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10-10795
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2010
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10-10795
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Last modified
2/7/2011 10:05:55 AM
Creation date
2/7/2011 10:05:53 AM
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Building Department
Building Department - Doc Type
Permit
Permit #
10-10795
Building Department - Name
ROSEMAN,STANLEY
Address
5246 18TH ST
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ACORD DATE (MM/DD/YYYY) <br /> ACORD CERTIFICATE OF LIABILITY INSURANCE 06/03/2010 <br /> PRODUCER Phone: (352) 796 -3594 Fax: 352- 796 -0354 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> SNOW & BELL, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 24 N. BROAD STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> BROOKSVILLE FL 34601 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> • <br /> INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED INSURER A: State Auto Insurance Co. <br /> SOUTHERN COMFORT ENTERPRISES, INC. INSURER B: <br /> 4109 CR 656 ti INSURER C: <br /> WEBSTER FL 33597 <br /> 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 ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br /> LTR INSRC DATE(MMIDDIYY) DATE IMM/DD/YY) <br /> GENERAL LIABILITY ' PBP2053679 05/22/10 05/22/11 EACH OCCURRENCE $ 1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 <br /> PREMISES (Ee occurence) <br /> I CLAIMS MADE © OCCUR MED. EXP (Any one person) $ 5,000 <br /> A PERSONAL .3 ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG. $ 2,000,000 <br /> 7 POLICY Ii JE0 I � LOC <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT <br /> ANY AUTO (Ea accident) $ <br /> ALL OWNED AUTOS BODILY INJURY <br /> SCHEDULED AUTOS (Per person) $ <br /> HIRED AUTOS BODILY INJURY <br /> NON -OWNED AUTOS (Per accident) $ <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY <br /> AUTO ONLY - EA ACCIDENT $ <br /> R ANY AUTO OTHER THAN EA ACC $ , <br /> AUTO ONLY: AGG $ <br /> EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> OCCUR ❑ CLAIMS MADE AGGREGATE $ <br /> DEDUCTIBLE <br /> $ $ <br /> WC STATU <br /> WORKERS COMPENSATION AND I TORY LIMITS 1 I OTHER <br /> EMPLOYERS' LIABILITY <br /> E.L. EACH ACCIDENT $ <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EMPLOYEE $ <br /> If yes, describe under <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ <br /> OTHER: <br /> DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEN RE THE <br /> EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS <br /> WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAI!CG TO THE LEFT, BUT FAILURE <br /> CITY OF ZEPHYRHILLS BUILDING DEPT TO DO SO SHALL IMPOSE•NO OBLIGATION OR LI ',BILITY OF ANY KIND UPON THE INSURER, <br /> 5335 8TH STREET IT'S AGENTS OR REPRESENTATIVES. <br /> ZEPHYRHILLS, FL 33540 AUTHORIZED REPRESENTATIVE <br /> Attention: FAX: 813 - 780 -0021 <br /> I W'�B} <br /> ACORD 25 (2001/08) Certificate # 42693 C> ACORD CORPORATION 1988 <br />
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