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10-10679
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2010
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10-10679
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Last modified
2/3/2011 11:17:54 AM
Creation date
2/3/2011 11:17:50 AM
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Building Department
Company Name
CRESTVIEW HILLS
Building Department - Doc Type
Permit
Permit #
10-10679
Building Department - Name
DOMALIK,NEIL & HEATHER
Address
7918 MERCHANTVILLE CIR
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07/07/2010 08:58 FAX 7275338835 .DURAMADE Z005 <br /> _ACORD., 'C:ERTIFICATE OF PLIABILITY INSU RANCE 2/23/2010 PDD/Y <br /> PRODUCER Phonr: 727- 461.6044 Fax: 727 -442 -7695 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Brown & Brown Insurance - Clearwater ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> P.0. Box 2456 HOLDER. THIS CERTIFICATE_ DOES NOT AMEND, EXTEND OR <br /> Suite 660 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Clearwater FL 3:;757 -2456 <br /> INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED INSURER A : S out hern- Owner s Ins. C <br /> Duramade Window(: & Doors Inc & Duramade O- <br /> 3.0-110.______ <br /> Windows & _Doors Inc dba Faf co Solar of Tampa INSURen8: FCCT znL r e = gmp_any_ 3.017 <br /> 5733 Myerlake C:.rcle INSURER :Auto - Owners Insl n 9 <br /> Clearwater FL 3:.760 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. <br /> NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES LESCRIHED HEREIN IS SUBJECT TO ALL THE <br /> TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADD'L POUCYEFFECTIVE POUCYEXPIRATITON <br /> LTR rISRQ TYPE OPI(ISURANCE POLICVNUMBER� 1 DATE IMMIDD� I DATEIMMIDD/YYI I UNITS <br /> A GENERALUABILm 207.15155 12/8/.2009 1::/8/201 EACH OCCURRENCE 31 000, 000 <br /> DAVIT E T ENTER <br /> 2{ COMMERCIAL 3ENERAL LIABILITY PR.SMISES (Ee occurence) , 3300 , 000 <br /> CLAIMS M o0E MI OCCUR MED EXP (Any one parson) 310 , 000 <br /> — — '.--... ... .. _ PEREONALBADVINJURY 31 000 0_0_Q____ <br /> GE'IERALAGGREGATE 3 2. 000 000 <br /> OEN APPLIES PER; PRODUCTS- COMPIOPAGG $2,000,000 <br /> POLICY I1 EC 1-1 I I LOC — <br /> C AUTOMOBILEUABIJTY 4784945900 2/25/2010 2 25 <br /> / / 201:1 COMBINED SINGLE MST <br /> X ANY AUTO (Enaadcnt) 3 1, 000, 000 <br /> ALL OWNED AL TOS <br /> BD)ILYINJURY 3 <br /> X SCHEDULED A JTOS (Per parson) <br /> X HIRED AUTOS <br /> BO )LLY INJURY 5 <br /> 'L NON -OWNED P UTOS (PQf'aWo^I) <br /> —� - - - - -- PROPERTY DAMAGE 3 <br /> (Peraccldent) <br /> GARAGE UABILITY AU70 ONLY • EA ACCIDENT 3 <br /> ANY AUTO EA ACC 3 <br /> OTHERTHAN <br /> Aura ONLY: AGG $ <br /> EXCESS/UMBRELLA UABIUTY EACH OCCURRENCE 3 <br /> T OCCUR [1 CLAIMSMADE AG3REGATE - $ <br /> 3 <br /> _ DEDUCTIBLE IS <br /> RETENTION $ f 3 <br /> I WC STATU OTH- <br /> 33 WORKERS COMPENSA,ICNAND 60870 12/8/2009 12/8/2011) X J Tome tIMRR I FR <br /> EMPLOYERS' LIABILITY -- <br /> ANY PROPRIETOR/PARTNE A/EXECUTIV>; 6.1. EACH ACCIDENT $ Ij O 0 , 000 <br /> OFFICER/MEMBER CXCLU(•ED9 <br /> Ilyes, describe under EL DISEASE - EA EMPLOYEE E 5.0.0-_.000 <br /> SPECIAL PROVISIONS bele w E.L DISEASE - POLICY UMIT S 500, 00 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br /> License Holders: Jo:3n MacLeod CBC010111 (Duramade Windows & Doors, Inc <br /> Jctfrey Saitta CVCS6/80 (Duramade Windows & Doors Inc dba Fafco Solar of Tampa <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DES`'RIBED POLICIES BE CANCELLED <br /> City o f h hills BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER <br /> Y P yr WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE <br /> 5335 Bth Street CERTIFICATE HOLDER NAMED TO THE LEFT, RUT FAILTJRE TO DO SO <br /> Zephyrhi]ls FL 33542 SHALL IMPOSE NO OBLIGJTION DR LIABILITY OF ANY RIND UPON <br /> TEE INSURER, ITS AGENTS OR REPRESENTATIVES - <br /> AUTHORIZED REPRESENTATIVE '' 'Al.- 51 <br /> ACORD 25 (2001/08) @ ACORD CORPORATION 1988 <br />
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