CERTIFICATE OF INSURANCE (6)
CERTIFICATE OF INSURANCE: PALO-1
!Oakes & Associates Insurance : CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
1,':~irclanan8 ;Lakes Blvd. 11108 I ~mc~~~ m~~' EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
Land 0 'Lakes FL 34639 I .
: i-------------C()i1f,-~~j[E-s--A-F~CiR-D][~G--c;()-"iiR:~(;Ei---------
I PHONE 813-996-4111 I
: -INSUREO---- - - - -- - - - -- - - - - -- -- -- --- - - n__ - - ----- - m__ - - - - : - CONPANY -LET! ER-A - -~~t~- - o~ ~~~- ~- - ][~~~~-~-~;;;- c~~- - - n ---
: I-COMPANY-LE!!ER-i3----------------------------------------------------
1______-----------------------------------------------_________________
IE. palomino Dairy, Inc _ / COMPANY LETTER C
Patsy Smi th 1------------__________________________________________________________
:12220 Garden Lake Circle : COMPANY LETTER D
Odessa FL 33556 ____n________________________________________________________________
I ! COMPANY LETTER E
I) COVERAGES (====================================================================================================================
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
I 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 AFFORDEO 8Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO
I ALL TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
l-coj------jYPE-O;-INsuRANCE----------------POLICY-NUM8ER-------i---POLICY-EPp--j--POLICY-EXP-----------------LIMITS--------------
ILlRI i . DATE I DATE
:---[-GIE~EiR~L:--~][~El-iL:i-i-\(- ---------------------------:---------------:-------------- GENERAL-AGGREGAjE--j:3;;Ci~();;C;--
: Rl [XI COMMERCIAL GEN LIABILITY 20363781-861912: 07/21/95107 /21/961 PROO:COMP/OP-AGG~--::3;;Ci:-ooC;--
: : [I CLAIMS MADE ~ I OCC. : I : PERs:-i-ADv:-INJURY i:3()C;:-o;;C;--
: : [ ] OWNERS'S & CONTRACTOR'S : J EACH-OCCURRENCE---- !:3;;C;~()OO---
PROTECTIVE ___________________,______________
I 1 \ I FIRE DAMAGE I
1 ill I !(ANYONEFIRE) 150,000
: : [ ] I I I MEO~-EXPENSE------- : ___m________
I I I I I(ANY ONE PERSON) 15,000
:---:-A-LJ:rCii1()i3i-~ii--~-iAEl-----:---------------------------:--------------- --------------:cOHi:-sINGLE-LIHli-:--------------
I / ANY AUTO I / IBODILY-INJURY------/--------------
: I ALL OWNED AUTOS i : (PER PERSON) I
\ I ~\~i~U~Q~o~UTOS ' IBOOILY-INJURY------I--------------
: : NON-OWNED AUTOS [(PER ACCIDENT) i
GARAGE LIABILITY ___________________ ______________
I / ,I I PROPERTY DAMAGE /
I __I ___ I 1 I
1- : -EixcEs-s--i:.-IAi3i-C][,.-y---: -----_m___m__m____m __m__________ _______m____ i EACH-OCCURRENCE----: --------------
__I [ J ~~~~~Lf~A~0~~8RELLA FORM : i [AGGREGAiE----------:--------------
- /-------------------------------/--------------------------- ---------------I--------------I--isTATU!ORY-LIMITs1--------------
I WORKERS' COMP I I lEACH ACCIDENT I
I I AND I I DISEASE -POL. LIMIT I
: : EMPLOYERS' LIAS : I IDISEASE-EACH EI1P. i
:---:-C;i-fiEiR----------------------:--------------------------- --------------- --------------:----------------------------------
I I / I I I
I I I ! I I
I-DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLE5/SPECIAL ITEMS-------------------------------------_________________________________
I
I
I
I
I) CERTIFICATE HOLDER 1------------------------------------) CANCELLATION 1-------------------------------------------------------
I ------------------------------------ --------------------___________________________________
I = SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
I = EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
i = 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
ICi ty of Clearwater = LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
IP,O. Box 4748 = LIABILITY OF ANY KIND UP E COMPANY,ITS AGENTS OR REPR ENTATlVES.
Flearwater FL 33518-4748 I
1 = AUTHORIZED REPRES I
i_ACORD 25-5 (7/90) Donald E. ; !
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