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11-11843
Zephyrhills
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2011
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11-11843
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Last modified
2/9/2012 11:31:24 AM
Creation date
2/9/2012 11:31:23 AM
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Building Department
Company Name
EMERALD POINTE
Building Department - Doc Type
Permit
Permit #
11-11843
Building Department - Name
HOLMAN,TANYA D (TRUST)
Address
39533 QUARTZ DR
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%'�'� <br /> ACOR� DATE (MMlDDlYYYY) <br /> `� CERTIFICATE OF LIABILITY INSURANCE ioiii2oii 9iioiaoio <br /> PRODUCER Lockton Companies,LLC NE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> 7 Times Square, Suite 3802 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> New York 10036 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 646-572-7300 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED AMERICAN RESIDENTIAL SERVICES OF FLORIDA INC. INSURER A Liberty Mutual Fire Insurance Company 23035 <br /> 1073055 3340 SCHERER DRIVE INSURER B Libertv lnsurance Co oration 42404 <br /> SUITE A � <br /> ST PETERSBURG FL 33716 INSURER C Navigators Insurance Company 42307 <br /> INSURER D <br /> INSURER E <br /> COVERAGES AMEREOZ RB THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING <br /> 1 TH D R P ENT TNE PR D R AN THE RTIFI T H LDER <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 /> INSR AUD'L POLICY EFFECTNE POLICY EXPIRATION <br /> LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MMIDD/YY) DATE (MMIDD/YY) LIMITS <br /> GENERAL LIABILRY EACH OCCURRENCE $ 2 OOO OOO <br /> A X COMMERCIALGENERALLIABILITY TB2 10/1/2010 10/1/2011 PRMMGETO aE�ED ce $ 1 OOO OOO <br /> CLAIMS MADE � OCCUR MED EXP (Any one person) $ ] � QQQ <br /> PERSONAL & ADV INJURY $ Z OOO OOO <br /> GENERAL AGGREGATE S 4 OOO OOO <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 4 OOO OOO <br /> PRO- <br /> POLICY JECT LOC <br /> A AUTOMOBILE LIABILITY AS2 1 1 lO/1/2010 10/1/2011 COMBINED SINGLE LIMIT g 2�000,000 <br /> �' ANY AUTO (Ea accident) <br /> ALL OWNED AUTOS BODILY INJURY $ XxXXxXX <br /> SCHEDULED AUTOS (Per person) <br /> HIRED AUTOS <br /> BODILY INJURY <br /> NON-0WNED AU70S (Per acadent) $ XXXXX�� <br /> PROPERTY DAMAGE $ XXXXXXX <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ XXXXXXX <br /> ANY AUTO NOT APPLICABLE <br /> OTHER THAN EA ACC $ XXXXXXX <br /> AUTO ONLY AGG $ XXXXXXX <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ S OOO OOO <br /> C X OCCUR � CLAIMS MADE NYl0UMR715088N ]O/1/2010 lO/1/2011 AGGREGATE $ S OOO OOO <br /> UMBRELLA $ XXXXXXX <br /> DEDUCTIBLE X FORM <br /> $ �'�'X�1'XXX <br /> RETENTION $ <br /> $ X�'X�'�'XX <br /> $ WORKERSCOMPENSATIONAND WC7 10/I/2010 10/1/2011 X WCSTATU- OTH- <br /> EMPLOYERS' LIABILITY y/ N TORY IMIT R <br /> ANY PROPRIETOR/PAR7NER/EXECUTIVE <br /> OFFICER/MEMBER EXCLUDED? N E.L. EACH ACCIDENT $ 1�OOO�OOO <br /> (Mandatory in NH) <br /> Ityes, descnbe under E.L. DISEASE - EA EMPLOYEE $ 1�OOO�OOO <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ I,OOO.,OOO <br /> OTHER <br /> DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUStONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> THE GENEKAL LIABILITY POLICY'S GENERAL AGGREGATE LIMIT APPLIES PER LOCA1'ION AND IS SUBJECT TO A$20,000,000 GENERAL <br /> AGGREGATE POLICY LIMIT <br /> CERTIFICATE HOLDER CANCELLATION <br /> 10733685 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> CITY OF ZEPHYRHILLS DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN <br /> 5335 8TH STREET NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL <br /> ZEPHYRHILLS IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> REPRESENTATNES. <br /> AUTHORIZED REPRES /J��G��/K„��. <br /> � f♦ <br /> G <br /> ACORD 25 (2009/01) 1988-2009 ACORD CORPORATION. All rights reserved <br /> The ACORD name and lo are re marks of ACORD <br /> For questions �agarding this cartHieate, wntact the number IisLd in ttie'Proaucer saction above and speciy the chent wde'AMERE02' <br />
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