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• A to <br /> , CERTIFICATE OF INSURANCE REQUEST FORM <br /> TODAY'S DATE : 11 /10/2010 <br /> INSURED NAME: VARA ELECTRIC CORPORATION <br /> CONTACT NAME: ROLANDO VARA <br /> E -MAIL ADDRESS: <br /> CONTACT PHONE NUMBER: 813 927 4938 813 239 6563 <br /> CONTACT FAX NUMBER: 813 232 3555 813 662 2630 <br /> CERTIFICATE HOLDER: <br /> CERTIFICATE HOLDER NAME: CITY OF ZEPHYRHILL <br /> MAILING ADDRESS: 5335 8 STREET <br /> CITY, STATE, ZIP CODE: FLORIDA 3 3542 <br /> ATTN: BUILDING DEPARTMENT <br /> E -MAIL ADDRESS: <br /> PHONE#: 813 780 0020 <br /> FAX #: 813 780 0021 <br /> JOB SITE LOCATION: <br /> PROJECT NAME: <br /> ADDRESS: 7932 GALL BLVD <br /> CITY, STATE, ZIP CODE:ZEPHYRHILL, FLORIDA <br /> PROJECT NUMBER (IF ANY): 11105 <br /> ATTENTION: KILLBRIDE INSURANCE <br /> PHONE: 813 9317467 <br /> FAX: 813 932 7336 <br /> "ti f ea:44 C i fry WO /fit 2 ,o /liere-/ <br /> 0 Ihng <br /> m..t_ CA../11- C Ate-CEA/ e y71227 <br /> t ' d SSSE2E2 -E18 3W1 sdanIf1H oar ebS :OT 0T 0T AoW <br />