CERTIFICATE OF INSURANCE
C.tificate of Insurance
[xIFLORIDA FARM BUREAU MUTUAL INSURANCE COMPANY ,
[ ] FLORIDA FARM BUREAU CASUALTY INSURANCE COMPANY
P.O, Box 730 Gainesville, FL 32602
DATE: March 24. 1982
THIS IS TO CERTIFYthat the Company named above has issued policy (ies)to the insured named below, If
such policy (ies) are canceled or changed during the, period(s) of coverage as stated herein, such a manner as to
effect this certificate, 10 days written notice will be mailed to the party designated below for whom
this certificate is issued,
Nanieand Address of Party to Whom This Certificate is Issued
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Name and Address of Insured
The City of Clearwater
ClearWater, FL
Robert E. Smith &
Evelio Palomino d/b/a
E. Palomino Dairv
366 Garden L K Circle
OdeRsa, FL 33556
Description of
Insured Operations:
65 acres on State Rd 580 and County Road 77
in Pinellas County, FL.
RECEIVED
MAR 30 1982
IDx ~1..Wt
Policy
Numbers t
Kind of
Insurance
Limits *
Eff,
Date
Expiration
Date
AUTOMOBILE
BODILY INJURY LIABILITY Each Person $
Each Accident $
PROPERTY. DAMAGE. LIABILITY Each Accident $
GL 639383
PUBLIC LIABILITY
BODILY INJURY LIABILITY .Each Occurrence
PROPERTY DAMAGE LIABILITY Each Occurrence ~
PRODUCTS -Completed Operations Liability
BODILY INJURY LIABILITY Each Occurrence $
Aggregate $
PROPERTY DAMAGE LIABILITY Each Occurrence $
Aggregate $
100.000
100 000
5/24/81
5/?4/R2
CONTRACTUAL LIABILITY
BODILY INJURV LIABILITY
PROPERTY DAMAGE LIABILITY
Each Occurrence $
Each Occurrence, $
Aggregate $
Oescri tion of Contract s Covered:
WORKERS' COMPENSATION
$ STATUTORY
cc:
Pol icyholder
Prod ucing Agent
File
29/rvj
Serviced by Fla. Farm Bureau at Valrico, FL
THIS CERTIFICATE OF INSURANCE IS NOT VALlO UNLESSIT IS COUNTERSIGNED
BY A DULY AUTHORIZED REPRESENTATIVE OF THE COMPANY,
t If more than one kind of ,insurance is written on one policy, ,the policy number need not be,repeated.
* Absence of an entry in these spaces means that insurance is not afforded with respect to the coverage
opposite thereto. ' .
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93-7,692 (Rev, 1/81)
D ;lORlDA FARM BUREAU CASUALTY INSURANCEJOMPANY
XfJ FLORIDA FARM 5U.~EA'J MUTU/.L 11\J5URAlKE COMPANY
END 0 R S E MEN TI14
I
Subject to all ot~er- terms and conditions of the po::cy 1'0 whicrl this endorsement is a1toched :t
is understood and agreed by and between ~he Company and the Named Insured that
ADDITIONAL INSURED
The Insured is hereby Amended to Include The City of Clearwater
Clearwater, FL as (an) additional insured(s) but only with respect
to Liability as their interest may appear.
65 acres on State Rd 580 and County Road 77 in Pinellas County. FL.
I
~ECE1YEl)
MAR 30 1982
t,
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Jl;:j1fX i;J QUI.
Nothing herein contC1'~ed shall aiter, vary, wo;ve. 01" extend WIY provision or condition of the
policy except os herein provided.
Attached to and forming part of policy number GL 63.23..83
Robert E. Smith & Evelio Palomino
d/b/a E. Palomino Dairv of~dessa. FL 33006
issued to
Effective date of this endorsement
0/?4/P,1
on
3/24/82
29/rvj
7~J
COu ntersigned at Go il'lesv i I ,Ie, ~Iorida
93-7-131 (REV. 6/80)
ORIGINAL
FLORmA ,ARM BUREAU MUTUAL IN~URANCE Cp~1P ANY
p,O, BOX. 730, GAINESVillE', FLORIDA 32602 .
GENERAL liABILITY DECLARATIONS
1, DECLARATIONS & POLICY PERIOD: The declarations of the policy indicated, during the period shown, beginning 12:01 A,M" Standard
lime nt the address 01 the Named Insured as stated below~ are subject to all other, terms, definitions, exclusions, and ,cqndiJions. of the policy.
