313 Willowbay Ridge St - BR19-000066 - FENCEBuilding & Fire Prevention Division
RESIDENTIAL FENCE PERMIT APPLICATION
Application No: ` ' )00o
Documented Construction Value: $ -3
Job Address: ) 1 ,'iOLA { Historic District: Yes No
Parcel ID: 2 14 !6 j -- Lj000 - -2, o-jo
Plan Review Contact Person:.Vkjl Title:
Phone: 316, 6. 1 `o ( ?- Fax:
Residential Fence Information
Type of Fence: Wood Metal PVC/Vinyl ron Other
Fence Height: ' Feet # Gates: Total Linear Feet: t1
Additional Information: 'T ,ti S TAv-tit , 1 n t ' I. / Lt P . ,,I 1 1 1- -ro
Fences with a height of over G feet will require signed & sealed structural engineering"
Property Owner Information
Name Phone: t' _
Street: Resident of property? : =
City, State Zip:`^,
Fence Contractor Information
Name _.. 1 .....__ Phone: _M& . 2-
Street: t 4'. _— Fax:
City, State Zip: ,.
Please Note: The Building Department does not perform site inspections on Residential Fence
permits. A signed and notarized Fence Affidavit is required to be submitted along with this
permit application. Please see the attached Fence Permit Submittal Guidelines.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR
AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
Effective: August 1, 2017
Application is hAft made to obtain a permit to do the work and installation as IrAie;*W. I car* that no work or installation has
commewed prior to the issuance of a permit and that all worse will be per&nned to med standards ofall laws tag Taft consuvotion
in this jurisdiotion. I understand that a separate permit must be secured for electrical work, plumb&& sips, wells, POWs,
ftmace4 bollw% heaters, tanks, and air tonditioners, etc.
FBC 1853 Shall be histribed with the date of appileatiou and the code In ~ as of tUt date. S* Mien (2414) Flatib BoUng Code
NOTICE In addition to the raqwroments of this permit, *m may be additional resuwbong applimble to dfla property that may be
ftnid in taropublic records ofibis oounty, and there may be additional permits required from other governmental entities such as water
management distriets, state ies, or Adetal agencies.
Acoepte= ofpermit is verification that I will notify the owner of tho property ofthe requirements ofFlorida Lion IAw, FS 713.
QMM"FXLDA=*- I cwtify that all of the foregoing information Is see nte and that all work will
be done in wntpftnee with on applicable laws regulating eonstmc,14nand zoning.
Ai of A Lute Sigwftre ofQ-trnau t
IXF.VN NO=, PnntCon lA VS: me
ofper,
Owner/Agertt
WAMAMUO 6
PLAN REVIEWAMOVAL: PLANNING:./ HISTORIC:
COMMENTS:
Effective August 1, 2017
12/1712018 SCPA Parcel View: 22-19-30-503-0000-2070
i
Property [sec rod.COrd
Parcel: 22.19-30-503-0000-2070
Property Address: 313 WILLOWBAY RIDGE ST SANFORD, FL 32771i r111MiM1YiMM1
Parcel Information Value Summary
Parcel 22-19-30-603-0000-2070 2019 Working 2018 Certified
Values ValuesOwner(s) PITTS, KEVIN - Joint Tenants with right of Survivorship
PITTS, THOMAS E - Joint Tenants with right of Survivorship i Valuation Method Cost/Market Cost/Market
Property Address 313 WILLOWBAY RIDGE ST SANFORD, FL 32771 i Number of Buildings 1 1
Mailing 313 WILLOWBAY RIDGE ST SANFORD, FL 32771 # Depreciated Bldg Value $190,284 $180,331
