVE <br /> IZephyrhills FL 33542 -4312 <br /> ACORD 25 (2009/01) • tI ri O9 J : • r . • r- N: All rights reserved. <br /> The ACORD name and logo are registered marks of ACO - <br />
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