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11-12313
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2011
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11-12313
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Last modified
6/11/2012 11:40:45 AM
Creation date
6/11/2012 11:40:44 AM
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Building Department
Building Department - Doc Type
Permit
Permit #
11-12313
Building Department - Name
MONROE,LAWRENCE
Address
6017 14TH ST
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��� OP ID: JW <br /> '`'�° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) <br /> OS/23/11 <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 POLICIES <br /> FLOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> PRESENTATIVE OR PRODUCE}2, AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate hoider 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 813 CONTACT <br /> Florida Insurance Center Inc Na,Me: Judy Wagner AAI AU AIS CPIW <br /> 414 N Alexander Street 813-764-8402 q�� Ex� 813-754-3561 A�� Na : 813-752-8794 <br /> Plant Ciry, FL 33563 nooRess. Jwagner@floridainsurancecenter.com <br /> Florida Insurance Center, If1C. PRODUCER <br /> CUSTOMER ID #: SENIC-� <br /> INSURER�S) AFFORDING COVERAGE I NAIC # <br /> INSURED Senica Air Conditioning IIIC. INSURERA Westfield Insurence Company 24112 <br /> 16640 Shady Hills Road INSURER 8 <br /> Spring Hill, FL 34610 <br /> INSURER C <br /> INSURER D <br /> INSURER E <br /> INSURER F . <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBEf2: <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 1MTH 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 7ypE OF INSURANCE I N DL U DR POLICY NUMBER MMIDD MM D�lYYYY LIMITS <br /> LTR <br /> GENERAL LIABILI7Y EACH OCCURRENCE I$ 'I �OOO�OOO <br /> A X COMMERCIALGENERALLIABILITY CMM3288093 06/01/11 06/01/12 � pREMISES Eaoca�rrence �$ ���, <br /> CLAIMS-MADE � OCCUR MED EXP (Any one person) $ 5,000 <br /> A X Contr Liab Incl PERSONAL & 4DV INJURY $ �,000,000 <br /> GENERALAGGREGATE $ ?,OOO,OOO <br /> GEN'L AGGREGATE LIMIT APPLIES PER I PRODUCTS - COMP/OP AGG $ 2,OOQOOO <br /> POLICY X PRO- <br /> 7 LOC $ <br /> AUTOMOBILE LIABILITY COMBWED SINGLE LIMIT � �,OOO,OOO <br /> X ANYAUTO CMM3288093 06/01/1'I 06/01/12 �Eaacodent) <br /> BODILY INJURY (Per person) $ <br /> ALL OWNED AUTOS <br /> � BODILY INJURY (PeracGdent)' $ <br /> SCHEDULED AU1C�S ' PROPERTY DAMAGE <br /> X HIRED AUTOS (per acadent) $ <br /> X NON-0WNEDAUTOS ! PIP I $ 'IO,OO <br /> X Hired Phys Damage <br /> s <br /> X UMBRELLa LIAB X OCCUR EACH CCCURI�ENCE $ 1,000,000 <br /> EXCESS LfA6 CLAIMS-MADE AGGREGATE $ 'I,OOO,OOO <br /> A CMM3288093 06/01/11 06l01/12 <br /> DEDUCIIBLE � <br /> $ <br /> X RETENTION $ O � $ <br /> WORKERS COMPENSATION V�C STATU- OTH- <br /> AND EMPLOYERS' LIABILITY ,� � N I ' T RY �IMIT ER <br /> ANY PROPRIEfOR/PARTNER/EXECUTIVE E.L EACI-I ACC.IDENT $ <br /> OFFICERlMEMBER EXCLU�ED� ❑ 'N / A <br /> (Mandatory in NH) E.L. DISEASE - EA EMPLOYE S <br /> If yes, descnbe under <br /> DESCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT $ <br /> A Leased/Rental EQ CMM3288093 06/01/11 06/01/12 Limt too,000 <br /> � Ded z,soo <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 10'I, Additional Remarks Schedule, if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> C ITYZE P <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> City of Zephyrhills THE EXPIRATION DA7E THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Building Department <br /> 5335 8th Street AUTHORIZED REPRESENTATIVE <br /> Zephyrhills, FL 33542 <br /> g� �� <br /> O 1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD <br />
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