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1228 LINKSIDE DR DWAY22-0035 Building Permit Application G GU �' ' t/pdnted 10/9/18 �`, i, City of Atlantic Beach Building Department '*ALL INFORMATION \, �_J, 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY Phone: (904) 247-5826 Email: Building-Deptecoab.us IS REQUIRED. Job Address:_____1.22 V ,4/rVA ,y9cc�� •_ Permit Number: D ZZ-- j 035 Legal Description irLU4 L`11tiA S r,)Lit,tv/771-r ,L_UT > RFH_ Z23 Z 5 50 Valuation of Work(Replacement Cost)$1fi'20JX __Heated/Cooled SF A.M. _ Non-Heated/Cooled /r/,f • Class of Work: ,-)New LiAddition C(Alteration i 1Repair 11Move ! (Demo i-IPool I ;Window/Door a�/U "`1Y l tri-'r • Use of existing/proposed structure(s): i 1Commercial CiResidential • If an existing structure,is a fire sprinkler system Installed?: I Yes ' !No • Will tree(s) be removed in association with proposed proiect?LJYes(must submit separate Tree Removal Permit) afNo I Deas' KDescribe in detail the type of work to be_ performed: 7 � a- r f=7 =x.� f -G A'-it-2--<-4.--7s.:s-f.�`. G/)t c'C.�.4 / y^s-s. �,C/ai_ts.�(-�?C„as(' c'.5-r- "' I ,p.""1/44,-(AO,(/2) un/.* rt.:pu < ,u-t,G:v (/yr 4) -,' -.sky/?..41) P i f.1-/2 t.✓erd c14.4 Florida Product ALO,—'e,3 r for multiple products use product approval form Property Owner Information 7- Name 4'1'. �'c° /3.0,77,7,.,,1, Address / 2 2 r L 4....v Ti 47,-. 7?,.• City Al 7%:.4.',..,-- < 3zii State Zip 3?1 7 7 Phone �' //o3 5/1/ E-Mail ,.,e.. i 4lie ZAki47,n,4..•l+) 9"»s/._ s....0,,`"q Owner or Agent Ilf A ent, Power of Attorney or AgerSCy Letter Required) r- k en() j q f(e j h e t`C\ 1-y1 n r' e Contractor Information J `J r'r‘Gc(`.J_ C c)rr\ Name of Company /i/,'A0G.:c 1,741/-'/..< r)i /`: /'S Qualifying Agent 6'4U 4-4..1 f—Z -7,4-/ cs Address /f�r27 ,i L�s� ,(), y ./),..'. /tt City irir�crAi State r[_"Zip 32o4? ice. Office Phone -2-Py__I', 2.) '5 /2_ Job Site Contact Number v'/ 3/ ) 5.'/2 State Certification/Registration H _•�E-Mail C.4/74.•7'a J.,1 oek Jiti;ti1 cC;=740,.t/n_a err, Architect Name&Phone H ---- Engineer's Name&Phone 8 W' Workers Compensation Insurer OR Exempt 0 Expiration Date Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or installation has w commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS, WELLS,POOLS,FURNACES, BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE:In addition to the requirements of this t, < L' permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and there may be additional permits required from other governmental entities such as water management districts,state agencies,or federal agencies. `•;" OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and mat all work will be done in compliance with iiia applicable laws regulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND ' TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDIYOUR NOTICE OF/COMMENCEMENT. , ___ >etiv ti e : . 1�1f1 �. _____ . _ (Signature of Ownei ui Agent) / (Signattu a of i iii III kit WI) Signed and sworn to(or affirmed)before me this dieray of Sig ed and swot n to(or, tied)befoie me this da of Y Mai . �c ,by 6 n 6tc,~ilcl�__•.