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12-12909
Zephyrhills
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Building Department
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2012
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12-12909
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Last modified
2/12/2013 11:43:44 AM
Creation date
2/12/2013 11:43:41 AM
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Building Department
Building Department - Doc Type
Permit
Permit #
12-12909
Building Department - Name
MCDORMAN,ROBERT
Address
5929 18TH ST
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=�� _ �JJ�(///�A�Jl'/V/`�� �-` / � <br /> ��'°�� ' 4� }f��� M/DD/YVYV) <br /> � �_�� CERTIFICATE OF LIABILITY INSU ANCE � �y 3�2 �2012 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA I'IOLDi3 - <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE'ffOLICI <br /> BEIOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER�$)jQ,UTH IZED <br /> REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE 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 tertns and conditions of the policy, certain policies may require an endorsement. Astatement on this certifcate does not confer rights to the <br /> ceRifica[e holder in lieu of such endorsemenqs►. <br /> PRODUCER <br /> NAME <br /> Buhl Insurance Agency Inc. a"c°.No,Ext 813-876-0057 arc,No>813-877-8540 <br /> P.O. Box 152698. - <br /> ADDRESS <br /> Tampa, FL, 33684-2698 INSURER�S) AFFORDING COVERP�GE NAIC# <br /> INSURER A OHIO CASUALTY INSURAIVCE COMPANY <br /> INSURED JAIME CENTRAL AC & HEATING INSURER B <br /> SPECIALIST, LLC INSURER C <br /> 16825 TAYLOW WAY INSURER D <br /> ODESSA, FL 33556 INSURER E <br /> 813-601-0643 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 f=OR 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 SUEIJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE P.DDL suea - <br /> LTR INSR WVD POLICY NUMBER (MM/DD/YYYY LIMITS <br /> ) (MM/DD/YYYY) <br /> GENERAL LIABILITV EACH OCCUf2RENCE $ 1 OOO OOO <br /> X COMMERCIAL GENERAL LIAB�LITY PREMISES(Ea occurtence) $ ZOO OOO <br /> ICLAIMSMADE �'OCCUR MEDEXP(Anyoneperson) $ 10 QQQ <br /> A BL053720540 03/05/12 03/05/13 PERSONAL&��DVINJURY $ 1 QOQ QQQ <br /> GENERAL AGGREGATE $ �Z�OOO�OOO <br /> GEN'L AGGREGATE UMITAPPLIESPER PRODUCTS-COMPIOPAGG $ 2 OOO OOO <br /> POLICY PR0. <br /> JECT LOC S <br /> AUTOMOBILE LIABILITY Ea accident $ 1�O/�0 0 <br /> IANYAUTO BODILV INJURY(Per person) $ <br /> ALLOWNED SCHEDULED BA053720540 04/03/12 04/03/13 <br /> A I AUTOS CI AUTOS BODILY INJURY(Per accident) $ <br /> NON-OWNED PROPERTY DAMAGE <br /> HIRED AUTOS AUTOS $ <br /> (Per aa�tlent) <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCUf2RENCE $ <br /> EXCESS LIAB CLAIMSMADE AGGREGATE $ <br /> DED RETENTION $ $ <br /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY �,�N TORY LIMITS ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N�A E L EACH ACCIDENT $ <br /> OFFICER/MEMBER EkCLUDED� <br /> (Mandatory in NH) E L DI'sEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> _ DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ <br /> HILLSBOROUGH COUNTY 5015271 02%11/12 02/11/14 $5,000 <br /> A CONTRACTOR'S CODE COIdPLIANCE BOND <br /> DESCRIPTION OF OPERATIONS/LOCATfONS I VEHICLES (Ariach ACORD 101,..ddtlional Remarks Schedule,rf morespace is requved) <br /> Job Location: 5925 18th St, Zephyrhills, FL 33542 <br /> CERTIFICATE HOLDER CANCELLATION <br /> � SERVEPRO OF TARPON/WEST TAMPA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 13911 W HILLSBOROUGH AVE #306 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> TAMPA, FL 33635 ACCORDANCE WITH THE POLICY PROVISIONf�. <br /> FAX:813-854-4059 <br /> AUTHORIZED RFPRESENTATIVE <br /> - erved. <br /> ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD <br />
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