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11-11875
Zephyrhills
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2011
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11-11875
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Last modified
2/9/2012 1:17:05 PM
Creation date
2/9/2012 1:17:01 PM
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Building Department
Company Name
ALPHA VILLAGE
Building Department - Doc Type
Permit
Permit #
11-11875
Building Department - Name
MCINTYRE,THEODORE & CHRISTINE
Address
7245 LANDOVER DR
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From'Whitney Atheras Fa�ID'Celedinas Insurance Page 2 of 2 Date:S/3l2011 10:51 AM Page2 of 2 <br /> '�� OP ID: WA <br /> ' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> 05/03/11 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATiVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIpES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORI2ED <br /> REPRESENTATIVE OR PRODUCER, AND THE CER7IFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL iNSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement s. <br /> PRODUCER 561-622-2550 CONTACT <br /> Celedinas Insurance Grou PBG NAME. <br /> 4283 Northlake Blvd. P 561-721-0540 A�c o Ext : A/C No : <br /> Palm Beach Gardens, FL 33410 E�AAIL <br /> William Hamilton ADDRESS: <br /> PRODUCER NORTH-1 <br /> CUSTOMER ID #. <br /> INSURER(S) AFFORDING COVERAGE NAIC # <br /> INSURED North County Plumbing Inc 8. INSURERA.AIIIeCI P Sa C II1SU�1�1C@ 42579 <br /> Agrusa 8� Sons Contracting Inc INSURERB Nationwide Mutual Fire Ins Co 23779 <br /> 9056 N Military Trl, Ste I INSURERC <br /> Palm Beach Gardens, FL 33410 <br /> INSURER D <br /> INSURER 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 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 LIMffS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS <br /> INSR <br /> �� TYPE OF INSURANCE POLICY NUMBER MM/DD YY MMI�D�D� LIMITS <br /> GENERALLIABILITY EACHOCCURRENCE $ 'I,OOO�OO <br /> A X COMMERCIALGENERALLIABIUTY CP5904564855 07101/10 �7���/�� pREMISES Eaoccurrence $ 1 ��,�� <br /> CLAIMS-MADE � OCCUR MED EXP (My one person) $ ��OOO <br /> PERSONALBADVINJURV $ 'I�OOO�OOO <br /> GENERALAGGREGATE $ Z�OOO�OOO <br /> GEN'LAGGREGATELIMITAPPLIESPER PRODUCTS-COMP/OPAGG $ 2,000�000 <br /> POLICY P LOC <br /> $ <br /> AUTOMOBILELIABILITY COMBINEDSINGLELIMIT $ ��OOO�OOO <br /> A X,4��v AuTO CP5904564855 07/01/10 07/01/11 (Ea acadent) <br /> BODILY INJURY (Perperson) $ <br /> ALL OWNEDAUTOS <br /> BODILY IN,AJRY (Per accident) $ <br /> >CHED� iLED 41 iTOS <br /> PkOFERTYDAMAGE <br /> HIREGHUTG= (Paracadent� � <br /> NON-OWNED AUTO: $ <br /> $ <br /> UMBREL�A LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MP,DE AGGREGATE $ <br /> DEDUCTIELE <br /> $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS' LIABILITY �, � N TORV LIMITS ER <br /> ANY PkOFRIETOk/PARTNE=R/EXECUTNE E L EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED'> ❑ N � �+ <br /> (Mandatory In NH) E L DISEASE - EA EMPLOVEE $ <br /> If yes, describe untler <br /> DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ <br /> B ontents 77PR7283333003 07/01/10 07/01/11 1000AOP/ 200,00 <br /> 5% Wind <br /> DESCRIPTION OF OPERATIONS ; LOCATIONS / VEHICLES (Akach ACORD 101, AddiUonal R�marks Seh�dul�, If mon epac� Is r�qulnd) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> City of Zephyrills Building ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Department <br /> 5335 Sth St AUTHORIZED REPRESENTATIVE <br /> Zephyrhills, FL 33542 � <br /> O 1988-2009 ACORD CORPORATION. All rlghts reserved. <br /> ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD <br />
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