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12-13570
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2012
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12-13570
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Last modified
8/22/2013 10:40:08 AM
Creation date
8/22/2013 10:40:02 AM
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Building Department
Building Department - Doc Type
Permit
Permit #
12-13570
Building Department - Name
CITY OF ZEPHYRHILLS PIGZ IN Z'HILLS BBQ & BLUES
Address
4626 KRUSEN FIELD RD
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'`�c R e GERTIFICATE OF LIABILITY INSURANCE H�15�ZO 2DD/riYY) <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INPORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVEIY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OP INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER�S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certiflcate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and condkions of the policy,certain policies may require an endorsement. A statement on this ceRiflcate does not confer rights to the <br /> certificate holder in Ileu of such endorsement(s). <br /> PRODUCER �ME: Andy Miller <br /> LEE REED INSURANCE PHONE 813 � <br /> PO Box 908 ,v No ��:( ) 82-5502 ac No.{813)788-1996 <br /> Zephyrhills,FL 33539-0908 no�Ress.andy@leereedins.com <br /> �NSURER�9) AFFORD�NG COVERAGE ��� <br /> INSURER A Owners Insurance Company 32700 <br /> INSURED Zephyrhills Chamber of Commerce,ItIC. INSURER B <br /> 38550 5th Ave. iNSUReR c <br /> Zephyrhills,FL 33542 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 ABOVE FOR 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 SUBJECT TO AlL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CIAIMS. <br /> INSR <br /> �7R TYPE OF INSURANCE INSR wvo POLICY NUMBER MM/DD/YYYY MM/DD� LIMITS <br /> GENERAL LIABILITY <br /> EACH OCCURRENCE $1,000,000 <br /> COMMERCIAL GENERAL LIABILITY PREMISESrE acu�rcence $ $O,OOO <br /> CLAIMS-MADE �OCCUR MED EXP(Any one person) $ $,��0 <br /> A 864612-20343749 3/3/12 3/3/13 PERSONAL 8 ADV INJURV g 1,000,000 <br /> Y <br /> GENERAL AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000 <br /> POLICY PR� LOC $ <br /> AUTOMOBILE LIABILITY <br /> Ea accident g 1,000,000 <br /> ANYAUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED 864612-20343749 3/3/12 3/3/13 — <br /> A AUTOS AUTOS X BODILY INJURY(Per accident) $ <br /> X HIRED AUTOS X NON-0WNED <br /> AUTOS Per accidenl A A $ <br /> $ <br /> UMBRELUI LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE <br /> AGGREGATE $ <br /> DED RETENTION$ <br /> "'WORKERS COMPENSATION $ <br /> �4ND EMPIOYERS'LIABILIN WCSTATU- OTH- <br /> viN TORY IMITS ER <br /> ANY PROPRIETOR/PARTNEWEXECUTIVE ^ $ <br /> OFFICER/MEMBER EXCIUOEDT �I N!A E.L.EACH ACCIDENT <br /> (MandNOry in NH) <br /> N yes,describe under E.L.DISEASE-EA EMPLOYE $ <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPER,4TIONS!LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> Event: Zephyrhills 3rd Annual Pigz in Z'Hil►s BBQ&Blues Fest <br /> Saturday,October 27,2012 <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Zephyrhills <br /> 5335 8th$t. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Zephyrhills,FL 33542 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE C�.—� <br /> � <br /> �O 1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD <br />
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