The policy may be extended for peri'Ods of one year provided the premium (including 'audit premium)'is-paid, and'acGepled bY the company,
prior' to the expiration date. Failure of the insured to provide ihe necessary audit information, and to pay the premium-'shall be"deemed'a re-'
quest for canc,ellation of the policy.
2, NAME AND ADDRESS OF INSURED:
~Robert E. Smith & Evelio Palomino
d/b/a E. Palomino Dairy
366 Garden L K Ci rcle
L~ Odessa, FL 33556
MEMBERSHIP NO.
*252822
Gl
5/24/8 f"e,e. PER'OO 5/24/82
TO
POLICY NO.
639383
FROM 12:01 A.M.
*252823
3~ LOCATION OF ALL PREMISES OWNED, RENTED, OR CONTROLLED BY THE INSU~ED:
)
534 acres on the E/S of Patterson Road, appro~imately
1 mile South of Tarpon Springs Road.
.-.-,.-,..----
L::::.:----=-~:=:--:-j2L__=__=_==::::=-=,\CRE":_ TOTAL ACREAGE OWNED, RENTED, OR CONTrlOLLEO
Ill$UranCe a!1prdo(1 IS only with respect lo slid, afJd so many 01 the coverages as are indicated by specific premium charge, The limit of the company's Iiapility against
each -such cov'eragr~ :Jhall be as :;tated tlerem subjacllo all terms 01 the policy having reference therelo,
5, FARM AND PERSONAL LIABILITY COVERAGE
, ~~~~;~;-E~,.IMA;~-~..---~-..~;;;;-;.'"-"--l'--.-"-.,DE0{;'RlPllON--oi-HA2ARD -1 '-C'OVERAGES~ANO l'IM'ITS OF lIABILlrf..-...--e:----..-;,c-,-- ,
1_ ANNUAl. PREMIUM i'~U!~8H--\ l-pe-rsorisT-LiabiJity -Including perso.nal COVERAGE A.~ ""'~COVERAGE-:;;;:=2- ,COVERAGE S, GOVERAGE-,C
~._,-,.._--- ~ __n..___...______._.__ ~~;~il~e~p' !~ya~~ lj~~~tiySe~~y~~r~DanOJ MEDiCAL'
I l~yS~~cL.rA~(~T_fy ~~~I~I~~yl~~'~I~I~~1~6 PFiOPCI~1iL~';yMAGE', PAYME~.lTS
fLnon-~..,-,'--~"-'-t-"-.."-..'''-...-.,,-m'",..-----tli..~-~~~:-~~'::I~i~:~~::~O R:tC:::: 8';': FARM EMPLO~EES (suH~~,(~b'~~i;~~C,~"C~,I) '=~~:~'R,
!$~lP_kOO__~_ __,,9Jc2_(JL-j~',O!eCS ~:"b,'"tY Payro'.' and $500 $ 300,000 $ none $ 100,000
P , ,'.-', " , ,,' "'" "" ,!(_)"btum Fd(~_ng ReceIpts." fACr-l!)CCUR'~INr:E l\r::)-")f--.:CU~lAENCE EACHQCc.:;,I.WAEN~
~$-.'-,-.,-.,..' 48.-...-8...~b-Oo-o=.~.,=~. ---.----~-~-;~";-~" .".mp~~:~~~IG~-R:';-018~~:~!;c:~~~~r;~~~ASES$~~~GS SHE ~40U~ u~0~OO -@~ -;~~~\~
.' t-- "-- ~ -_:... EXCESS co, AMOlJNT -
. ~~-nQne----'- -~Q1335 -- i "~'M^"~-';U;;-"'; ~;F~~~_-~~~~_;;;;;:~~,~;'~~ OF ..F!,~M_ HAZA~~~..:=-=--:-@___=~--~:- E.;~"vE'
t~:!E~,u 31~~~i~lir~:::~:~~: '~''':.m:~~'':;~;,G= =-'~
~$___ "____ --tn- 1.-,-, NO COVERAi.:i.E: _P~OVIDED UN_~SS THE(8l-ZARO is DESCRI;;H;ffi AND PREMIUM PAID ~ .~
~~~O:=-i -='~ .IF;.~:~:~I;;~~-r~ - -~"~~:" ;r~~,:;;.,,~,-J
/ .