Depreciated EXFT ValueSubdivisionName ?I3YAT tAK MONROE UNIT 2
Tax DistrlctSISANFORD Land Value (Market) $40,000 S40,000 tDOR
Use Code 01-SINGLE FAMILY Land Value Ag UstlMerk_
@t Yn1uQ `. $230,284 $220.331 Exemptions . 00 HOMESTEAD(2009) _... Portability
Adj Save
Our Homes Adj $96,787 $89,580 Amendment
1 Ad) $0 $0 sP&
G Adj > $0 $0 Assessed
Value $133,497 $130,751 Tax
Amount without SOH: $3,354.00 2010_
Tgx_¢ij(Arnount $1,673.00 1
Tax Estimator Save
Our Homes Savings: $1,681.00 rI
Does
NOT INCLUDE Non Ad Valorem Assessments Legal
Description LOT
207 PRESERVE
AT LAKE MONROE UNIT 2 PB66PGS10&
11 Taxes
Taxing
Authority Assessment Value Exempt Values Taxable Value County
General Fund 133,497 50,000 83,497 1 Schools
133,497 26,000 108,497 City
Sanford 133,497 50,000 i,, 88,497 SJWM(
Saint Johns Water Management) 133,497 60,0D0 83,497 County
Bonds 133,497 50,000 83,497 Sales
Description
Date Book Page Amount Qualified Vac/Imp CORRECTIVE
DEED 2/1/2009 07139 1041 100 No Improved i(
WARRANTY
DEED 11/112008 07097 0898 189,900 Yes Improved j
WARRANTY DEED 12/1/2005 06131 280,600 Yes Improved FWW
C "Salta Land
Method
i Frontage Depth Units Units Price Land Value LOT'
40,000.00: _ 40.000 1 Building
Information coyi '
iicl fere Description
ActuaUEBective Fixtures Bed Bath Base Area Total SF Living SF Exi Wall Adj Value r Repl Value Appendages http://
parcoldetail.sepafl.org/ParcolDetailinfo.aspx?PID=22193050300002070 112
L "J " -'- "
FENCE OUTLET
www.fenceouUetonline.com
L/
CUSTOMER NAME
Proposal I Contract
PHONE: HOME # _J.__MOBILE
OWN PROPERTY? YES 0 NOOI""",.""It'll"ll"I I'll OWNLRS NAMEI1
E-MAIL 'p DATE (85,
PVC WOOD ALUMINUM
PVC Fee Wood Feet AluminumFeet
PVC CUM _WR 'T- lf . ....... .. Cypress 0 PT Pineo Pres. 'us [I Height 4! 0 V 0 6 Height
4'0 6 0 6'BOB[] STKD [I VS', 71 1Residential Col 0 T&G PdvKyM Domed [3 Scall 1:1 Privacy
With Lattice 0 other style __ I Municipal 0 1 ustrial 0 Other
Style "11.111-1-1-1- Height
60 1 El Black 0 WmhNkbe Other Gaila
Sim Picket 11? x 4*," 3 Vxit" 0 Gate
Size Runner
2 Post Size . ......... ..... .. Gate
0, Gate lZe Gate—
Size. r .AteSize Flat
Cap 0 Bal Capi 0 size Gothic
New Eng. 0 ,fc Top 0' Traditonal Top Coachman
r- Tear ether El Remove
existing Fence Ft Good
Side In M Out a No
r
of slope Level top with slope Fence
Line to be Cleared by Fence OuUet El Fence
Line to be Cleared by Owner 19 Corner
Lot Yes 0 No M Permit
Needed Yes J Y No C1 Jurisdiction--,,,
Special
Instructions: 1,4 A ieA Vjp
M 01
FE-
19671
S. Orange Blossom Trail - Orlando, FL 32837 Tol (
407) 851.660 17U
Wait Broadway SC, Suits 100 - Oviedo, FL 32M Tel (
4M 3594M E]
201 S. Falkenbefg Road - Tampa, FL 33619 Tel (
813) 6513623 11507
us Hwy 19 - Port Richey, FL 34664 Tel (
127) 857-7590 Ei
12994 Tomiami Trail S. - North Port FL 34287 Tel (941) 346MI00 45
S. Wickham Road - Melbourne, FL 32904 Tel (
321) 802-6480 1726
South Nova Rd., Unit N - South Daytona, FL 32119 Tel (
346) 267-8760 3
Rail Flat lop CHAIN LINK Chain
Link Feet Height
4'0 60 91-1 3
Rell Box S Other Height W
JI Residerift 0 C iercial El IT
Commo lustriall 3
Spear T p Galvanized I] Black Vinyl 171 Green
V 0
Gaten.z F
I! IP 10ole Ga Size., T
