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10-10464
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2010
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10-10464
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Last modified
2/1/2011 9:33:10 AM
Creation date
2/1/2011 9:33:08 AM
Metadata
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Building Department
Company Name
ZEPHYR COMMONS
Building Department - Doc Type
Permit
Permit #
10-10464
Building Department - Name
SUN MEDICAL CORP
Address
6713 GALL BLVD
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• CERTIFICATE OF LIABILITY INSURANCE OP IDEN DA'E'"P"°D"""' <br /> KTECH -1 05/11/10 <br /> PROOIDER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> MORROW INSURANCE GROUP ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> LENORA C. OLNEY /A196064 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 16606 NORTH DALE MABRY HIGHWAY ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> CARROLLWOOD FL 33618 <br /> Phone: 813- 963 -1669 Fax: 813 - 961 -3743 INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED <br /> INSURER A' AMERICAN STATES INS CO 19704 <br /> INSURER 8. <br /> K -TECH SOLUTIONS, LLC INSURER C: <br /> 19239 NORTH DALE MABRY HWY 211 <br /> LUTZ FL 33548 INSURER O: <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 CONTRACTOR 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 /> ESTI ADDS <br /> LTR IM8TA TYPE OF PEEWEE POLICY NUMBER DATE AIMEDA YY) DATE (1 E]IPRA YY) <br /> DATE n DATE IIYUMTTY) LIMITS <br /> GENERAL IJABLITY EACH OCCURRENCE S 1000000 <br /> DAMAGE TO RENTED <br /> A X COMMERCIAL GENERALLNBILITY 01CH43503440 02/23/10 02/23/11 PREMISES (Es mown* $ 1000000 <br /> CLAIMS MADE X OCCUR MED EXP (My one person) S 10000 <br /> PERSONALSADV INJURY S 1000000 <br /> GENERAL AGGREGATE $ 2000000 <br /> GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG S 2000000 <br /> PRO <br /> X POUCY JECT LOC <br /> AUTOMOBLE LIABILITY <br /> COMBINED SINGLE LIMB S 500000 <br /> A X ANY AUTO 01C120337820 03/29/10 03/29/11 (Facade") <br /> ALL OWNED AUTOS <br /> BODILY INJURY <br /> SCHEDULED AUTOS ( person) <br /> X HIRED AUTOS <br /> BODILY INJURY <br /> X NON -OWNED AUTOS (Pef accident) E <br /> PROPERTY DAMAGE <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT i <br /> ANY AUTO <br /> OTHER THAN EA ACC 5 <br /> AUTO ONLY: AGO S <br /> EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE S 1000000 <br /> A X OCCUR CLAIMS MADE 01XS15730620 02/23/10 02/23/11 AGGREGATE 81000000 <br /> DEDUCTIBLE <br /> i <br /> X RETENTION S 0 i <br /> WORKERS COIPENSAG 111 %RC STATU- OTH <br /> AND EMPLOYERS LIABILITY TORY LsIrrS ER <br /> r/ 11 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ( E.L. EACH ACCIDENT E <br /> OFFICERAIEMBER EXCLUDED? <br /> ( ary in ) E.L. DISEASE - EA EMPLOYEE E <br /> It yes, describe under <br /> SPECIAL PROVISIONS belay E.L. DISEASE - POUCY LIMIT E <br /> OTHER <br /> DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECAL PROVISIONS <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIED POLICES BE CANCELLED BEFORE 711E EXPIRATION <br /> CITYZEP DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MIL 30 DAYS YEMEN <br /> NOTICE TO THE CBt11FICATE HOLDER NAMTD TO 711E LEFT, BUT FALIAE TO DO SO SHALL <br /> IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON 714E INSURER. ITS AGENTS OR <br /> CITY OF ZEPHYRHILLS <br /> BUILDING DEPT REPRESENTATIVEL <br /> 5335 8TH STREET ESENTA1T <br /> IZEPHYRHILLS FL 33542 <br /> ACORD 25 25 (2009/01) © 1988 -2009 COR CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />
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