COUNTERS~CiNEO _;td-. _,_~_
J\T C:;^INE-.sVILl~E, F ,RIDA - Ai
____029 'f)W
COUNTY celD,,"
-_5.JJ.-J'QL_-
DA,E
-HM1NIMUM r--'REMIUM
H-8 {HEV 9IBO)
*FI~'J.""L PHEMIUM TO BE DETERMINED BY AUDIT AT END OF' POliCY PERIOD
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ENDORSEMENT # 2
FLORIDA FARM BUREAU MUTUAL INSURANCE COMPANY
Subject to all other terms and conditions of the policy to which this endorsement is attached it is under-
stood and agreed by and between the Company and the Named Assured that
In consideration of the premium at which this policy is written, it is hereby agreed and
understood that no coverage is provided under this policy for riding academies, riding
stables, or the giving of riding instructions or riding lessons on the premises or away from
the premises of the named insured.
Nothing berein contained shall alter, vary, waive, or extend any provision or condition of the policy
except as hcrein provided, Attached to and forming part of policy number GL 639383
issued to Robert E. Smith & Evelio Palomino
d/b/a E. Palomlno Dalry
Effective date of this endorsement 5/24/81
of
Odessa, FL
7
on 029/qw
1-7-517 (10/76)
5/7 /81
(jd~
Authoriz
Countersigned at Gainesville, Florida
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END Ci RS'.E /iii EN T #1
,
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CJ-Fld-~";~,:"~ARM' f'.; Ik:EI~_U U,SUi\i.1'Y If,i~I.;RN'ICE 1C.IMP/,h.j'(
~!J Flo~nDA F/\RM IlUI~E/\U MU,U'-'_L 1~~:-:,u,'f.'.N(f:: L:C;N\I'f-\N"-'
,Subiec1 to uil
is 'understc.iod
other "tern"I:', (1(Id- condilions. o(thE(. policy to which this',"endo.tsement, is ottached it
clSji"eGd by (,mcJ bel.we~n the C~)r:lp~,ny' ond. t.he NCH,ned Insur"f'Jd that '
ADDITIONAL NAMED INSURED:
The Named lnsured is hereby amended to include
of Miami as Trustee a.s an additional named insured,
respect to 1 i abil ity as thei r ; nterest may appear.
,
, N~thi ng,_ hEn 'iC'in,_ con 10 ined 'sholl alter:. vary, waive, or extend any provision o~" cond,i'~:i'~:~): ,6f"All-~ ,I:'
po.licy e'Xce'p'~ as, herein- provided.
GL 639383
A1'tCJc:hed to and forming pad of policy number
Robert E. Smmith & Evelio Palomino of
dT5Ta--r:-Va 1 om1r1OIJaTi''y
Effedive- cI(1k of 1his endorsement._ 5/2'4/81
Odessa, FL
, ' .
._---,----,---~--
on~17 /8L__029/gw
Countersigned at Gainesville, Florida
,.
93..7-131 (REV. 6/80)
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ENDORSEMENT
I
1/2
INCLUSION OF PRODUCTS HAZARD COVERAGE
AND COMPLETED OPERATIONS
Subject to 1111 oiher t.erms and conditions of the policy to which this endorsement is attached, it is understood and agreed by and
between the Company and the Named Insured that Exclusion(i) of the policy is hereby deleted.
,..Ui
In consideration of the additional premium set. forth herein, the policy is extended to cover the Products Hazard which is defineci
as follows:
(1) "Products Hazard" includes bodily injury and property damage arising out of the named insured's products or reliance upon
a represe.ntation or warranty made at any time with respect thereto, but only if the bodily injury or property damage OCC'l.:\ffi
away from premises owned by or rented to the named insured and after physical possession of such products has been re-
linquished to others.
(II) "Completed Operations" include~ bodily injury or -property damage arising out of operations or reliance upon a warranty
made at any time with respect thereto, but only if the bodily injury or property damage occurs after such operations have
been completed or abandoned and occurs away from premises owned by or rented to the named insured. "Operations"
include materials, parts, or equipment furnished in connection therewith. Operations shall be dee_med completed at the_
earliest of t.hl:' following times:
(1) When all operations to be performed by or on behalf of the named insured under the contract have been completed,
(2)
When all operations to be performed by or on behalf of the named insured at the site of the operations have be~n
completed, or
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. ',,-'
(3) When thE' portion of the work out of which the injury 'or d~mage. al'ises has been put to its intended J,.lse by any
person or organization other than another contractor or subcontractor engaged in performing operations fOJ:: a prin~
cipal as a part of the same proiect.
Operations which may require further service or maintenance work, or correction, repair or replacement because of
any defect or deficiency, but which are otherwise complete, shall be'deemed completed.
The completed operations hazard does not include bodily injury or property damage arising out of:
(a) operations in conne-ction with the transportation of property, unless the bodily injury or property damage
arises out of a condition in or on a vehicle created by the loading or unloading thereof,
(b) the existen(~e of topls, uninstalled equipment or abandoned or unused materials.
EXCLUSIONS
This insurancl;' docs not apply;
(1) to bodily injury or property damage resulting from the failure of the named insured's products or work completed by or
for the named insured to perform the function or serve the purpose intended by the named insured, if such failure is due
to a mistake or deficiency in any design, formula, plan, specifications, ad....ertising material or printed instructions prepared
or developed by any insured: but this exclusion does not apply to bodily injury or property damage J;'esulting from the
active malfunctioning of such products or work;
(2) to property damage to the named insured's products arising out of such products or any part of such products;
(3) to property damage to work performed by or on behalf of the named insured arising out of the work or any portion
thereof, or out of materials, parts or equipment furnished in connection therewith;
(4) to damages claimed for the withdrawal, inspection, repair, replacement. or loss of use of the named insured's products or
work completed by 01' for the naml."d insured or if any property of whieh !'lIch products or work- form a part, if such
products, work or property al'l' withdrawn from the market or from USl.' l~l~cause of any known or suspected defect or
deficiency therein.
Irrespective of the limits of liability shown on the declarations of this policy, the limits of liability for this coverage are:
BODlLY INJURY
PROPERTY DAMAGE
$
$
300,000
300,000
Each Occurrence
Aggregate
$
$
100,000
100,000
Ea:ch 0 ccurrence
Aggregate
The definition of "Each O{;currenc\~" is as defined in the policy. The definition of "Aggregate" is the total limit of the
Company's liability [or all damages arising out of all occurrences during the policy period.
Nothing herein contained shall alter, vary. waive, or extend any provision or condition of this policy except.as herein provided,
Attached to and forming pMt of policy number
~T ';1.9~Q'l
issued to
Robert E. Smith & Evelio Palomino
d/b/a E. Palomino Dairy
of
Odessa, FL
Effective date of this endorsement
5-24-81
on
5/7 /81
029/gw
COMPANY
Coun~rsil.I1ed at Gainesville, Florida
Representative
6-7-614 (Rev. 6/7D)
,
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GErtltAL LIA,BILITY ENDORSEMENT +
On or after 4-1-81 subject to all otber terms and conditions of Policy No. GL 639383
to which this endorsement is attached, it is understood and agreed by and between the Company and
Robert E. Smith & Evelio Palomino d/b/a E. Palomino Dairy
that the insurance afforded by this policy is hereby amended by the following conditions indicated by
specific symbol "X":
[ 1. The limits of liability for BODILY INJURY & PROPERTY DAMAGE are hereby amended
to $ ,000 EACH OCCURRENCE.
[ ] 2. The limits of liability for EMPLOYER'S LIABILITY are hereby amended to $ ,000
EACH OCCURRENCE,
[ ] 3, The Name and/or Address is hereby amended to read:
[xx] 4. The total number of ACRES amended to 599 in lieu of 534
[ ] 5. The total number of COWS or HORSES is amended to
[ 6, The FARM LABOR PAYROLL is hereby amended to $ @
[ ] 7. The total number of TENANT FAMILIES is amended to in lieu of
[ ] 8, The total number of ADDITIONAL RESIDENCES amended to in lieu of
[ ] 9, Coverage is hereby CANCELLED on the following classification(s):
[ ] 10, Coverage is hereby EXTENDED to include the following classification(s):
[ ] 11. The following classification is hereby amended to read:
[ ] 12, The expiration date is hereby amended to read:
[xxi 13, Other: The location is hereby amended to include: 65 acres on SR 580 &
County Rd. 77, Pinellas Co., FL.
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As a consideration for the above change(s) there is
no change 5/7/81 029/gw
This Endorsement shall not bs bJndin, upon
the Company unless counte1"S~.ned by ilJ duly
authonzed officer or reprelJentative of the
Company.
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FLORIDA FARM BUREAU MUTUAL
SURANCE COMPANY
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