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14-15448
Zephyrhills
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2014
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14-15448
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Last modified
8/17/2015 10:11:35 AM
Creation date
8/17/2015 10:11:28 AM
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Building Department
Company Name
K-MART
Building Department - Doc Type
Permit
Permit #
14-15448
Building Department - Name
K-MART
Address
7422 GALL BLVD
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i <br /> /'� j TAYLO-2 OP ID:SD <br /> '`��_°RO� CERTIFICATE OF�.Ip►BILI�Y INSURANCE °"�,2�"'W�' <br /> THIS CERTIFlCATE IS ISSUED AS A MATTER OF INFORMA710N O LY AND CONFERS NO RIGHT8 UPON THE CER?iFlCATE HOLDER. THIS <br /> CERIIFlCATE DOES NOT AFFIRMATiVELY OR NEGATNELY AME D, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES <br /> BELOW. THIS CERTiFlCATE OF INSURANCE DOES NOT CONS71 TE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CER7IFICATE HOLDE <br /> IMPORTANT: If the certiflca�e holder is an ADDITIONAL INSURED, policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and concptions oi tlw policy,certain policies may require a endorsement A stabameot on this certlflcate does not confer rights to the <br /> certiHcate holder in Iku of such endorseme s. <br /> PRODUCER �� <br /> Wllliams-Hess Insurance <br /> 161T E Gary Road P�E �. <br /> L.akeland FL 33801 , ���: � <br /> R.BRANbEBERRY-A028698 <br /> INSU AFFORDINO COVERAOE NAIC s <br /> I u�sur�re�:Hertnita e Ins Co. <br /> INSURED Jack Franks Inc. � ,NSU�ee:lnfln Insurance Grou 39497 <br /> dba Taylor Rental Centers j iNSUa�c:AGCS Marine Insurance Co <br /> � PO BOX 2636 <br /> Brandon,FL 33509 I IN8URERD: <br /> ; msu�e e• <br /> N RER : <br /> COVERAGES CERTIFICATE NUMBER: � REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELO HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. N0TIMTHSTANDING ANY REQUIREMENT,TERM OR COND ON OF ANY CONTRACT OR OTMER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFF RDEJ BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDt110NS OF SUCH POLICIES.LIMRS SHOWN MAY VE BEEN REDUCED BY PAID ClA1MS. <br /> ��g 7YPE OF INSURANCE POIICY NUMBE M MMID V�� <br /> OENERAL 1JA81UTY EACH OCCURRENCE S i.�r� <br /> A X COMMERCIAL GENERAL LIABILITY HGL543772-13 07H3I2013 07H3/Z014 pREMISES Ea ocauranca = �•�� <br /> CW MS-MADE ❑X OCCUR MED EXP(MY�D«�) i �,� <br /> PERSONAL 6 ADV INJlN2Y S ����.� <br /> GENERALAGGREGATE S Zr��� <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUGTS-COMWOP AGG i It1CIUfI <br /> X POUCY PRO- �� s <br /> AUTOMOB1lF UABLLITY � BIN D I MI ��QQQ�OOO <br /> B �wv nuro 508251507938001 10/29/2013 10/29/2014 9001LY INJURY(Pw penon) s <br /> Al/TOpySyNED X �OSDULED BODILY INJURY(Px eoddaM) i <br /> X HIRED AUTOS X A�IJTO�ED PER A �D�E'N�"^ s <br /> p�p p� s 10,OOC <br /> UMBRELM LIAB p��R FACH OCCURRENCE S <br /> El(CESS W18 CLAIMSMADE AGGREGATE S <br /> OED RETENTION S <br /> WORKERS COIiAPENSAiION WC STATU- TM- <br /> AND EMPLOYEitS W18�LITY I <br /> OFFlCEWMEAA�B�EXCUJDED7 C��Y� I EL EACH ACCIDENT i <br /> NIA <br /> (Mand�tory M NH) � EL DISEASE-EA EIYIPLOYE i <br /> M yet dssatbs under EL qSEASE-POLICY L�MIT S <br /> DESG°RIPTION OF OPERATIONS be�ow <br /> C Equipmern Floater MXI93021323 I O7N3/2013 07H312014 Blanket 2����� <br /> Special Form UNSCHEDULED(B NKET) P�W�ertY <br /> pESCRIPTION OF OPERATION81 LOCATONS 1 VEHICLES(Altaeh ACORD 101,AddMinW S�MduN,K�w�M���) <br /> I <br /> I <br /> .. I <br /> I <br /> I <br /> I <br /> � <br /> CERTIFICATE HOLDER CANCELLATION <br /> K-MART <br /> I SHOULD ANY OF 7HE ABOVE DESCRIBED POUCIE8 BE CANCELLE�BEFORE <br /> THE EXPIRATION DATE THEREOF. N0710E YVILL BE DELIVERED IN <br /> K-Ma�t Corp Sears Hoidings ACCORDANCE WITH 7HE POLICY PROVISION8. <br /> Corp <br /> #216Zephyrhills I Aun�o�n�nr�rne <br /> 7422 Gall Blvd I � � � ? �� � <br /> Zephyfiills,FL 33541 i �F1d���•c��'O'�'-"'"� <br /> i m 1988-2010 ACORD CORPORATION. All�ights reserved• <br /> ACORD 25(2010I05) The ACORD name and lo�o are registered marks of ACORD <br /> I <br /> � <br />
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