__,.1�f1�(1 �i� f (Signa re of Notary) - gda, Al. ,., :.�... . -.. --I t Cs"rr_e,•..:f oerrsy‘wria•Notary Seal N:y Tt1Nl G;NDIESPERc,ER SKR:SCtDEN•Notary Pullet Personal) Known i t [ )Personally Known OR ° I I V MY COMMISSION S GG 353178 ` AuTs Couey I I ioduced Identifica [1}Produced Identificatiof� omr, 'o•ExOires Decrrbr 23,I024 t. EXPIRES 0.:.?-er u,2023 Type of Identification: 1Jn Vt9,-S Li ss+or Nuirer+3144+7 1 yl a of Identification: k rr, .,, .,.r,. h , ss,i ttten ,�.- -� �J�UC�G 1 Owner's Na neCLVOV 6e(g,n lri1 _ �'�5= ,41 n�-4 1j Property ride,.Z2 L4. E-:-.,.. - _ __ lot No. /� / Phone 1-t l L-4niT1C ez i4 E-Mai 5()Pa5lallei rt,bevsrnovi. grnC�l ,Cv►r►1 frC' 3aa33 Owner s Alaang Address(If different hum above)- Whatype of;arojeotArnprcrvement me you requesting?_Fence Roof EXta'ior Pardslg �Deck/Paly Enclosure _ Outbuilding Other petals) UY2i V(a(!1 7 For your application to be complete,please provide us with the fcl er g tnfamation: I.Phase prov'de a complete*eswam of youprofectlimprovement.bung as*elated as pee able. 2. ryes d maf er.ats to be used and damps cda s 4 avowals e 3.Cravings,b ot:n es,photos,etc. 4.Copy of mos:recent oert4ed rat sty eharAr7g bcason d proposed improvementpcsect S. li repensng.you must essay oidtrim and mak or oat cdon deta.a,samples d new cohon caor of root,and brick or masonry moors 6. li irstaal4r q vnyI siding,euGrnt detailed Geecnpson of sting type,color sample d Weigand Iron cakes,actor's Of roof and any masonry On your name, 7. If dry heavy equipment is b be..sec t you.mist IWmate what Noe of access you plan b use tactile:kr.equipment,etc.el ogler to reach your boatyard 8.My damage to sidewapka,curbs,roads,grasses,and common grounds of SUNS LINKSJOic UN T ONE.ASSOCIATION,INC wr haste to be restated b its curtail conorson and w1 be IL enw t9rsty of the twmeownce making Woe squat. Has the proposed ctengels}been a sc uis ed yetn you ne>isr1Da1 Yes No :0.NOTE:xisthe nJporuavaty c`.'..te HouteowneriContrector I 3 Lecure ER a ecerserypermits/rawDuvalCountyandto comply with'!'s/zeal Building Cation far sadacks from property lines,retention ponds,exiatr g strut a'eY, esemertts,end eafraty ouirersns �. % TAC/c)-0 a Owner s Eghature/, Ck=-l— � )7 ) �--^ Dade c%•1- ()ay she r oqu wren of record may rawest✓cntethaet approval Apprved pfouacts Intel be suoetanuly tomfliiad Whin 3 ltOOAtTHS or you must rouilmait once commenced. The a9pllraaad cantdrudtln must proceed tlkgen4 luestionesity.the AHC .tsc.1)-days ham the date min!Kim i is nicervert to act on 1 e request .I?owaver the ARC u,9 mataa an a. mpt Pt)rxpeTh Ole 112.wound wskn run f idi buskee s days.No work should be started wrh ul&fprow.,from the ARC. )(f_.. ) ARCfiITECTURALM1EVIi3Wwean Date Reperved __Roa+ivedSy • lit LcAt - Aid'!" !1:�o1rd :e ek� outs !•G '.2z_ di r Mansber- -...-Y"., 4,.11 .12/ . IIRCt�w1Et11r8: /( /�ir,6,-/>6tit !i �¢� 46e--#17 ey,/ /,;),L.,,-. ... 44e- jetA_ ')'2.a.