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12-13735
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2012
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12-13735
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Last modified
9/13/2013 10:39:46 AM
Creation date
9/13/2013 10:39:45 AM
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Building Department
Company Name
CRESTVIEW HILLS
Building Department - Doc Type
Permit
Permit #
12-13735
Building Department - Name
DOMALIK,NEIL & HEATHER
Address
7918 MERCHANTVILLE CIR
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A �'� �' DATE(MM/DD/YYV`� <br /> �`�R'� CERTIFICATE OF LIABILITY INSURANCE IZ,ZB,z�l2 09 5� AN. <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.TFiIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORI2ED REPRESENTATIVE <br /> OR PRODUCER AND THE CERTIFICATE HOLDER. <br /> IMPORTANT:If the certicate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED, <br /> subject to the terms and conditions of the policy,certain policies may require an endorsement.a statement on this certificate <br /> does not canfer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT NM1E <br /> HiqhpOint Risk S2rViCes LLC c�wne uvc,ra,��; (800)728-0623 FNI(A�C,NO� (972)404-0380 <br /> 5501 I,BJ Freeway, Suite 1200 E#IA1L1100RES5: <br /> Dallas, TX 75240 <br /> INSURERS AFFORDING COVEflAGE NAIC# <br /> INSURERA.�o.TPa�,o� Proper[y a��„as,:aicy i�.s��a�.�e comPa�y 12157 <br /> INSURED: �yS 1/c/f: INSURERB: <br /> GULF TO BAY FENCING INC INSURER C. <br /> 3391 LAKE SHORE LANE INSURER D: <br /> CLEARWATER, FL 33761 <br /> Phone (727) 593-3439 Fax (72'7) 533-8105 INSURER E. <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER: AC12-38300002-1169654 REVISION NUMBER: <br /> NOTW ITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIF'ICATE MAY 8E ISSUED OR MAY <br /> PERTAIN,THE INSURANCE AFFORDED BY THE POIICIES DESCRIBED HEREIN IS SU&IECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN <br /> MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL ueR pOLICV NUMBER POLICY EFF POLICY EXP <br /> LTR INSR wvo DATE MM/DD Y DATE MM/DD Y LIMRS <br /> GENERAL LIABILITY EACH OCCURRENC;E $ <br /> COMMERCIAL GENERAL LIABILITY <br /> OAMAGE TO RENTEO $ <br /> CLAIMS MADE ❑ OCCUR ❑ ❑ PHEMISES(Ea occurrer�) <br /> MED EXP(Any one person) $ <br /> PERSONAL 8 ADV INJUfiY $ <br /> GENERALAGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: <br /> PRODUCTS-COMP/OP AGG <br /> POLICY j�} lOC <br /> AUTOMOBILE LIABILITY <br /> $ <br /> COMBINED SINGLE LIMIT <br /> ANY AUTO (Ea accident) $ <br /> AlL OWNED AUTOS er person <br /> SCHEDULED AUTOS ❑ ❑ BODILY INURV(Per acatlent) $ <br /> HIREDAUTOS PROPERTVDAMAGf_ $ <br /> NON-OWNED AUTOS (Per accident) <br /> UMBRELLA LIAB CLAIMS-MADE $ <br /> EACH OCCURRENCF $ <br /> EXCESS LIAB OCCUR <br /> ❑ ❑ AGGREGATE g <br /> DEDUCTIBLE <br /> RETENTION $ <br /> $ <br /> $ <br /> WORKEkS COMPENSATION AND <br /> EMPLOYERS'LIABILRY YM X I S <br /> ANY PROPERIETOR/EXECUTIVE ❑ EI.EACHACCIDENI' $ 1000000 <br /> OFFICER.MEMBER EXCLUDED? <br /> Nia DPE2627279fl260 04/O1/2012 04/O1/2013 <br /> p (Mandatory inNH) E.L.DISEASE-EAEAAPLOYEE $ 1000000 <br /> If yes,describe under <br /> SPECIALPROVISIONbelow E.L OISEASE-POLICVLIMIT $ 1000000 <br /> � � <br /> DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES(Ariached ACORD101,Additional Remarks Sehedule,if more spaee is requlred <br /> App�1. Thiqs certificate z�m�ir�s in effect� p�ro�ided the client's acCOUnt is in Ood standin wi.th AMS. <br /> IieBe ls ��� ov e �rYan� emp o or which the clgient is not repori� ❑ wd es F�Mgp <br /> Ins red is a orde�dtWorkePs�COmpe�sati1�ng&aEmployersLliabil'�ityFas�aNCOIemployer��under�L�g1F,olicy for <br /> emp�oyees leased trom AMS. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES E3E CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF,NOTICE W ILL BE DELIV'ERED IN ACCORDANCE W ITH <br /> CITY OF ZEPHYRHZLLS BUILDING DEPT <br /> 5335 8TH ST THEPOLICYPROVISIONS. <br /> ZEPHYRHILLS, FL 33592 <br /> AUTHORRED REPRESENTATIVE �,.� �„�y:ly._,_� <br /> �_...-r <br /> ACORD 25(2010/05) OO 1988-2010 ACORD CORPORATION.All right reserved <br />
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