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11-12571
Zephyrhills
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Building Department
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2011
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11-12571
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Last modified
6/19/2012 2:38:24 PM
Creation date
6/19/2012 2:38:23 PM
Metadata
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Building Department
Company Name
LINCOLN HEIGHTS
Building Department - Doc Type
Permit
Permit #
11-12571
Building Department - Name
BEASLEY,GWENDOLYN
Address
39412 LINCOLN AVE
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__. _....„�� �. �„. 1V n,•, rNU�. ,�� v rax �erver <br /> ACORD � � � <br /> +�El�'.'C'i�'t��l.'l"�. Q� L��:�3:IL1�"'�f :I�V���.� I���:N:�:� o ATE(MM/DD/YY) <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER <br /> 7HIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE <br /> POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S►, <br /> AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br /> IMPORTANT. If the certiticate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, <br /> subJect to the terms and conditfons of the policy, certain policies may requlre an endorsement. A statement on this certificate <br /> does not confer rfghts to the certtticate holder tn Ileu of such endorsement(s). <br /> PRODUCER <br /> PAYCHEX INSURANCE AGENCY, INC. COMPANIES AFFORDING COVERAGE <br /> 150 SAWGRASS DRIVE ` GUARD INSURANCE GROUP <br /> ROCHESTER, NY 14620 <br /> COAApqNY <br /> INSURED B <br /> AIRTECH SERVICES OF PASCO INC cornanNv <br /> 38835 COUNTY ROAD 54E � <br /> ZEPHYRHILLS, FL 33542 <br /> COM1APANY <br /> D <br /> � ��� ��AEY �� :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. <br /> ��t�tl�t�A1'�;N�:NI� Lt#;: <br /> ............. <br /> :���±i�or�: �i�:�t��:�;. <br /> ............. <br /> HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED qBOVE FOR THE POLICY PERIOD <br /> INOICATED, NOTWITHSTANDING qNY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICN THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AL� THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> Co TYPE OF INSURANCE <br /> LTR POLICY NUMBER POLICY E�FECTIVE POLICY EXPIRqTION <br /> DATE (MM/DD/VY) DATE (MM/00/YV) LIMITS <br /> GENERAL LIABILITY <br /> COMMERCIAL GENFRAL 1 IABILITY GENERAL AGGREGATE $ <br /> �LAIMS MADE �jCCUR PRODUCTS COMP/OP AGG $ <br /> OWNER'S & CONTRACTOR'S PROT PERSONAL 8 ADV INJURY $ <br /> EACH OCCURRENCE $ <br /> FIRE DAM/1GE (Any one lire) $ <br /> AUTOMOBILE LIABILITY MED EXP (Any one person� g <br /> ANY AUTQ <br /> COMBINED SINGLE LIMR $ <br /> ALL OWNED AUTOS <br /> SCHEDULED AUTOS <br /> BODILY INJUHY $ <br /> HIRED AUTOS (Per person� <br /> NON-OWNED AUTOS BOOILY INJURV <br /> (Per accidem) $ <br /> PROPERTY DAMAG[ g <br /> GARAGE LIABILITY <br /> ANY AUTO AUTOONLY - EA ACCIDENT $ <br /> OTHER THAN AUTO ONLY• <br /> EACH ACCIOENT $ <br /> EXCESS UABILITY nGCREGATE g <br /> UMBRELLA FORM EACti ocCURr�ENCE g <br /> OTHER THAN UMBREI_LA FORM AGGREGATE g <br /> WOflKER'S COMPENSATION AN� g <br /> (� EMPLOYERS'LIABILITY AIWC241921 11��9�1� X wC57A7U- otH- <br /> 11l09/12 <br /> 7HEPR(WqIETOq ELEACHACCIDENT $ 100,000.00 <br /> PARTNEFS ,execunve O �NCL <br /> OFFICERS ARE O EXCL EL DISEASE - POLICY LIMIT $ 500,000.00 <br /> OTHER EL DISEASE - EA EMPLOYEE ¢ 100,000.00 <br /> DESCRIPTION OF OPERATIONS / IOCATIONS / VEHICLE3 (Attach ACOflO 101, Additlonal Remarks 3chedule, H more space Is required) <br /> c�ar��cAr�;�ao�:a��: . .. .. .. .... <br /> � �.� . .. . <br /> �AN��E<E:A°f��N . . ... <br /> CITY OF ZEPHYRHILLS SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> 5335 8TH 5T DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY <br /> ZEPHYRHILLS, FL 33542 PROVISIONS, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGA710N OR <br /> LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OH REPRESENTATIVES. <br /> AUT �ED REPRESENTA IVE �� <br /> • �;�l�� s.r��f�[�-�T� ` W. <br /> :.AC.QRD;25���t,^L,QO�lO�) .................................................................�:. ,. .� .. <br /> �. <br /> . ' .:...................................................�AGCiff�:CQ�t?Qf'tAT3biil;i988.... <br />
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