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11-11729
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11-11729
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Last modified
2/8/2012 11:23:16 AM
Creation date
2/8/2012 11:23:14 AM
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Building Department
Building Department - Doc Type
Permit
Permit #
11-11729
Building Department - Name
CHILI'S BAR & GRILL
Address
7643 GALL BLVD
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From:Sherry t0`�Iver FaxID:863,967-7592 Page 1 of 1 Date:02/� 1/11 10�19 AM Page.1 of 1 <br /> ��� OP ID: SM <br /> '4`_°R°� CERTIFICATE OF LIABILITY INSURANCE °"�`""'°°"""", <br /> 02/11/11 <br /> THIS CERTiFiCATE IS ISSUED AS A MATTER OF INFORMA710N ONLY AND CONFERS NO RIGHTS UPON THE CERTiFICATE HOLDER. THIS <br /> CERTIFlCATE DOES NOT AFFIRMATiVELY QR NEGATiVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIdES <br /> BELOW. THIS CER7IFlCATE OF INSURANCE DOES NOT CONS7ITUTE A CONTRA�CT BETWEEN THE ISSUING INSURER(S�, AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER, AND THE CERTiFiCATE HOLDER. <br /> IMPORTANT: If the certfficate holder is an ADDITIbNAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIYED, subjed to <br /> the terms and cordkions of the policy, ce►tain policies may require an endorsemerK. A atatement on this certificate does not confer rights to the <br /> certificate holder in lieu oi such endorsemeM s <br /> PRODUCER ��967�� CONTA <br /> NAME: <br /> Mulling Insurance Agency, Inc. 863.96T-�592 PNO F^X <br /> P O Box 308 208 E Park Street "'�• "° � <br /> E AIL <br /> Aubumdale, FL 33823-0308 ADO'�S� <br /> rao°u�R SU NS-13 <br /> Brien Spann, AAI w �nr. <br /> INSURER(S) AfFORDING COVERAGE Np�C s <br /> wsu�o Sunshine Pressure Cleaning, In ,NSU�Rn. United Fire Grou 13021 <br /> Dale Dombrowsky INSUFtERB <br /> PO Box 5836 iNS�R c. <br /> Lakeland, FL 33807 <br /> iNSUr�R o . <br /> INSIAtER E . <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 NAMEU ABONE FOR THE POLICY PERIOD <br /> INDiCATED. NO7WITH5TANDING ANY REQUIREMENT, TERM OR CONDRION OF ANY CONTRACT OR OTHER DOCUMENT WfTFi RESPECT TO WHICH THIS <br /> CERTIFlCATE MAY BE ISSUED OR MAY PERTAIN, THE NSURANCE AFFORDED BY 7HE POLIGES DESCR79E0 HEREW !S SU9JECT TO A1L TME TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMffS SHOWN MAYHAVE BEEN REDUCED SY PAID CLAIMS. <br /> �� TYPE OF pVSURANCE POLICY NUMBER MMIDD� MMADMYYV LRARS <br /> GENERAL LIABILITY <br /> EACFiOCCURRENCE § 'I,OOO,O <br /> A X COMMERCIAL GEN£RAL LIABIIITY GO3�s�O 01/07111 O�/OT/�2 pREM�SES Es omrrence E 'IOO,O <br /> CLAIMS-rAADE aOCCUR I MEDF�W(Myoneperson) E �O,O <br /> PERSONRL BADV INJURY a 'I,OOO,O <br /> GENERAI AGGREGATE S 2,QOO,O <br /> GEN'L AGGREGAT£ lIM1T APPLIES PER� PRODUCiS- COMP/OPAGG ; Y,OOO�OO <br /> POLICY PRO- LOC <br /> S <br /> AUfOMOBILE LIABILITY COMBINED SNGLE LMIT <br /> (EeacadeM) S 7,0��,� <br /> A �Y�7o oa9ss�o ovoTr�� o�ro�nz <br /> ALL OWNEpAUTOS <br /> BOU1lY IN.IJRY (Per person) S <br /> X SCNEWLEDAUTOS BODIIYWJURY(Pereccident} S <br /> PROPERTY DAMAGE a <br /> X H82EDAU70S (PeracdderM) <br /> X NON-OWNEDAUTOS S <br /> X UMBRELLA LIAB X OCCUR a <br /> EACH OCCURRENCE § 1,000,0 <br /> EXCESS LIAB aqp�qS{,��E AGGREGATE S 'I,OOO,OO <br /> A 60399610 01107N 1 01l07112 <br /> DEDUCTIBLE g <br /> X REfENT10N S �O,OOO <br /> WORKERS COMPENSATiON f <br /> WC STATU- OTH- <br /> AND EMFLOVERS' LUBILITY Y � N TORY L ITS ER <br /> AM' PROPRIETORRAR7NERIE�CUTIYE S <br /> OFFICERMIEtdBER EXGLUDED9 ❑ N i A El. EAG-1 ACCIDENT <br /> (Manddory in NH) E.L. DISEP„SE - EA EMPLOYEE <br /> Nye s, desaibe under E <br /> DESCRIPTIONOFOPERATIONSbelow E.L.OISEASE-POLICYLIMR S <br /> DESCRPTION OF OPERq71pN5 / LpCqT10NS / VEMCLES (Attath ACORD 101, AddioonY R�marlts ScAedW�, If mon spK� la r�qulnd) <br /> "BIDDING PURPOSES ONLY" <br /> CERTIFICATE HOLDER CANCEILATION <br /> SNOUL� AM' OF iHE ABCVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRA'T10N DA'�E 7FiEREOF, N0710E 1Ndt BE DEt.IVERED iN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHpRIZED REpREgENTATI4E <br /> ����1F� <br /> B 1888-2009 ACORD CORPORATION. All rights reserved <br /> ACORD 25 {2009/09) The ACORD name and togo are registered marks of ACORD <br />
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