CERTIFICATE OF INSURANCE (9)
-,CERTIFICATE OF INSURANiE: EPALO-l .. CSR DO 07/12/99
:6~~~~K & Associates In~rance t~~M~K~~t~~~Msj~p~~'frl~ ~MI~~tm ~~Lm~k~~guM~iM~~E i
~gency, Inc. I OOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDEO BY THE I
,4111 Land O'Lakes Blvd. 11108 ,POLICIES BELOW. 1
:Land 0 'Lakes FL 34639 :mnmnmCOMPANIES--AFFORDING--CO-VERAGEmmm:
, PHONE 813-996-4111 , ,
:-iNsuRED-------------.-..--..-..-..-....-.-......-.......-:-CO"PANy-LETTER-~--A~t:~--()~~~~~--I;;~~~~-~;;;;-c:~~-.------:
: :-COMPANy-LETTER-Ei-----------------------....-.----..-------.---------:
IE _ Palomi no Dairy. I nc _ I -COMPANy-LETTER-cmnmmnn.mmn.nn.--mm-n.-mnn.-:
patsb Smi th 1_0000_0000_000000_000000_000000_000000_._.00.______.__..______________
~~~~sa G~[d3~s~~ke Circle : .~~~~~~:_~~::~~_~._..______.__._n__nm_m_.mmnnmnm_m:
,- ! COMPANY LETTER E I
i) COYERAGES {====================================================================================================================1
\ ~~~iO~sI~~I~~~~~~Y ~~~~I~~~~~~5iN~FA~~S~~~~~~E~~~j~DT~~~0~RH~~~D~~j~NI~~U~~yT~O~~~Ai~s~~E~T~~~E~o~~~~~TF~~T~H~E~~~i~YTO I
: WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOROED BY THE POLItIES DESCRIBED HEREIN IS SUBJECT TO :
I ALL TERMS; EXCLUSIONS; AND CONDITIONS OF SUCHPOLrcrES. lIMlTSSHOWN MAY HAVE"BEEN REDUCED BY PAID- CLAIMS. ,
:-coj------iypE-OF-INsuRANcE--------j-------POLICy-NUMBER-------j---POLicy-EFF--j--POLicy-Exp-.j-.-.------.---LIMIis--------------:
\ LTR, _ ,.. . ., 1 .. I ..OATE 1 DA TE I I
:.--:-GiENER-Ai:.-~-i~8iii:i-;r;;-:-------------.---..-.-.----:---------------:--------------:GENERAL-AGGREGATE--j:30c;~-C;C;c;--:
: Ai [~ COMMERCIAL GEN LIABILITY : 861912-203637811 07/21/991 07 /21/00iPROD:coMPiop-AGG:n~oc;~oC;onl
: : [J CLAIMS MADE D< ) OCC. : :: :PERs:-&-;;Oy:-iNJURyl:30c;~.C;C;O--:
I : [ ] OWNERS'S & CONTRACTOR'S : I I : EACH-OCCURRENcEnn ~oo~oc;on:
, I PROTECTIVE 1 1 I IFiRE-DAMAGEmmnlmmmnml
: : ( ] : : I I(ANY ONE FIRE) 150,000 :
I IrJ 1 1 I 1 __0000_000000_00001000000"000000,
- -1- -f-L .'., n . c.. --+- i I MED. EXPENSE I I
I I -I. I - --I-~ I(ANYUNt.Pt.K50N)-IS,OOO. I
\.--1-...-...---------.-------------1------------------.--------1---------------1-------.------1---....---.--.---.-1---..-.-------1
I I AUTOMOBILE LIAB I I I ,COMB. SINGLE LIMIT 1 I
1 , ANY AUTO ' 'I 'BODiLy-iNJuRy-m--I-------m-m,
I 1 ALL OWNED AUTOS I I I I (PER PERSON) I I
, , SCHEDULEO AUTOS i I I '000000_000..000__..1_____________.1
I 1 HIRED AUTOS 1 1 I 1 BODILY INJURY I I
: : NON-OWNED AUTOS: : I : (PER ACCIDENT) I i
I , GARAGE LIABILITY, i I 'PROPERTY-DAMAGE-m!"----mmm,
\ 1 1 1 I I I I
1---'-E)(c;E:~-~--~i~Eli.~j[;r;(---,-.--..----.--.-------------,-.-.-----------I--.----------.'EAcH.occuRRENCE----1--------------,
I If J ~~~~~Li~A~O~~BRELLA FORM i I I iAGGREGATE..--.--.--I--...---------I
'00_1 nnn_nnCnnCn______C_c___I___._____________nnn_._.I_...n.______._I n._______~c_)=~_"~_"~c_______I___n__n___n I
, , I 'I I :STATUTORY LIMITS I I
, I WORKERS. COMP I 1 I lEACH ACCIDENT I I
1 I AND 1 I I I DISEASE -POL. LIMIT I 1
i I EMPLOYERS' LIAB : Ii: DISEASE -EACH EMP. ! I
,---'-c;;riiE:Ft-.----.-.-.-.--.-----.I---------------------------,---------------1--------------,----------------------------------1
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I , I 'I' I
I-OESCRIPTION OF OPERATIONS/LOCATIONS/YEHICLES/SPECIAL ITEMS----:---------------:--------------:-----..--.-.-----------..---------1
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I) CERTIFICATE HOLOER (-------.--.-.-.~..'..--.,..----------) C'ANCELLATION (---------.-.--------------------.--------------....----I
, ---------.------- ---: ------------. -------.-------.---------.--.-.-----.------.-.---------1
I :: .SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 1
I , ..,,- '5::; ~ ~ .EXJj~ATI~~Y~A~~If~~~E~~flt~ET6s~~~N~E~~~~~~~T~I~6L5~~E~~~~DT~OM~~~ I
ICi ty of Clearwater _. = LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR :
,P_O. Box 4748 . '; = LIABILITY OF ANY KIND COMPANY , lTS AGENTS ORR R ATIVES'I
Clearwater FL 33758. ' .e :_________00_____00_00 00000000__ - ___ 00___00
I = AUTHORIZED REPRESEN ATIVE I
! .ACORD 2S-S (7/90 )---------...' = !