lip e Size low
0
Fellow contour of ground Level top with rolling terrain Fence
Outlet will mist the customer, upon request, In determining wham the fence is to be waded, but under no circumstances does Fence Outlet assume any responsibility concerning property lina`#isr,'/ any
way guarantee their accuracy If property pins cannot be located, R is recommended that the customer have the property surveyed. Fence
Outlet will assume the responsibility for locating underground cables and uIllides, however, Fonts Outlet Is not Is for a nklers or other unmarked burled lines or soft. 2 "s 0 " aid
in IU w it, PayroantIsdueatthetimeofcompletionofwork, and a finance charge of 1 1/2% per month shall Ba'app-a-d-G-aft —acc6,=na!_p_ &-property of FenceOutletuntilpaymentisreceivedinfull. Rot of access and removal is granted to Fence Outlet in the event of nonpayment per theterms of this contract. The customer agrees to pay all Interest and any costs
incurred in the collection of the debt Including reasonable attorney fees. If
the buyer refuses to slow the seller to begin work or complete work already begun, or to accept materials contracted for, Buyer agrees to pay Seller liquidated damages of a sum equal to 33 1/3% of entire contract
prim, plus cost of materials and labor already furnished or in progress. warranty, may be voided N sign is removed. Customer
assumes W!oaporlsillIft jlilir obtainamtkwiters seeptlation ,royal farthe type and location of fence. ICCEMi
III ROKS CIMUCHOR Uri III (SEUIMS M.011-713111, REM NIMES). 11101[ we UK 01 1 11 I'llOR MAINE 111100110 An ARE
in rim I nil off A on I OIFMCE NOR CUIIM fOl film no on mm. W 11011 Is II Is A C113111001 U11. If 90 CORTRIC101
011 SUBCOMACIII NU 0 PIV SUBCOVICIR SO-CiliNUM. OR 111101111 SIPRUN: 11 MUMI MIKE MR 1311V 1011181 PINEITS. THE
W9 Ill ARE 010 11019 MAV [IN TO YOUR MM OR FAM, IN If M RAN fill V011 COMO 11 fill FYNI'All TO MY
VIM coll= V111 cowl NIV Also HAVE A Ull 11 VAN! rinn. as IBIS If A us I His MR 1`1111M MU! OF SRI 10119 W 011111 M
NO 1.1111t MOOIIIIS, 0 OTHERSMICES NO V111 W11011 11 A MCORMIR NO Ulf HIM I MY. RORIN'S C8101190111 E LAW IS
Mft[K 00 IT IS RECOMMERM 1111 Iffiffil A Mfg MW RAISES, VO11 C01119 III VNM1fV.,*j'* AaLAumld weather and arced
go" will appear bet~ boards. Cracks In the wow we a common and NOTICE To PURCHASERS OF
WWD MM.
az,vy
L 370 Waysnont Court
i v
sa. +t *as•. s.;s':,. ....- YaeM.Wr• +aaaaa
Lake Mary, FL 32746 . Void: 407.688.7631 : Fax 407.688.7691
Lot 207, PRESERVE AT LANE MONROE UNIT 2. according to the
plat thereof, as recorded in Plat Book 66, Page(s) 10 and 11, of the
Public Recordrof Seminole County, FL.
Community number. 120294 Panel. 0060
Ste: F F.I.ILM. Date: 912812007 Flood Zone: X
Date offield work: 1111112008 Cmaltlaoon Darter 1111112008
j Certij ed to.
Ej Kevin Pitts: Jessica Pitts; Thomas E. Pitts; Thoroughbred Title, LLC:
Chicago Title Insurance Compatry: Quicken Loans, Inc.. its, successors
j and/or assigns. LOT 7
PLAT OF THE FLORIDA LAND AND
COLONIZATION COMPANYS CELERY
PLANTATION PLAT BOOK 1. PACE 129
IWSS CONNER
rrt t/2-
NW06-05-W 53.06' tP1 4y BRICK WALL
MAIWCW CC
WALL IS MMWr CLM
23 w LOT 207
M.... M
tE.• 1 -30' 2A
D.
LOT 208`
313 111LLOWSAY Pj= N SIREET
coc r
wr
WATER 1+IU
ELECTRIC Box
ELECTRIC BOX\\\'''``` • ~
PHONE BOX """""-- T
F1N 1/2' trr L.C. !
AWto Sbe*
WALL 13
2.3' W
zz
LOT 206
JJ
N&D
FO. N&D S0OV6'05-E n.O1 M
astir.
WILLOWi9A Y RIDGE STREET` Property Address. 50' R1W (1MPROWD) 313 Wlllowbgy Ridge Street
Sanford FL 32771
Survey number; SL 100508
LEGEND GENFXU NOTES
t>- Woad Fence W.M. Water Meter N.TS. Notto Sale 1. UP94 description provided by odhers. 12. ROOD ZOW DtfTERBNNATIONS AREWoeFeriaTELTelephoneFadBlesOAOfficialRecords2. The Iarnds shown hmaon wera not P &MW AS A OtXWnFSY ONLY ANDC".. Chain UnkFor" CsR7CoveredArea O.R.B. Official Records Book abstracted for easemansorodwrnmed. ARE DAWa/1RMTHE SWSOURIS FN. Found Nail B.R. Beo* Referem P.C.P. Pennanern Control Point ad encumbrances not shown on the plat. AVAiLAkE TO THE Wr#TYON. TNS HChardM.M. Pwonanern Raleomm Mo uTeM 34 nivc ror porbord Of fmsthtgs. four IM ORMAT10N SHOULD NOT EE e
not RELED UPON FOR MOD NAURANCE WAM
2;, , -46
POWEkP PF -, TTO, Nty
1110teby'"Ale "a appoint (1,
1,
NAME)
of F'nee .. tlet to be, my lawful Attorney- XOMPANY'Alt -BU01 iis)
IA-fU4 to set for Ine, and Apply to t1ke :5&& ) L2Q 'ftilding.DVartmezit.
for a. —yenct. Pernik for work to be porformed at a 10C400A &0$ctibed ay., MR—)
Seetion Township
Lot Blo,6k—. Subdivi-sio
and to sign joy name and do All.things necessary to this oppointJmend
Acknowledge-.:
SWOM to and -subseribed before we by Rajuj'Pate4 president OfFtnee Outlet, this
Day of A.D. 2Q_jj,
SHRM. NOTARY ftnic StAff-7DP EO—RWA
June,23 2010-
LI402418
41" p 011
JP
401
4#JN'M1ftAWV*1"M\ *ww
370 Vapnout Court - Ukamary. n32746 Voices 407.688.7631 Fax 407.688,7691
Lot 207, PRESERVE AT L4XE MONROE UNIT2, according to the
plat thereof, as recorded in Plat Book ". Page(s) 10 and 11, ofthe
Public Records ofSeminole County, FL
Commmnliy number: 120294 Pend.- 0060
SqOW F F.LR. AL Owe. 912812007 Flood Zone: X
Deft of held work: 11/1112008 Coagilefion Date. 11/1112008
Certykdto:
Kevin Pills Jessica Pills Thomas F. Pitts Thoroughbred Title, LLC
Chicago Title Insurance Company; Quicken Loans, Inc., its'succe4sors
andlor assigns.
PLAT OF THE FLORIDA LAND AND
COLONIZATION COMPANY'S CELERY
PLANTATION PLAT BOOK 1. PAGE 129
VAINIE-a CORNER
FW 11r
N00-06-0.5-01 55.00' (P) / s' BRICIC WALL
a,
T
WALL a
2.X W 1 esatvxr 01.9111M im
LOT 207
L c WALL 6
2.S W
A
PfJP PLA
SCALE.- I 0=30'
44
LOT 208 Ail?
Y" SMAY RE809" LOT 208
pi p
99313
WiLLOWAY Rim 0 STRE" -
t 0 WATER
METER ELECTRIC
am CONCRETE
DRIVE
11 ELECTRIC
WX PHONE
BOX na
tr Ux FD. N6D 7-
7— lb —T r comemw OUM M
NAD S00.0 106#05"IE SOO'
N'050E 55.00' nPI KIL
L 0 WBA Y RIDGE STREET Property Adk&ess: W'
RIB' (IMPROVED) 313 WillawbayRidge Street LEGEND
GENERAL NOTES Sanford,
FL 32771 Survey
number: SL 100508 43—
Wood Fer" W.M. W&W mew KT.& " to scaie 11. UV81 description pro by Wthem 12. FLOOD ZONE DITEMUMMONS ARE ts—
Wre Fmce TEL Tolephone fadbes O.R. Official Records 2. The lands shown hereon were not PROVIDED AS A COURTESY ONLY, AND C.T.F..Chain Link Fence Covered Arft O.R.R. Official Records No* abstracted for easements orodw recotd. AREDMEDRUMATHEUMSOURCES FX
Found '"i B.R. Bea" Rekw'mP.C.P. Permanent Control Point ed enorbanots not shown on theplat AVAILABLE TO THE SURVEYOR. THIS nd
rlions of footings. foun- INFORAIN"O" SHOULD NOT be WAORAML8000
W"RAN42
0 Building & .Fire bwe ' nhdfl Division
6 FEET OR LESS IN HEIGHT)
DDREss. 3 !
L "
PLAC7R»sATION' IS TRUE AND Act LI A*M WiI,L E NSTALLM IN resit APOVW LOCATION AS OWN ON THE APPROV aPLAN. THIi PENCE 'WILL HE SO HIGHER THAN 6 Pam', m wABI]RED PROM (pB Da. THE PINISHED 89m OP THE PENCE n REQVaW TO.FACI? OL7T, iT18 THP HOM'MWNM S FILWNSIBILtry TO V&U" DIE FENCE Is PLACED WI7 iIN THE PROPERTY LT1IE8 AND ANY UIBPUTHBEADJACENTJI3vlia.. BE ACIVIL tfATTLR. T LiNI)ERSTAND THAT i+AILtH2M TO JwRbi tLY FOLLO-W TBPSB CaU LLit tANDADIIERETOALLCITYCODES (SANPORD LAMDEVELOPMENT REGULATIONS, SMEDULE F3 C013i iI RESULT IN THE F Ii 73A1rIN TES "98 R 'L'kCWs RELOCATED OR REMOVED AT O'S P,7II'7F 7SE,
1r"Cz CON13UMR
1"X Sl+i i' o TWS AFPWAWT, YOU ARX ACKNOWUWGINc, IOU RAVE Mi,DIa THE 110WOSTakJI.ATIONS A5 STATID ON DOCLyMCKT. AWAR7C OA t MCIAVTP
COMPANY 1 CO
Ct7tv7RACTOR SIONATIJU:
DATA: Z- ElROI41ECN4lNzx (O
OWNM J.Bi7 DER SIGNATURE:
DATE
TM FU%r riING IIEPAR "PLEA3gE NOTV*
WML NOT CONDUCTANY INSPXCTTONS ON RXSrDZNTL4L nNCI&S. T131C8AI! MAVrf A+1EIT8'T BE PROVIDED, S'GnD AND NOTAR=Dv AT THE TiM.E OF Ptp_ IT SUMffTAL AND 'C MLSUMCEASTK9FINALINSPECTIONAPPROVALFORTHEPENCE.
STATE OF FLOMA COUNTY OF
Sworn to *Ad Subs abed before =* wo 1 4-01day of yy
11 . a, TM— 2,0 by:
Wko it 0 PMQMWY Known to me or Baer G Produced (tnm of
tit! )
I+%a i,ublic
w
S of a
Prle
of Nobatry rubllc
N
as identmesuan.
LN' a KAY CARPENTER
t3 My COMMISSION # Ga 202261
4' EXP Ap111.2M
Ba1dYd?EroNota+YY+oMclJndanMNiM
FENCOUT-01 ---m AYQV.W
CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DDrYYYY,
w-- " r 4i 3io s
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 poiicy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
H 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 Iieu of such endorsement(s). of _..__ ._
w ,_....... __-_..._._..__..
PRODUCER N: Deidra MalleyCACT
Morse Insurance Agency, Inc PHONE !FAX
1000 Wekiva Springs Road (AIC, No, Exq: (407) 478-6529 (A/c, No):
Longwood, FL 32779 _Al b%Jss: dmaiiey@morseagency.com
INSURED Fence Outlet Inc., Fence Outlet of Oviedo Inc„ Fence Outlet
of Tampa Inc,
Fence Outlet North Port LLC, Fence Outlet Melbourne LLC
Fence Outlet Port Richey LLC, Fence Outlet Daytona LLC
Fence Outlet MDC, LLC„ 9671 S. Orange Blossom Tr.
Orlando, FL 32837
INSURER(S) AFFORDING COVERAGE NAIL N
INSURER A: Allied Property & Casualty Insurance Company i42579
INSURER a: Nationwide Ins Co of America 25453
INSURER C : Travelers Casualty and Surely Company of Arnerica i31194
INSURER D: FC:CI insurance Group _ 10178
INSURER E : _
INSURER F :
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEWOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TLRM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE iNSURANCL AFFORDED BY 'THE POLICILS DESCRIBED HEREIN IS SUBJECT TO ALL THC TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ISR ADDL SUBR POLICY EFF : POWCY EXPToTYPEOFINSURANCEwcnur, POLICY NUMBER .uarmnrvw, euutnws— LIMITS
0
X COMMERCIAL GENERAL LIABILITY
CLAIMS-MADF X OCCUR
X Contractual Liab
X $O Deductible
GEN'L AGGREGATE LIMt I I APPLIES PER
X PJI_ICY X -P, LOC
AUTOMOBILE LIABILITY
Xj ANY AUI.O
OWNED SC'IEDULED
AUTOS ONLY AUTOS
RED r
A JIO ONLY I AUTOS ON
C X— UMBRELLA L-AB-- . -X OCCUR
EXCESS LIAR CLAIMS-MAD[
DED __X RETENTION 10,000N $
D WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIFTORJPARTNERiEXECUTIVE Y / NIOFFIGERMFMBEREXCLVOG.D9 IN N I A
Mandatory in NH) .—.
i Iryrs dercnbe underEutecsamrmNr3Fnr3w rannnros r,.,.,,
EACH OCCURRENCE ... S 1,000,00E
ACPGLP05983684403 12/31/2017 12/31/2018 OAO'GFTORENTEDFtREMLSE$ (Ea oecwreme) S 100,00C
ME EXP (Any one t>erson) 51000
PERSONAL & ADV INJURY 11000,000
GENERAL AGGREGATtLL 2,000,000
PRODUCTS - COMP/OP AGG 2,000,000
COMBINED SINGI F I..IMN 1,000,000Eaacddont) .. _
ACPBAZ5983684403 12/31/2017 12/3112018 Rom Y wN jimY ;r>r, person)
BODILY INAiRY (Fgr aociden)
PROPERTY PAMAGrPeratxidenl7
PIP 10,000
FAC H OCCURRENCE 10,000,000
ZUP-71M20191.17-NF 1213112017 12/31/2018 10,000,000AG6RE3ATE
X PER OTH-
STATUTE- ER
001-WC18A-73596 05/04/2018 05/0412019 1,000,000E.L. LACH ACCIDf NT
E.L. DISEASE FA FMPLOYFbF $ 1,000,000
1.000.000
84403
DESCRIPTION or OPERATION$ i LOCATIONS J VEHICLES (ACORD 101, Additional Remarks Schodule, may be attached If more space is required)
quipment!
C;ER7IFICATE HOO,LDER w_wu.___ _ __ .. -. CANCELLATION-,",
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, Ability Management ACCORDANCE WITH THE POLICY PROVISIONS
E WILL BE DELIVERED IN
6736 Lone Oak Blvd
Naples, FL 34109
AUTHORIZED REPRESENTATIVE
Gr+a
ACORD 25 (2016103) _ 0 1988-2015 ACORD CORPORATION, All rights reserved.
The ACORD name and logo are registered marks of ACORD