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12-12930
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2012
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12-12930
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Last modified
2/12/2013 11:58:10 AM
Creation date
2/12/2013 11:58:10 AM
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Building Department
Building Department - Doc Type
Permit
Permit #
12-12930
Building Department - Name
SMITH,PATRICIA
Address
5440 5TH ST
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A,¢��. CERTIFICATE OF LIABILITY INSURANCE � �"'�,��°°o" <br /> TMIS CERTIFICATE IS ISSUED AS A MATTER OF INFQRMATION ONLY AND CONFERS NO RIGHTS UPON TM�CERTIFICATE MpLDER.THIS CERTIFICATB DOES <br /> NOT AFFIRMATIVEIY OR 13EGATIVELY AMEND,EXTEI�D OR ALTER TNE COVERAGB AFFORp�D BY THE POLICIES BELOW.TFIIS CERTIFICATE OF <br /> INSURANCB DOES NOT CONSTRUTE A GONTRACT 6ETWEEN 7FIE ISSUING INSURER(S),AU7HORIZEO REPRI?SE1�1'TATNE OR PRODUCER,AND 7HE <br /> CERTIFICATE M LDER. <br /> IMPORTANT:M the ceRHitato hold�r Is an ADDITIONAL INSURED,the pollcy(ias)must bo�ndofsed.If SUBROGATION IS WAIVED,supjoet to the terms and <br /> conditions o!the policy,certain pvlicios m!y requirc an endorboflto„t•A stsEsman!on this teftl}Itab do�s not Co�e�right�to the certific3to holdQ►In�ieu of suCh <br /> endoreeme s. <br /> COIRAR <br /> appcucea wnc <br /> w�,�.,�.u: t.eoo-zn•�ezo �aeao �,,,a: 7s�•��.moa <br /> I^RANKCRUM INSUFiANCE AGENCY,INC. ���oa�ae�s. <br /> 100 3.MISSOURI AVE iNS RDINO CovE 6E NAIG1 <br /> CLEARWAT@qf133756 INSURER�: FRANKNANSTONCRUMINSURANCE,INC. ttgpp <br /> �NSUaen INBURflR 9• <br /> INSUR R C: <br /> FrankCrum t-eoo-277-tazo �Neunaa a. ,_ <br /> �oo s MissouRi nvENUE 1 RER E <br /> CLEARWATER FL 33756 u+su R F. <br /> COVERAG�S C NUNBL°R: 2 775 REVI910N N{MA <br /> iMS tS TO CER TXAT TFIH POLICIE9 Of OiSYRANCi LISTED DEL.OYY NA IS6t1l0 TO 7ME 1NSUNlO NMA�D AHOVE fOR ZMi�POUCY PERIOD INDICA7E0. <br /> N0IMMTMSTANDINO ANY RflGll��&NT,TERM OR OONDITION 0'ANY OONTRACT OR OTMER DOCUMCNTNlITM j1ESPBCTTO WNICH TM19 CERTIP�CA'�@ VAY QH ISSUED OR MAY <br /> PlRTAIN,TMfi�NSWGNCE AFFORDEO BY TH6 p0��DESCRIBEO NBR@IN IS SU9J�7O ALL TN!TERMS,EXGLU�ONS AND CONDITIONS OP SUCH POLICIES�U�TS SHOWN <br /> rrur MavE eeEN IIEOUCEO BY aao cuuYa <br /> POLICYiFF roucraP <br /> �� TYPtORINNR�NC! �l 8� POUCYMIYliR �� �W� LitT6 <br /> OENHMtLIABILITY 11 GWII�NCR S <br /> CµKi .� <br /> CCMLIERCWLG@PEWLLUA61 TY P M �1a�0�+a��nu1 S <br /> GWMSi+WOE �OCCVR MED81tP ane 1 <br /> Ci11tONAL L AOV MLURY = <br /> oe rE s <br /> CEMLAGGREGAT@ LINIYAPPLIES PER. �niODUCT6.COMNOP A00 f <br /> pOIKY MOJ6CT L� f <br /> 4NI7 <br /> AY70MOBILE LIABILITY 1!��ed� S <br /> ANY NJYO BODILY INJURY(Pw Perwn) s <br /> µIONMEC 6CMEOV�O <br /> AVTOG AUTOS 0004V INJURV(Pn�LtiGMp $ <br /> NOM�WN�bO OIMAO <br /> 111RE0 AUTOR AUT08 P 7Cadu+1 S <br /> _ <br /> uMenrawWa occua s�cMacuiaEnee s <br /> ^.i6i�B ClNM5�MN0E I16GNl'C�� f <br /> DFD FFT6NTION S S <br /> p wpaMtlls cOMPENBATION 11ND ��1��� 1/712012 7H/2013 x ro�.x�n � <br /> arn.or6pe�u�ewn <br /> �rr PROwuEron��nrN�cunvC e�.ewcw ncao rrc S 1,000 006 <br /> OFPY'„iqIMEMBFJIB%CLUpEC? WA <br /> (M�n�ilOry M NM� <br /> rtYr�ONtlaO�w1Ax E ^FA:l.BA EYPLOYEH S1 000 000 <br /> OBa'GRiPTION Of OPEftATldi'r beler� <br /> EL q8PJ1^a8•POLKY yWT f'I OOO OOO <br /> DEfCpPT10N 010�[MifONt f LOCATONS!�lMILLB�(Atltl ACORG 101.�riai Rrnvb BCIIaWN�Rnrn��0 6 NyuY�Q <br /> EFfECTIVE 02/0412002.COVERAGE IS FOR 100Yo OF THE EMPLOYEES OF FRANKCRUM LEASED TO RICK GAVIN DBA GAV�N ROOFING(CIJENT)FOR�NMIOM <br /> THE CLIENT IS REPORTING HOURS TO FRANKCRUM,COVERAGE i3 NOT EXTENDED TO STATUTORY EMPLOYEES. <br /> CERTFICAT!MOI.DBI! CANCBLLATION <br /> SHWLD ANY OF THE ABOVE pESCitlYBD POLIpE3 BE GANCELL&C BEFORE <br /> 'n��pIPIRA710N Oa��TE THERI�F.NOTCE NMLL BE DELIVERED IN <br /> /1CCORDANCE NRiN THE AORICY PROWSIONS. <br /> CITY OF ZEPMYRHILLS FL <br /> 5335 8TH ST AYTIIOpfapllVRClENTAiNE <br /> ZEPHYRHII�S, FL 33542 ���� <br /> m 19N-2010 ACORD CORPORATION� MI►ighes ro�enetl. <br /> ACORD 2s(�tolo6) 7f��ACORD nun��nd logo�m reglseewe mrko of ACORD <br /> �oo��oo�i wna� bozozszza�� xv� a� oG ZIOZ/LZ/EO <br />
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