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10-10389
Zephyrhills
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2010
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10-10389
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Last modified
3/22/2011 1:48:21 PM
Creation date
3/22/2011 1:45:37 PM
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Building Department
Company Name
ZEPHYR PLACE LLC
Building Department - Doc Type
Permit
Permit #
10-10389
Building Department - Name
ZEPHYR PLACE LLC
Address
6834 GALL BLVD STE 105
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RPR- 22- 2010(THU) 10:55 Tri- County Electric, Inc. (FRX)7277917396 P. 003/004 <br /> ACOBP,, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DO'WYY) <br /> PROOU 04/22/2010 <br /> 81 3)63 7 - 8877 FAX (813)637 -8484 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Insurance Office of America, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 4915 W. Cypress Street ALTER THE OCERTIFICATE A FORDED BY THE ES BELOW, <br /> Tampa, FL 13607 <br /> Sherry Barrett INSURERS AFFORDING COVERAGE NAIC e <br /> INSURED Tri- County Electric, .Inc. minim A: FCC( Insurance Co. 10175 <br /> .27837 US Hwy 19 North INSURER B: FOCI .Insurance Group <br /> Unit NMD NBURERc; <br /> Clearwater, FL 33761 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 /> �POUCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> t P M I TYPE OF INSUMNCE PolICY NUMBER 4 1 RYNI ZAI PdJCY lYNp`TIp,1N Lams GENERAL LIABILITY GL 0009973 .1 03/01/2010 03/01/2011 EACH OCCURRENCE $ <br /> X ` COMMERCIAL GENERAL LIABIU $ 100 rY DAMAGE TO RENTED 1,000.0X- 00 ■ 1 © OC CUR Ge O EX? (My w PIla , 00 <br /> CLAIMS MADE MED EX? (MT one pawn) 1 <br /> A 5.00 <br /> PERSONAL $ ADV INJURY 1 1 1 000,00'. <br /> ■.1 <br /> GENERAL AGGREGATE $ 2,000 , 0K <br /> GEN'L AGGREGATE LIMIT APPUEA PER: <br /> PRODUCTS - COMPAW *00 <br /> I POLICY 1 1 jg l l LOC 2,000,00 <br /> AUTOMOBILE Wintry <br /> MB LIMIT g <br /> ANY AUTO <br /> (Es <br /> —1 ALL OWNED AUTOS <br /> SCHEDULED AUTOS BODILY INJURY $ <br /> (Per perwn) <br /> _ —, HIRED AUTOS <br /> NON-OWNED AUTOS ( I NI QY ddent INJURY ' <br /> I <br /> PROPERTY DAMAGE $ <br /> (Per eaoltlonU <br /> GARAGELABILRY <br /> R ANY AUTO AUTO ONLY - EA ACCIDENT $ <br /> OTHER THAN EA ACC 1 <br /> AUTO ONLY; AGO $ <br /> OIC!BBA)MBRELLA Liman <br /> OCCUR El CLAIMS MADE EACH OCCURRENCE $ <br /> AGGREGATE $ <br /> DEDUCTIBLE 5 <br /> $ <br /> RETENTION g $ <br /> WORKERS CONFIRMATION 001 -WCO9A -6146 <br /> ENB 03/01/2010 03/01/2011 X � g <br /> EMPLOYIRB• UNIILITY TWtnCV i Awirt9 Mt <br /> B OFFICERR/MEMBER EXCLUDEE ECUTNE E.L. EACH ACCIDENT 1 100,000 <br /> 11yywa desaloe oneor EL. DISEASE • EA EMPLOYEE $ 100,000 <br /> SPECIAL PROV ISION S WOW <br /> OTHER EL DISEASE • POLICY LIMIT $ 500,000 <br /> DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPEpAL PROVISIONS <br /> CERTIFICATE H DER CANCELLATION + <br /> AI <br /> SHOULD ANY OF THE ABOVE oescRIBED POLICIES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br /> 10 DAYS WRITTEN NOTICE TO THE CERTMICATE NOLAR NAMED TO TN! LEFT, <br /> Ci ty of Zephyrh ills BUT FAILURE TO MAR, OUCH NOTIC! SHALL IMPOSE NO OBLK#ATION OR LIABILITY <br /> 5335 8th Street OF ANY KNo UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br /> Zephyrhi l l s, FL 33 542 AUTHORD`ED RIPREOENTATNE .., / <br /> Don Leggett/BARRES 2 `` e c ;,e, '`r,+� <br /> ACORD 25 (2001/08) FAX: (813) 780 -0021 <br /> ACORD CORPORATION 1966 <br />
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