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11-11832
Zephyrhills
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2011
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11-11832
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Last modified
2/9/2012 11:24:44 AM
Creation date
2/9/2012 11:24:40 AM
Metadata
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Building Department
Company Name
CITY OF ZEPHYRHILLS
Building Department - Doc Type
Permit
Permit #
11-11832
Building Department - Name
CITY OF ZEPHYRHILLS
Address
39450 SOUTH AVE
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��1 THEFGSG-01 WUJ1 <br /> '` � C�ERTIFICATE OF LIABILITY iNSURANCE �ATE(MM/DDlYYYY) <br /> 2/15/2011 <br /> PRODUCER (813) 984-3200 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Baldwin Krystyn Sherman ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> P.� 4ox 23T27 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> T•� a, FL 33623 <br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED FRS Environmental Remediation, Inc. dba The FGS INSURERA: CI181'tIS SF18CIaI�/ II1SUf811CQ CO 10328 <br /> Group iNSUaeR s: Commerce and Industry Company 0328 <br /> 120 E. MLK Blvd. �� 3—�f/ Z.3' � s'�� ,NSUReR c Travelers Casualty & Surety Co-19038 9038 <br /> Tampa, FL 33603 <br /> 3 � O 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. NOTW ITHSTANDING <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 DD' POLICY NUMBER P��Y EFFECTNE POLICY EXPIRATION u �� s <br /> c�eRa� uaewrr �,cH occuw��ce s 1,000,000 <br /> A X connnnERaa_ �eNew� una��m PROP15652970 2/19/2011 2/19/2012 pREMISES Ea occurence 3 100,00 <br /> CLAIMS MADE � OCCUR MED IXP (Any one parson) $ 5 ,��� <br /> , X General Liab $0 Ded PERSONAL 8 ADV INJURY $ 1,000,000 <br /> X PolluHon Liab $2500 Ded GENERALAGGREGATE $ 2,0��,0�0 <br /> I GEN'L AGGREGATE LIMIT APPLtES PER: L OOO OO <br /> PRODUCTS - COiu�/OP AGG $ r � <br /> X POUCY PRO- L � <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ') �OOO�OO <br /> B X ANYAUTO CA1932178 2/19/2011 2/19/2012 (��Gaent) <br /> X ALL OW NED AUTOS <br /> BODILY INJURY $ <br /> SCHEDULED AUTOS �P�' Pe�) <br /> X HIRED AUTOS <br /> BODILY INJURY $ <br /> NON-OW NED AUTOS (Per acGdent) <br /> " X $10,000 Pers inju Protect <br /> PROPERTY �AMAGE <br /> X SQ Llab Ded (Peraccident) b <br /> GARAGE LIABILITV AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO EA ACC $ <br /> OTHERTHAN <br /> AUTO ONIY• AGG $ <br /> EXCES3 ! UMBRELLA LIABIUTY EACH OCCURRENCE $ S,OOO,OO <br /> A X occuR � c�n,inns nnnoE PROU15653021 2/19/2011 2/19/2012 qGGREGATE y 5,000,00 <br /> $ <br /> DEDUCTIBLE <br /> $ <br /> X RETENTI6N $ $O $ <br /> WORKERS COMPENSATION W C STATU- OTH- <br /> AND EMPLOYERS' LIABILITY Y I N <br /> ANY PROPRIETOR/PARTNERlEXECUTIVE❑ E.L. EACH ACCIDENT S <br /> OFFICER/MEMBER EXCLUDEQI <br /> (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ <br /> If yes, describe under <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMI7 $ <br /> OTHER <br /> A Professional Liability PROP15652970 2119/2�11 2/19/2012 �ncluded;9MMl$2MM 10 ,000 Ded Each Claim <br /> C Rented and Leased Equipment QT6608205C508TIL10 2/19/2010 Z119/2011 Specfal Form Incl Theft 82so $5K D <br /> DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT ! SPECIAL PROVISIONS <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRI6ED POLICIES BE CANCELLED BEPORE THE EXPIRATION <br /> DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN <br /> City of Zephyrhi I Is NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> � Purchasing Department <br /> IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> 5335 8th Street REPRESENTATIVES. <br /> Zephryhills, FL 33542� AUTHORIZED REPRESENTATNE <br /> .�--° ,�o-,.�_ r - --��--� <br /> -- �--,..__ <br /> ACORD 25 {2009/01) O 1988-2009 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />
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