(i.ecia-/-vz-i-0 P/Uee--/ ARS Fin' f.ASJC i',S s4.00 7:1120 i 7 MAP SHOWING BOUNDARY SURVEY Oi i i 4U. #t*4A r NCST IL G$Ue. "11 ' r P,r1r !mewAS 5 tCRGL) Ft4s „ „i 56. rJ:,s. ,1, 'J4 If,...tithe '2. Cif INC C,171104, POONA KC0405 of r.,�vt.,. ,.�-1.1 .tea A 001111011)101 MINN1 MOWS i 1•0411411•0411411•04114114M aswS.s. Gutatl cr Mr I 1. I li 444 rrir'r►ea's Yrrr h ` 6 eP4�-- ,JV /Z : 3 / MAP SHOWING BOUNDARY SURVEY OF LOT 9, ACCORDING TO- THE PLAT OF ' SELVA LINKS 1,101E , L..",Ntigi 1 AS RECORDED IFI PLAT BOOK 44 , PAGE(S) 23 & 23A OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. CERTIFIED TO: WILLIAM K. BERGMAN, GWEN GIALLELA .BERGMAN, FIRST AMERICAN TITLE INSURANCE COMPANY, PHH MORTGAGE SERVICES CORPORATION AND WATSON & OSBORNE, P.A. )( ii LINKSIDE DRIVE - (5' R/W) BEARING REFERENCE.UNE N 83-42'00" E, 49.84'(M) a N 83'42'00" E, 50.00'(R) 10'1110' aE ;! 4'114' 1/2' IP -TRANSFORRER 4:-...'-*- --T LB 1704 A EASEMENT '7 ,, 7.6' ILA.A EAMETVT 4. \_,`R. ) ---- - - E. -- `- - moi: - • I �i`�1 '�o 1ti atl'r4.T CONC ` �.E 1�,. 1 • 63 q B7' R6. 6e'. ET. PAD ��. •A• t ! 0 (1) --.... ht N 4 1.5' .d .;- % N. /N OC ;-4( DIRT ' ✓ 0 0.4 1 G 1411 \\q. N 0 Sr a COMERED DONC [ p0 •m /6244- \ o t-STORY = at a' 03 04/UuuR jl/79.424F EMTIw NA F-- ; VINYL S1OED tAi 41~ O �t v OJ t = & BRICKin RESIDENCE 0 J 0 -o) .o c NO. 1228 • 0 p • 00 I °0 ` ZD un � o � Z o o —o—ni .4 vt eb Z 11. zar k. ^ i o.1 0 'CapC g- Y.: 14.4' ' fo. .4 IPATIO ,4 El s o• 4'I .12 __ rt I A/C PAD I� LOT9 fa - Y 4'x( a1• r,.---' 5✓SDtVi5,dAJ aa' lir P LB 1704 S 83'42'00" W, 50.00'(R) d s 83.20'45" W. 50.01'(M) ( -` Ir fl zgt. 20 10 0 20 NOW OR FORMERLY, PART OF SECTION 17 '-' ►-- + r SCALE IN FEET ---0 0 o—�ti—o o 0 0 .t:13. 1' = 20' TOWNSHIP 2 SOUTH, RANGE 29 EAST o, TREMRON® ---__ HOME(HTTPS://WWW.TREMRON.COM) PRODUCTS HTTPS://WWW.TREMRON.COM/PRODUCTS ( v.F Mb*"EAS'/ j ( ) (https://www.tremro n.com) INSPIRATION(HTTPS://WWW.TREMRON.COM/INSPIRATION) CATALOG(HTTPS://WWW.TREMRON.COM/HARDSCAPE-CATALOG) COMPANY(HTTPS://WWW.TREMRON.COM/ABOUT) RESOURCES(HTTPS://WWW.TREMRON.COM/PROFESSIONALS) MEGA OLDE TOWNE Home (https://www,tremron.com) / Pavers (https://www.tremron.com/products#pavers) / Mega Olde Towne 114 : 4. A t • • T.- Lel xp • • 4311111114 • PORCELAIN MFE � OLDE TOWNE PAVERS (HTTPS://WWW.TREMRON.COM/PAVERSrPORCEM111)` TEMPLEHURST (HTTPs://www.TREMRON.COM/PAvEa4rE613115-10Alf0pean look on a larger scale. Mega Olde Towne pavers are the perfect choice for BLUESTONE large projects or when your design demands a dramatic paving style. Mega Olde Towne provides all (HTTPS://WWW.TREMRON.COM/PAVER$/BLUESTONE) ROMA the features of the popular Stonehurst paver,while offering a sleek smooth surface. (HTTPS://WWW.TREMRON.COM/PAVERS/ROMA) PLANK _ S G oe- (HTTPS://WWW.TREMRON.COM/PAVERS/PLANK) PRODUCT SPECS COLORS PATTERNS 9.4,-TK—SHEETS TUSCANY (HTTPS://WWW•TREMRON.COM/PAVERS/TUSCANY) STONEHURST (HTTPS://WWW.TREM RON.COM/PAVERS/STONEHURST) MEGA OLDE TOWN E STONEHURSTANTIQUED f. PRODUCT CODE: PV21330 (HTTPS://WWW.TREMRON.COM/PAVE RS/STONE ANTIQUED) - . THICKNES • "160MM) MEGA OLDE TOWNE (HTTPS://WWW.TREMRON.COM/PAVERS/MEGA- DIMENSIONS: 6^xe^,5^x8 9^x72 OLDE-TOWNE) SF PER CUBE: '16 CUBE WEIGHT: 30'5 LBS DIVISION OF CORPORATIONS of fr Japartment of State / Division of Cors / Search Records / Search(Ty Entity Name / Detail by Entity Name Florida Profit Corporation ORANGE PARK PAVERS, INC. Filing Information Document Number P16000003664 FEI/EIN Number N/A Date Filed 01/11/2016 Effective Date 01/08/2016 State FL Status ACTIVE Principal Address 4625 subchaser ct 100 Jacksonville, FL 32244 Changed:06/28/2020 Wiling Address 4625 subchaser ct 100 Jacksonville, FL 32244 Changed:06/28/2020 Registered Agent Name&Address GORANFLO,JAMES 1822 Foggy Day Dr Middleburg, FL 32068 Address Changed: 06/28/2020 Officer/Director Detail Name&Address Title PVST GORANFLO, JAMES 1822 Foggy Day Dr Middleburg, FL 32068 Title D • •.."�...:. e- , . .. 1 • li t i a I . , i iiR , 111.1111111111111111W Y' I, .,£ l l? �, T T fir' .4 �-1 . J . i (, y'I b 'i id r , r , ; 6` , k, r - .. -. . , ...- ... N.,,,,..Nle\ --� I cam . \„ N �• s c `. 2 cJ Q'''. ''..... X' 4 a n .,k),4 . C • , -.,,,1 i • _ `'�� I _ tot I tl ` -fin - - �" - �� \ie .4 A , . , r �� '. . II • ,.- 1:0: ' i 3110...:. 411011 . . 0 W N Ilk . 1ll �: . . • Ik.s,\ ‘s4 oV • -,,..., r,-3. --\___,-,-( r_ -, +- .. .,4 i ., 1 . , d, _ . . 111 / S •-....„ I' ' IklAt./ '; +k ,..-.4 ,,� r r t [ . ,`; ..3 % Cir MAP SHOWING BOUNDARY SURVEY OF LOT 9, ACCORDING TO THE PLAT OF SELV'A LK$IIDE NT 11 AS RECORDED IN PLAT BOOK 44 , PAGE(S) 23 & 23A OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. CERTIFIED TO: WILLIAM K. BERGMAN, GWEN GIALLELA BERGMAN, FIRST AMERICAN TITLE INSURANCE COMPANY, f PHU MORTGAGE SERVICES CORPORATION ! AND WATSON & OSBORNE, P.A. .. • LINK SIDE DRIVE (yr BEARING REFERENCE. LINE N 83'42'00" E, 49.84'(M) :n~.' c_i N 83'42'00" E, 50.00'(R) 10'x10' J.E.A. •�, 4'r4' 1/2" IP :iv TRANSFORMER LB 1704 „t EASEMENT 7.5' ILA. EASEMENT , . .4. •... •V N. 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L9,..) . .}:________L____ •••• 1i! \ '\ UTil: DIRT "� Ilik r ,f' S41 •C f'' ! \0 9.s' r51 \ A•; O 0.4' a i� g I \ N O \ 0 it 8" 'L• -cav>�TED coNc �. a m LX{��e'Oa1 - I ,n) Q1 ed�' 1-- - VINYL ISIDED c tai +� ago s's 97� � � O do BRICK _ in OJ �� 2 ,e1 RESIDENCE o `f �— li o N0. 1228 0 p to i — o ,01 o ig, • O (f) /z 0 �J1� I 42 ZB' 23.1' 1 o. 0 X. 1 'MAC TIOQ • PA u 14.4' .CI.". ❑—.❑—C—❑ O. ❑ Q [0.4' °t S !1 -°--- CdNC hl I A/C PAD •) 1 LOT 9 1 7A -Li X • r 4'm 0.1' r-.!-.St/6DtV/Sic.o../ ION 1r, P ((( LB 1704 • S 83'42'00" W, 50.00'(R) I , S 83'20'45"&- 133 50.01'(M) :p' i -ve 1 u 9 20 10 0—______-- _ 20 NOW OR FORMERLY, PART OF SECTION 17 r►, \o. / SCALE IN FEET ---❑ a ❑--fin ❑ - ❑ 4&'0 ❑ n y 1' = 20' TOWNSHIP 2 SOUTH, RANGE 29 EAST °moo / ACORN® DATE(MMIDDIYYYY) �� CERTIFICATE OF LIABILITY INSURANCE 05/05/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT Certificates Desk PRODUCER George A Zellner Co NAME' 4114 Sunbeam Road PHONE ( (A1C.Nn F4 (904)356-1492 FAX X Nn)•(904)3544328 Suite 101 n-DRIFss: cert�cates@zellnerinsurance.com