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09-9389
Zephyrhills
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2009
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09-9389
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Last modified
3/22/2011 8:45:41 AM
Creation date
3/22/2011 8:40:43 AM
Metadata
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Building Department
Company Name
ZEPHYR COMMONS LLC
Building Department - Doc Type
Permit
Permit #
09-9389
Building Department - Name
CHINESE RESTAURANT
Address
7940 GALL BLVD
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JUL -29 -2009 08:43 Fr om: AIRCORPS 7278417647 To:18137800021 Page:3 /4 <br /> i .... CERTIFICATE OF LIABILITY INSURANCE OP ID Cl DATEIMNIOOFeern <br /> BItiSA -1 07 27 09 <br /> 'MMER THIS CERTIFICATE IS A AMA OF NFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> South Poi0tet Apuranoe Svas HOLDER. THM CERTIFICATE DOES NOT AMEND. EXTEND OR <br /> 710 0akfield Drive, Ste 102 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Bs'andon "FL 33511 <br /> Phone: 813- 661 -0382 Fax: 866- 643 -7770 INSURERS AFFORDING COVERAGE_ NAIC $ <br /> INSURED INSURER A: Ohio Casualty Ins Co 24074 - <br /> • Breatheasy Seating 6 Air INSURER B: <br /> Conditioning, Inc. - -- - - - .-- - - <br /> sibs wSUR6R C: <br /> 1P0 x 898 <br /> P o r t Richey FL 34673 -0898 INSURER D. -~ <br /> I INSURER E. <br /> COVERAGES <br /> THt POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THF- POLICY PERIOD INDICATED. NOTWITHSTANDING <br /> ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH HIS CERTIFICATE MAY 8E I$$uE) OR <br /> MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS ANO CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ��// I1��T�11� <br /> lTR MIRE TYPE OF R14URANCE — POLKY NUYSER OA (1MIID /W 2 p1 0omYY1 -- LIMIT'S — — - <br /> GENERAL L&%HI TY EACH OCCURRENCE s 1000000 <br /> A I COMMERCIAL u,wAUe v1¢Nrlu <br /> GENERAL LIABILITY SLO (10)53639870 07/01/09 07/01/10 PREM1SEb(Ene 4.... $ 100000 <br /> CLAIMS MADE Ill l OCCUR MED MP (Aar one Pslwn) a 10000 <br /> -_ •. - . _. ,�_ ►•ERSONAL A ACV INJURY $ 1000000 <br /> GFNFRAL AGDRec,ATC $ 2000000 <br /> OEMLAGGRE LIMB APPLIES PER• • PRODUCTS • COMP/OP AOG $ 2000000 <br /> 7 POLICY 1=] J _pi LOC +--•- - .� <br /> t . <br /> AUTOMOBILE LIABILITY COMBINED BINDLE LIWT <br /> A X ANY AUTO BAO(10)53639870 07/01/09 07/01/10 (fismodam) 1000000 -- <br /> ALL OWNED AUTOS BODILY INJURY $ <br /> -- SCHEDULED AUTOS (Per person) <br /> X HIRED AUTOS BODILY INJURY $ ^- <br /> X NON -OWNED AUTOS (P!, •) <br /> —• PROPERTY DAMAGE $ <br /> (P•racclWrd) <br /> GARAGE Lemur( AUTO ONLY - EA ACCIDENT 3 <br /> ANY AUTO EA ACC $ ~.. — <br /> OTHER THAN <br /> AUTO ONLY ACC $ <br /> EXCESS 1 UMBRPU.A LIABILITY EACH QCCURReNCE $ 1000000 <br /> A .X I OCCUR I J cuIMS MADE U30 (10) 53639870 07/01/09 07/01/10 AGGREGATE _ - $ 1000000 - - <br /> DEDUCTIBLE $ <br /> RETENTION $10000 - $ — -- <br /> woman commies -1010 iTo Y I IMR6 j. 1 ER _ <br /> AND EMPLOYERS LIABILITY YI N __. <br /> ANY PROPIUETOILPA$TNEWGftCUTlV1r L E. <br /> L.ACN ACCIOCNI $ <br /> OFFICER/MEMBER EXCLUDED? 1� J I <br /> Nlr In NN) E.L. DISEASE - EA EMPLOYEE S <br /> Myw7 d 11•rJIW e1dI - -.... <br /> SPECIAL PROVISIONS hl ow E L, DISEASE - POLICY LIAR•r _ $ <br /> OTHER <br /> 066dtlP11011 OF OPERATIONS I LOCATION" / MECUM / EXCLUSIONS ADDED BY EMDORSEMENT I SPECIAL PROVISIONS <br /> CERTIFICATE HOLDER CANCELLATION <br /> MOULD ANY OP THE ABOVE DESCRIBED POUCES BE CANCELLED "EFORS THE BXPMATION <br /> CITYZEP DATE THEREOF, THE ISSUIKi SISUNeN WA.l. ENDEAVOR TO MAIL 30* _ DAYS ~YEN <br /> NOTICE TO THE C5R 1P1CATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO 00 BO SMALL <br /> City of Zephyrhills INPOU NO OBU7ATION OR UMILITY OF ANY NMO UPON THE IMSS1IE*, ITS Mows OR <br /> 5335 8th Street RSPNEJENTATHVIr , <br /> Zephyrhills FL 33540 'w'"°RaeD aEPRlSEIHTATA IE/ <br /> Mika Swam <br /> ACORD 26 (2009101) 111916 -2009 • - • CORPORA • 1 <br /> nglits reversed. <br /> The ACORD name and logo are rommerod marks of ACORD <br />
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