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12-12989
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12-12989
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Last modified
2/12/2013 1:28:18 PM
Creation date
2/12/2013 1:28:17 PM
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Building Department
Company Name
CHALFONT VILLAS
Building Department - Doc Type
Permit
Permit #
12-12989
Building Department - Name
ROBERTS,RICHARD & JOAN
Address
4773 SILVER CIR
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From:Eileen Corsini FaxID:Morrow Insurance Page 1 of 1 Date:4/11l2012 0520 PM Page 1 of 1 <br /> �r1 CRAFT-1 OP ID' EN <br /> '`���.__°R° CERTIFICATE QF LIABILITY INSURANCE �ATE�MMIDWYYW) <br /> 04111112 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA710N ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMA7IVELY OR NEGA7IVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S�, AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CER7IFICA7E HOLDER. <br /> IMPORTANT: If the ceRificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGA710N IS WAIVED, subject to <br /> the terms and conditlons of the policy,certaln policies may requlre an endorsement. A statement on this certiflcate does not confer rights to the <br /> certificate holder in lieu of such endorsement(sj. <br /> PRODUCER 813-963-1669 °�E: MORROW INSURANCE GROUP <br /> MORROW INSURANCE GROUP �C No E :$13-963-1669 <br /> �ENORAC.oLNEY/A196o64 813�61�743 P"°"E aC No:813-961-3743 <br /> 18936 NORTH DALE MABRY HIGHWAY E-MAIL <br /> TAMPA, F�33548 nooRess:EILEEN MORROWINSURANCE.NET <br /> Lenora C.Olney INSURER(S)AFFORDING COVERAGE ruic� <br /> INSURERA FCCIINAT'L TRUST INS.COMPANY 33472 <br /> INSURED CRAFTSMAN GROUP INC. iNSUaeRs <br /> 5509 IKE SMITH ROAD <br /> PLANT CITY,FL 33565 INSURER C <br /> INSURER D <br /> INSURER E <br /> 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 ABONE FOR THE POLICY PERIOD <br /> INDICATED. NOTWffHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WffH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUS�ONSAND CONDITIONS OF SUCH POLICIES.LIMffS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR <br /> �7R lYPE OF INSURANCE POLICY NUMBER MMILD�D1`/YYY MMNDIYYYY LIMfTS <br /> GENERALLIABILITY EACHOCCURRENCE $ ��OOO,OO <br /> /Ol X COMMERCIAL GENERAL LIABILITY GL 0000835 70 08�09j1� �8/O9J�Z pREM SES Ea ocwrrence $ �0�,0� <br /> CLAIMSMADE �OGCUR MED EJW(Any one person) $ S,OO <br /> X CONTRACTUAL LIAB. PERSONAL&ADV INJURY $ 1,000,00 <br /> GENERAL AGGREGATE $ Z�OOO,OO <br /> GEN'L AGGREGATE UMIT APPLIES PER PRODUCTS-COMPlOP AGG $ Y,OOO�OO <br /> POLICY X PR� LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ea aaident $ ��0,�� <br /> A X ANY AUTO CA 0001920 10 �$/�9)�� Q$fQ9J�Z BODILY INJURY(Pe�person) $ <br /> ALLOWNED SCHEDU�ED <br /> AUTOS AUTOS BODILY INJURY(Per acadenq $ <br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE <br /> AUTOS Peracaden[ $ <br /> $ <br /> UMBRELLA LIAB OCGUR EACH OCCURRENCE $ <br /> E%CESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WOPo(ERS COMPENSATION WC STATU- OTH- <br /> AFD EMPLOYER3'LIABILITY Y�N TORY IMITS ER <br /> ANY PROPRIETORIPARTNERIEXECUTIVE <br /> OFFICER/MEMBER EXCLUDED� ❑ N/A E L EACH ACCIDENT $ <br /> (Mandatory in NHj E L DISEASE-EA EMPLOYEE $ <br /> If yes,describa untler <br /> DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERA770NS 1 LOCATIONS 1 VEHCLES (Akach ACORD 101,Additional Remarks Schedule,if more space is require� <br /> CERTIFICATE HOLDER CANCELLATION <br /> CITYZEP <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> CITY OF ZEPHYRHILLS TME EXPIRATION DATE THEREOF, N0710E WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISION3. <br /> BUILDING DEPT <br /> CONTRACTOR LICENSING BOARD qu{�.pRIZEpREpRESENTATNE <br /> 5335 8TH ST. <br /> ZEPHYRHILLS, FL 33540 � �� � fn /,,,,, ,� <br /> (�ti•"°� <br /> O 1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks ofACORD <br />
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