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12-13054
Zephyrhills
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2012
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12-13054
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Last modified
2/14/2013 11:46:08 AM
Creation date
2/14/2013 11:46:07 AM
Metadata
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Building Department
Company Name
MICROTEL/JAMM HOTELS, LLC
Building Department - Doc Type
Permit
Permit #
12-13054
Building Department - Name
MICROTEL/JAMM HOTELS, LLC
Address
7839 GALL BLVD
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i <br /> ' I <br /> , <br /> � SCHEDULE OF OPERATIONS � <br /> � This Schedufe of Operatlons farms a part af the policy efFective on the inceptian date of the policy unlsss another date is I <br /> indicated belaw: <br /> � 1N5URER: TWIN CITY FIRE INST3RANCE COMPANY <br /> Company Gode: '� <br /> � Policy Number: $3 wE RX4208 5chedule Number: oi-oi-o1 . <br /> � Effective Date: 03/31/12 Effeetive haur is the same as stated an the Information Page of the palicy <br /> � Named Insured and Locafiion Address of operations covered by thls schedule: <br /> ! N THR & AS50CIATES CQRPORATZOIV INC. <br /> Nd SPECIFIC LOCATTON <br /> ,� IN STATE OF AL <br /> 0 <br /> � NAICS: 453998 <br /> w° FEIN: 8002Z2695 L7IN: SIC: 5999 N0. OF EMPL: 000002 <br /> N . <br /> � 4. The �remium for this pallcy w11! be determined by our Manuafs af Rui�s, Glassiflcatlons, Rates and Rating � <br /> � Plans. All Informatlon requlred below is subject to variflcatl�n and change by audi� <br /> o Premium Basls <br /> q Classi'fications Total Estimated Rates F'er Estimated <br /> ry Code Number and Annual $100 of Annual <br /> � Descrlptlon Remuneratlan Remuneration Premfum <br /> �8742 IF ANX .86 <br /> �SAI�ESPERSONS OR COI�LECTORS - OUTSIDE <br /> ..�. <br /> � <br /> �, � <br /> =INTERSTA2`E EXPERIENCE �IODIFICATION 913193822 1.560 <br /> �TERF20RISM (9740) 0 .020 p <br /> �CATASTROPHE (974"�.; 0 .02 D p <br /> �. � <br /> � <br /> � <br /> � <br /> � <br /> � <br /> � , <br /> � ' <br /> �. <br /> � <br /> ..... <br /> �� <br /> � ..� <br /> � <br /> � <br /> � <br /> � <br /> � _ , <br /> � , <br /> Countersfgned by � <br /> Authorized Representatfve • <br /> Forrn WC 99 00 05 {1j Printed in U,S.A. <br /> Pracess Date: 03/2o/xa Policy Explratlon Date: 03/31J13 � <br />
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