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12-12926
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2012
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12-12926
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Last modified
2/12/2013 11:54:24 AM
Creation date
2/12/2013 11:54:23 AM
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Building Department
Building Department - Doc Type
Permit
Permit #
12-12926
Building Department - Name
WARREN,WILLIAM & KATHLEEN
Address
39031 3RD AVE
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' �'1 � OP ID:JD8 <br /> � '`��° CERTIFICATE OF LIABILITY lNSURANCE °"��31'W°,°z"Y' <br /> THi8 CERTIFICATE IS ISSUED AS A MATTER OF IN�ORMATION ONLY AND CONFERS NO RIGHT8 UPON THE CERTIFfCATE HOlOER.THIS <br /> CERTiFfCATE OOE$ NOT AFFIRAAATIVELY OR NEOATIVELY AAAEND, EXTENd OR ALTER THE COVERAGE AFFORDED BY YHE POLICIES <br /> BELOW. ZHIS CERTIFlCATE OF INSURANCE OOE8 NOT CONBTITUTE A CONTRACT HE7VVEEN TFlE iS8U1NG IN8URER(S►, AIfTHORIZHD <br /> REPRESENTATNE OR PRQDIJCER.AND TNE CERTiFlCATE HOLDEit. <br /> {MPORTANT: N ths cortlflcata holdot i�an ADDITI01VA1. INSURED,fhs poilcy(los}tnuat bo sndorsed. If SUBROCiATtOM IS WAf1/HD.aubject to <br /> Me terms end condlqons oT th�polley,certaln pol{cles may requlre an sndorsement A stabmsnt on thls certiflcata doas not co�isr rlghts to the <br /> ceAlficate holde�In Ileu of euch andoreemsn s. <br /> PqODUC6R 831-288-42T1 • <br /> Poroh 8Mbling Wabb 831-288-4911 ° Ne c ko: <br /> 132 E Maln Sbeet !: . —__ <br /> wsv.Ny,nr n�ss „� :� <br /> Davls S.Porch III -•- <br /> ���ro r CONSO-1 _ _ _ <br /> - ° -- - lN9UR s AFFOI�DINO COVERAG! _ NAIC�_. <br /> aeuneo J�Consolidatod Industriea,LLC u�E�A:Ownsrs Insurance Company 32T00 <br /> Oavid Sullivan �- -- - <br /> P.O.Box 108 ���e: � ...-- -- <br /> Paris.TN 38242 °��c: ------ --.. - -- - - <br /> o�ween o: <br /> INBUqER F: <br /> r: <br /> COVERAOE8 CERTIFICATE NUMBER: REVI810N NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF IN3URANCE LISTED BELOW HAVE BEHN ISSUED TO THE INSUREO NAMHD ABOVE FOR THE POLICY PERI00 <br /> INDiCATED. N071MTNSTANDING ANY REGUIREMENT,TERM OR CONDITIOM OF ANY CONTRACT OR OTHER OOCUMENT W17H RESPECT TO NMtCH THIS <br /> CERTIFICATE MAY BE lSSUED OR MAV PERTAIN, THE tNSURANCE AFFORDED BY THE POlIC1E5 OEBCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS ANO CONOITIONS OF SUCH POUpES.LMAITS SHOWN M�AY HAVE BEEN REWCEO BY PNO CLAIMS. <br /> nrve oF iwsuR�nCe pa�y�� �' urrts - - <br /> Q����� EACHOCCURRENCE f �.00O,O <br /> A X co.aMeacw.c,�n�weiurr 3098092 0?J01112 OTro1n3 pp aE8 Ee_�oaoa�— s 300,0 <br /> _ CLA�M6�AADE a OCCUR YIEO E1tP(My onspason t 70A <br /> PERSOru�i nov auUnr t 1,000,00 <br /> �„_„�_ GENERALAGORE(3ATE i ' Z.00O,00 <br /> OEN'�ACGREWI7E L�qT IIPPLIEB PlR� PRODUCTS•COM170P A00 s 2,000,0 <br /> POIICV � LOC ~ 3 _` <br /> AUTOM081LE lYiBIL(iY GOMBINED S1NGlE lIM{T = �,Q�.O <br /> A X arv auro 871$89802 0?J9D1/12 02/01/�3 �Ea�aidwn) � <br /> aoour iwuRr�aa�p«�au s <br /> X ILLL OWNEO AUTOS BOOLLY INJURY(Per soeiQ�nt) S <br /> _X SCNEDULEO AUTOS PROpERiY DAI�MGE <br /> X HIREDAIJTOS {PeraoeJ0au) s <br /> X IiON-0WNEDAUTp9 ^ i <br /> - --' _ • <br /> UYYREU.A 1.u9 )( �C� EACN OtCURRENCE S 6,C00,00 <br /> FaccESS une cw�s.auoe wocr±ECU►TE s 5,000,— <br /> A -- 6718686�3 0?ro1H2 0?J01113 - -- - --- - <br /> OEDUCTIBIE 3 _ <br /> R NTION = <br /> WORKlM COMhENBATION W STATU• Ori+ <br /> aro BrPWY@Re'W�eartr ,.. IORY.LfMI <br /> A nN1IPROPRIETORIPARTHERlE7�ECUTNE Y/N 03�•j��J•2 OZ/01/12 04/01/13 E.L EACNACCIOENT S 1���0�0� <br /> Oii10EWMEAtBERExCLUDEDO � N�A ._ <br /> (M�nQMOry M MX) E.l.D�SEISE-EA EMPLOYEE S �.��rOd <br /> � T�OON�MTIDHS bMOw E L O�SEASE.POLICY IIMR S 7�UOO,OO <br /> OEBC WPTtON OF OVERA190N9/LOC/1TpON9 f VQNOCLEB(Ap�M ACppD/01,AOdltleml R�mMn leMA�A�,tt ena�rpae�N r�quksa) <br /> CE TIFICATE HOLDER CANC O <br /> SHOULD ANY OF THE ABOVE DE8CRIBED POLIC163 BE CANCELLED BEfORE <br /> PROOF OF INSURANCE TME E%PIRATiON DATE THHREOF, NOTICE 1MLL BE dEUVERED IN <br /> PROOF OF INSURANCE <br /> �►ccwea►ace wrr►i nie Poucv PROV�siorrs. <br /> PROOF OF INSURANCE AI/TMOII¢EpR81R88ENTATNE <br /> �?a� 3 ,��.�- <br /> �198e-2009 ACpRD CORPORATtQN. Ail eiqMs nserved. <br /> ACORD 2B(2009108) The ACORO nama and Iogo are regiatered merka ot ACORO <br />
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