Jacksonville FL 32257- INSURERIS)AFFORDING COVERAGE NAIC# INSURER A:Heritage Insurance 14407 INSURED INSURER B: Orange Park Pavers Inc. INSURER : - 1822 Foggy Day Dr INSURER D: Middleburg FL 32068 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE 'NKr) wvn POLICY NUMBER IMM/DDIYYYY) IMMIDDIYYY`Q A X COMMERCIAL GENERAL LIABILITY HCR011381 09/20/2021 09/20/2022 EACH OCCURRENCE $ 1,000,000 ' X DAMAGE TO RENTED 100,000 CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 3 2,000,000 X POLICY JECaT I I LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Pa accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) 5 AUTOS ONLY —AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY —AUTOS ONLY (Per accident) UMBRELLA LIAB I OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEO RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE ER nit ANY PROPRIETOR/PARTNER/EXECUTIVE N 1 A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? — (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIEle-Af�E HOLDER CANCELLATION Al 033207 // / \ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Client Proof of Coverage ) ACCORDANCE WITH THE POLICY PROVISIONS. - AUTHORIZED REPRESENTATIVE _- ___- - ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACOROX CERTIFICATE OF LIABILITY INSURANCE DATE(MNIDO/YYYY) kii..../- 05/05/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsementls). PRODUCER George A Zellner Co CONTACT Certificates Desk 4114 Sunbeam Road PHONE (904)356-1492 FAX (904)354-4328 IA:C.Nc L>t,. .AC Nur Suite 101 E-MAIL certificates@zelinerinsurance.com Jacksonville FL 32257- INSURERS AFFORDING COVERAGE NAIC t INSURER A:Heritage Insurance 14407 INSURED INSURER B: Orange Park Pavers Inc. INSURER C: 10091 Andean Fox Dr INSURER o Jacksonville FL 32222- INSURER E INSURER f COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LYE 11,1C11 wvu POLICY NUMBER tM1E :Y DOYYY, MM'LOL1 yJ LIh1r75 A X COMMERCIAL GENERAL LABILITY HCR011381 09/20/2021 09/20/2022 EACH OCCURRENCE _ 1,000,000 XI DAMAGE TO RENTED CLAIMS-MADE OCCUR :,;_,,,,L, c $ 100,000 MED EXP(An',one,ersonl $ 5,000 PERSONAL&ADV INJURY $ __ 11,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY LOC PRODUCTS-COMP/OP AGG $ 2,000,000 s AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) 8 OWNED SCHEDULED BODILY INJURY Per accident 8 AUTOS ONLY AUTOS I ) HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY !Per acodenli $ UMBRELLA LIAB OCCUR EACH OCCURRENCE •• EXCESS LIAB CLAIMS-MADE AGGREGATE $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY N STATUE ER ANY PROPRIETOR/PARTNERJFJCECUTIVE E.L.EACH ACCIDENT OFFICER7EMBER EXCLUDED? N/A ' (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ Nye s,describe under DE'C-IPT',N r,-0,E*,,,-r I,r4q ce.r. E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remrrks Schedule,may M attached N mon span Is required) CERTIFICATE HOLDER CANCELLATION Al 033207 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Client Proof of Coverage ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD