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10-10460
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10-10460
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Last modified
2/1/2011 9:28:40 AM
Creation date
2/1/2011 9:28:35 AM
Metadata
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Building Department
Company Name
PINECREST M.H.P.
Building Department - Doc Type
Permit
Permit #
10-10460
Building Department - Name
PINECREST MOBILE HOME PARK
Address
6109 CRESTON ST LOT 67
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Jul 29 10 03:117p Lg Edwards Ins 3525676766 p,1 <br /> t ) <br /> ACORD 'CERTIFICATE OF LIABILITY INSURANCE OP ID KS DATE (MM/DDIYYYY) <br /> 07/29/10 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER LUNIAI.I NAME: <br /> PHONE >AX <br /> L.G. Edwards Insurance Agency (aC, IL No, Ext): I (A/c, No): <br /> MA <br /> P.O. Box 1548 ADDRESS: <br /> Dade City FL 33526 -1548 PRODUCER <br /> CUSTOMER ODONO -1 <br /> Phone:352- 567 -6751 Fax:352- 567 -6766 INSURER(S) AFFORDING COVERAGE NAIC0 <br /> INSURED INSURERA: Allstate Insurance Co 09020 <br /> O'Donovan' Air Conditioning & INSURERB: Maryland Casualty Co 119305 <br /> Heating Company <br /> Timothy O'Donovan INSURER C : <br /> 4839 Allen Rd INSURER <br /> Zephyrhills FL 33541 <br /> INSURER E : <br /> INSURER F : <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> ' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHS I ANUING ANY REQUIREMENT, TERM OR CONDITION or ANY CONTRACT OR OTHER DOCUMENT WITH RFCPFCT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN <br /> POLICY <br /> H MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> I TYPE OF INSURANCE NSR , WVD' POLICY NUMBER ( MMUD 1(MMID MCP LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 <br /> UAMACat I (Ea 1itNIEU I S 1D0 DDD <br /> A X COMMERCIAL GENERAL LIABILITY 049851744 01/07/10 01/07 PREMISES occurrence) <br /> CLAIMS -MADE l X OCCUR , MED EXP (Any one person) $ 5,000 <br /> PERSONAL 8 ADV INJURY $ 1 , 000 , 000 <br /> GENERAL AGGREGATE E 1 , 000 , 000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG L$ 1,000,000 <br /> X POLICY n J n LOC 1 $ <br /> AUTOMOBILE LIABILITY 1 COMBINED SINGLE LIMIT g 50 ,GOO <br /> (Ea accident) <br /> A ANY AUTO 650419867 10/15/09 10/15/10 BODILY INJURY (Per person) $ <br /> ALL OWNED AUTOS BODILY INJURY (Per accident) $ <br /> X SCHEDULED AUTOS PROPERTY DAMAGE <br /> HIRED AUTOS (Per accident) r $ <br /> X NON .OWNED AUTOS ' <br /> S <br /> UMBRELLA LIAR 1 , OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR CLAIMS -MADE AGGREGATE $ <br /> DEDUCTIBLE a <br /> RETENTION $ I $ <br /> B WORKERS COMPENSATION WCO29841 06/02/10 06/02/11 X TOR STA ITS I I <br /> LI <br /> AND EMPLOYERS' LIABILITY <br /> ABILITY CUTIV9J N E.L. EACH ACCIDENT $ 100000 <br /> (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ 100000 <br /> It yes, describe under <br /> DESCRIPTION OF OPERATIONS below E.L.OISEASE - POLICY LIMIT $ 500000 <br /> If <br /> DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD tot, Additional Remarks Schedule, if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> CITYOFZ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. *30 days for <br /> CITY OF ZEPHYRHILLS <br /> (813) 780 -0021 - AUTHORIZE() REPRESENTATIVE 'fork comp <br /> 5335 8TH STREET <br /> ZEPHYRHILLS FL 33541 <br /> I <br /> ©1988 -200 ACORD CO P N. A rights reserved. <br /> ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD <br />
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