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11-11491
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2011
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11-11491
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Last modified
10/21/2011 10:56:07 AM
Creation date
10/21/2011 10:56:06 AM
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Building Department
Company Name
LUPTON
Building Department - Doc Type
Permit
Permit #
11-11491
Building Department - Name
LUPTON
Address
5130 GALL BLVD
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0^102!'_01 1 10 48 Paye 111 <br /> �►���' CERTIFICATE OF LIABILITY INSURANCE 0 08/1� <br /> THIS CER7IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGAl1VELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTiFICATE OF INSURANCE DOES NOT CONS7ITUTE A CONTRACT BETWEEN THE ISSUING INSURER�S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br /> IMPORTANT. If the certlficate hdder is an ADDI710NAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the tertns and condldons of the policy, certain policies may require an endorsement. A statement on this certlflcate does not confer rights to the <br /> certificate holder in lieu of such endorsement s. <br /> PRODUCER CONTACT <br /> NAME. <br /> Varcas Insurance Agency, LLC PHONE AfC No <br /> 2901 B West Hillsborough Ave -MAi� <br /> Tampa, FL 33614 P UCER <br /> Phone (813) 319-1940 Fax (813) 319-1944 INSURER S AFFORDING COVERAGE Nwc � <br /> INSURED INSURER A Bankers Insurance Group <br /> Hood Master Services LLC INSURERB. <br /> 1614 Marumbi Ct INSURERC <br /> W estley Chapel, FL 33544- iNSUReR o. <br /> INSURER E <br /> (813) 957-8197 <br /> INSURER F . <br /> COVERAGES CERTIFICATE NUMBER. REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR POLICY OLI Y XP <br /> �7R TYPE OF INSURANCE N POLICY NUMBER MMIDDIYYYY MMIDDlYYYY LIMITS <br /> GENERAL LIA&LITY EACH OCCURRENCE $ 'I,OOO,OOO <br /> � COMMERQAL GENERAL �IABILITY PREMISES Ea occurrence $ ��� <br /> �� c�niMS-Maoe � occuR 090410003184700 Meoe>w�a.nyonePerson� $ 5,000 <br /> fi ❑ N '��'�/20'�� 12/31l2011 pERSONAL& ADVINJURY $ �.��0.��� <br /> � GENERAL AGGREGATE $ 2.000 OOO <br /> GEN'L AG!=REGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 'I OOO OOO <br /> � POLIry ❑ JECT ❑ LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> � AfJ'f AI_iT0 BODILY INJURY (Per person) $ <br /> � ALL OWNED AUTnS BODILY INJURY (Peracaden[ $ <br /> ❑ Sr_HEGULEG qUTpg <br /> ❑ PROPERTY DAMAGE � <br /> HIRED AUT�=�S 1Pei acudent) <br /> ❑ VJON-OWPIEGAUTOS $ <br /> ❑ � <br /> � UMBRELLA LIAB � �CCUR EACH OCCURRENCE $ <br /> EXCESS LIAB rLAIMS-MAGE AGGREGATE $ <br /> � DEDUCTIBLE $ <br /> RETENTIGN $ $ <br /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS' LIABILITY Y� T RY IMIT ER <br /> ANY PROPR�ETORIPARi1JER/EXECUTIVE E L EACH ACCIDENT $ <br /> OFFICERIMEMBEREXQUDED� N!A <br /> (Mandatory in NM E L DISEASE EA EMPLOYE $ <br /> If ves desaibe undai <br /> DES�`RIPTION OF ��PERATIONS below E L DISEASE - POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS l VEHICLES (Attach ACORD 101, Addkional Remarks Schedule, if more space is required) <br /> CER7IFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCElLED BEFORE <br /> THE IXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Hood Master Services LLC ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 1614 Marumbi Ct <br /> W estley Chapd, FI 33544 AUTHORIZED REPRESENTATIVE �:r <br /> r ,� - : �;°+tiF:%: 9�"�es�r.�� ,' i= %"'' <br /> O 7988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25 (2009109) QF The ACORD name and logo are registered marks of ACORD <br />
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