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10-11011
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10-11011
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Last modified
8/16/2011 8:57:04 AM
Creation date
8/16/2011 8:57:01 AM
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Building Department
Building Department - Doc Type
Permit
Permit #
10-11011
Building Department - Name
CARVER,EARL J & DAVIS,DOROTHY
Address
38048 12TH AVE
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CERTIFICATE OF LIABILITY INSURANCE OP ID Ss DATE(MM/DD/YYYY) <br /> ALLFL -1 , 10/13/09 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Scarr Insurance Group HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 8200 113th Street N Ste 202 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> inole FL 33772 <br /> .Ine:727- 393 -5055 Fax: 727- 392 -0497 INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: AMERICAN SAFETY INDEMINTY co <br /> INSURER 8: <br /> ALL FLORIDA WEATHERPROOFING <br /> & CONSTRUCTION INC. INSURER C: <br /> 13555 AUTOMOBILE BLVD STE 4 1 1Z--- INSURER D: <br /> CLEARWATER FL 33772 <br /> I 3 <br /> 3`7(02 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 /> LTR INSRC TYPE OF INSURANCE POLICY NUMBER DATE (MMIDDIYYYY) DATE (MM/DD/YYYY) LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> A X COMMERCIAL GENERAL LIABILITY lOTSR- GL2587 -00 10/11/09 10/11/10 P $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 /> PRO- <br /> POLICY JECT LOC <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT <br /> ANY AUTO (Ea accident) $ <br /> • <br /> ALL OWNED AUTOS c7 7 2- M/9 BODILY INJURY <br /> SCHEDULED AUTOS (Per person) <br /> HIRED AUTOS <br /> 7 i -/S---60 BODILY INJURY <br /> NON -OWNED AUTOS $ <br /> / Z S (Per accident) <br /> O RTY AMAGE D $ <br /> (Per PR acc <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> — <br /> ANY AUTO <br /> OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> OCCUR CLAIMS MADE AGGREGATE $ <br /> $ <br /> DEDUCTIBLE <br /> RETENTION $ — <br /> WORKERS COMPENSATION WC 5I A I U- 0I H- <br /> AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIV1 I <br /> OFFICER/MEMBER EXCLUDED? E.L. EACH ACCIDENT $ <br /> (Mandatory In NH) <br /> If yes, describe under E.L. DISEASE - EA EMPLOYEE $ <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ <br /> OTHER - <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br /> RESIDENTIAL ROOFER DOING ONLY FOAM AND RUBBER MEMBRANE ROOFING (NO TAR, <br /> FLAME, ETC) ON ONE STORY RESIDENCES AND MOBILE HOMES * ** *SUBJECT TO POLICY <br /> TERMS, CONDITIONS AND EXCLUSIONS * * ** <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF, THE ISSUING INSURER WILL. ENDEAVOR TO MAIL 30 DAYS WRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> City of Zephyrhills REPRESENTATIVES. <br /> 5335 Eighth St AUTHORIZED REPRESENTATIVE <br /> Zephyrhills, FL 33542- Paul Flaig <br /> ACORD 25 (2009/01) ©1988 -2009 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />
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