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10-11078
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2010
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10-11078
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Last modified
8/16/2011 8:13:03 AM
Creation date
8/16/2011 8:13:03 AM
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Building Department
Company Name
K-MART
Building Department - Doc Type
Permit
Permit #
10-11078
Building Department - Name
K-MART
Address
7422 GALL BLVD
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• <br /> ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> 10/19/2010 <br /> PRODUCER D080720 1 -407- 332 -0033 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Insurance Solutions of America, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 910 Belle Avenue, Suite 1140 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Winter Springs, FL 32708 <br /> Scott E. Lugering INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED <br /> INSURER A: Everest Indemnity Insurance Company <br /> Alliance Fire & Safety, Inc. Alliance Protective Systems <br /> Inc., dba Alliance Fire & Safety INSURER B: Saf Co <br /> P.O. Box 637 <br /> INSURER C: <br /> Venice, FL 34284 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 POLICY EFFECTIVE POLICY EXPIRATION <br /> LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS <br /> A GENERAL LIABILITY 51GL002413 - 101 04/27/10 04/27/11 EACHOCCURRENCE $1,000,000 <br /> DAMAGE X COMMERCIAL GENERAL LIABILITY PREMISES a $ 50,000 <br /> CLAIMS MADE X OCCUR MED EXP (Any one person) _ $ 5,000 <br /> PERSONAL & 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 /> POLICY PRO - <br /> PRO- LOC <br /> B AUTOMOBILE LIABILITY 01CI35908110 <br /> 04/27/10 04/27/11 <br /> COMBINED SINGLE LIMIT $1,000,000 <br /> ANY AUTO (Ea accident) <br /> ALL OWNED AUTOS <br /> BODILY INJURY $ <br /> X SCHEDULED AUTOS (Per person) <br /> X HIRED AUTOS <br /> BODILY INJURY <br /> X NON -OWNED AUTOS (Per accident) $ <br /> X Comp Ded $1000 <br /> PROPERTY DAMAGE <br /> X Coll Ded $1000 (Per accident) <br /> GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $ <br /> ANY AUTO <br /> OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> OCCUR CLAIMS MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND WC STATU- OTH- <br /> EMPLOYERS' LIABILITY <br /> TORYIIMITS ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ <br /> If yes, describe under <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ <br /> OTHER <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> City of Zephyrhills DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> 5385 8th Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> REPRESENTATIVES. <br /> Zephyrhills, FL 33542 AUTHORIZEDREPRESENTATWE y � t J <br /> USA t ON k u <br /> ACORD 25 (2001/08) cleopoldl <br /> © ACORD CORPORATION 1988 <br /> 17945204 <br />
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