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11-12372
Zephyrhills
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Building Department
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2011
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11-12372
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Last modified
6/11/2012 12:55:20 PM
Creation date
6/11/2012 12:55:18 PM
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Building Department
Building Department - Doc Type
Permit
Permit #
11-12372
Building Department - Name
BOYETTE,ASHLEY
Address
5826 17TH ST
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SEP-13-2011 13:42 P.04 <br /> �'�� � <br /> �'� ° CERTlFlCATE OF LIABILITY INSURANCE i2;7`;';zo o" <br /> THIS CERTIFICAT@ IS I$$UED A$ A MATT�R OF INFORMQTIQN ONLY AND CpNFERS NQ RIGHTS UPGN THE CERT1FtCATE HOI,DER THIS <br /> CERTIFICATE DOES NbT AFFIRMATIVELY OR NEGATIV�LY AMENO EXTEND OA AL7�R TMIE COVERAGE AFFORDED BY 7Ne PqUCIES <br /> BELOW. TH19 CERTIFICATE OF INSURANCE OOFS NOT C�NSTITU7E A C4NTRACT BETYVEEN THE ISSVING iNSUREA(S), qUTHORIZED <br /> REPAE$ENTATIVE OR PRGDUCER, ANb TFIE CLR7IFICATE HOLDER. <br /> IMPORTANT: It the certlflcata hotder Is an ADDITIONAL INSURED, tbe poflcy(ks} must be endoroed. lf S178ROQATION IS WANED, sub�oct to <br /> the te�m9 and conditlo�9 oT the pplicy, Certain poli�ils may requlre an entlor6ament. A statement on tnls cartificata doas not conter righb to the <br /> a9rtlHCate holdar [n Ilau of such ondors�moM(s). <br /> PNOWCER !� Kim 6chaartakopf <br /> Hen Srown iasurance Agency PMONE ��; (941) 366-9373 M �� F � ���(961)365-3313 <br /> 3731 S Tuttle Ave �� .kiml�benbrownins.aom <br /> Pp ��� 00014296 <br /> saraaota FL 34239-6410 NVWpER AFFOHDINGGOVERAGE ru,�c� <br /> INSURED INSUpFnA�ational Trust Ins Co <br /> INSURER B : �• <br /> D� D Garage Doors, inc INSUREFC <br /> 1177 Cattlemea Road INBUqEpD <br /> lNSUAFAE: __�......,.�...._,- <br /> 6arssotis �'L 34232 IN URERF <br /> COVEI�AGES CERTIFICATE NUMBER GL/CA/UMB qe�nS�qN NuMBER: <br /> THIS IS TO CERTIFY TFfAT THE POLICIES OF INSURANCE IISTEO BELdW HAVE BEEN ISSUED TO THE INSURED NAMED A80VE FOR THE POLICY PERtOD <br /> INDIQATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 1MTH RESPECT TO WH1CH THI$ <br /> CERTIFICATE MAY 6E ISSUED OR MAV p�RT/UN, 7H� �NSUAANCE AFFOpDED B� TNE PQ�ICIES DESCRIBEO MER61N IS SU6JECT TO ALL THE TERMS, <br /> EXCIUSIONS AND CONDITIONS OF 5UCN POUCIES. uMri'S SMOWN MAY HAVE BEEN REOUC6D BY PAlD CLAIM3, <br /> ��*p TYPE OF INSURANCE iOLiCY NYM66h P � uM� <br /> GENeaal uaeam � occuRaE►� L 1, 000, OOO <br /> X COMIAERCIAL GENERAL LWBILITY AQE TO RE D : 100 � 000 <br /> A ewata�,00E �occua ]C L0011328 /i/2oii /i/zoiz MEOEXP w�e s � 5,000 <br /> X Contractual Liabililq P$ReoNALaADVIN,KIRV � 1,000,000 <br /> % XCV GEN[wu,�c�cn� i 2,000,DOO <br /> (3�N'l AqOfiEC+ATE I.IM�7 APAUES PER: PRODUCTS • COMP/OP AGG E Z OOO � OOO <br /> Poucr x � wc a <br /> AUTOMOBILE LIASIIJTY � COMDINED SINGLE UMIT <br /> � S 1,000,000 <br /> x ANY AUTO BODILY INJURY (Pcr onsan) 5 <br /> A auowr�EOnuros n001760? /i/aoii /i/zolz <br /> BODIIY INJUiiY (Pa accident) _ <br /> x SCHEOULED AUT06 pqppEqT+/ p/WLqGE <br /> R MIR�O AlJT03 I� ��^U s <br /> NqN.OWNED AUTOS Wrrourcd Malaria� Lio6/ & i <br /> Mcdicvl payment i <br /> X UM�RELLA LIAB X��q EACM OCCURREHCE = S� OOO � O00 <br /> ��� � ouuM3-MADE ncGRECnrE _ ` 1, 000, 00� <br /> DEDl1CT19L£ �— s <br /> A � q NTICN s 10 000 +�6011Bb7-1 iiizoii /i/soia 5 <br /> WORKERS CONpENSATION wC 8YA'R/- Or+ <br /> ANO ENPLOYERR' WSILITY <br /> ANV PROPRIfiTOH/PMTHERfD�ECUTIVE Y � N EL EACN ACGDENT 0 <br /> OFFYCERIMGMDCREXCWDEDT � NJA —. <br /> {Mentletay In NFq E.L DISEASE . EA FJAPLOYE � <br /> Hycz dr.m'ba undar � <br /> DEBCRIPTION OF W'FNA �ON OqOw E,L D18EA8E - POUCY LIMIT S <br /> DE8CRIPTION OF OPERATIONS! LOCAT10N9! VEHICLE9 {Atlaoh ACORQ 1a7, Aadfllonol Rame�ks Ca�dule, ll mon sprc. Is roqul►ae) <br /> Garage door installatioe and mainbaoanca• Qualifiec � Dslla� Nillor 8tata Lic�oxe M- CSC1258205 <br /> C�RTIFICAT� HOLDER CANCELLATiON <br /> ( 813 ) 780-0021 3HOULD ANV OF THE ABOVE DESCRIBED POLICIES 8E CANCBLLEp BEFCRE <br /> THE EXPIAATION DATE TH6R60F, NOTICE WI�L BE DEUVERLD IN <br /> City of Zephyrhills ACCORDANCE WITH TNE P061CY PROVISIONS. <br /> Building uepartimenti p�OA�OREPRESENTA7IVE <br /> 5335 8th 8t <br /> Zephyrhills, FL 33542 <br /> Ryaa BroWU/KIM �� ��, �� <br /> ACOAD 25 (2009/0.9} � 1988-2009 ACORD CORPORATION. All rights reservod. <br /> INSO25 rmoeoe� The ACORD name and logo are reg�stered marks of ACOflO <br /> TOTAL P.04 <br />
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