CERTIFICATE OF INSURANCE (10)
ACORDm
c;jllllllliblfl mIII.J!lI'I'I.si...".'.'iN~d~..ii. , DATE (MMIDDNY)
ii .'.',.,'...'.',....','...".'......:,...'...,.'...i..i.....i.....ii. .'. .',.,'. "...,~O\l.i.".....'.... 07/05/00
~, THIS CERTIFICATE IS I'D AS A MA'ITER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON TIlE CERTIFICATE
HOLDER. TIllS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER TIlE COVERAGE AFFORDED BY TIlE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
PRODUCER
Oakes & Associates Insurance
4111 Land 0' Lakes Blvd. #loB
Land 0' Lakes FL 34639
Donald DeGain
Ph"~N". BI3-996-4111
INSURED
FnNo.
COMPANY
A
Auto Owners Insurance Co
COMPANY
B
RECEIVED
J U I I 1 2000
E. Palomino Dairy, Inc.
Patsy Smith
12220 Garden Lake Circle
Odessa FL 33556
COMPANY
C
COMPANY
D
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER(OD
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,
--HXGWSIGNS-AN-D--GO.WDI1'IQNS-OE-StJ.GII POl.fr<IDC lU,UTS-SUO\\-'N.-MAY-HA.v.E-BEEN-REDUCED--1Vt-P-AIO.-CLAIML._"
CO
LTR
TYPE OF INSURANCE
POlJCY NUMBER
POLICY EFFECTIVE POLICYEXPIRATIO
DATE (MM/DDIYY) DATE (MMIDDIYY)
LIMITS
GENERAL LIABILITY
A X COMMERCIAL GENERAL LlAB1LlTY 861912 20363781
CLA1MS MADE 00 OCCUR
OWNER'S &CONTRACfOR'S PRCT
07/21/00
07/21/01
GENERAL AGGREGATE
PRODUCTS" COMP/OP AGG
PERSONAL & ADV [NlURY
EACH OCCUBRENCE , 300000
. 300000
FIRE DAMAGE (Anyone fire)
MED EXP (Any one person)
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AlITOS
HIRED A UTas
NON-OWNED AUTOS
COMBINED SINGLE LIMlT
BODILY lNlURY
(Per person)
BOD1L Y INJURY
(Per accident)
PROPERTY DAMAGE
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT $
OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE S
EXCESS LIABILITY
EACH OCCURRENCE
AGGREGATE
s
s
i.
TH-t-"-
ER
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS-COMPENS-ATION-AND-
EMPLOYERS'LIABILITY
THE PROPRIETORf
PARTNERS/EXECUTIVE
OFFICERS ARE:
OTHER
INCL
EXCL
EL D1SEASE POLICY LIMIT
EL D1SEASE EA EMPLOYEE $
DESCRIPl'ION OF OPERATIONSlLOCATIONSfVEBlCLESISPECIAL ITEMS
50ola~res -hsection 11lth~u 20, TWP 27S., RGE 17E
Hll sDoroug County, F orlda
-.~
<"
Iili
,:'1:7
CLEARWA
SHOUlD ANY OF THE ABOVE DESCRIBED POLlcms BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL E1't.'DEA VOR TO MAIL
~DAYS WRITTEN NOTICE TO THE CERTD1CATEHOLDER NAMED TO THE LEJiT,
BUT FAILURE TO OTICE SHALL IMPOSE NOOBLI
OF ANY
AUTHORIZED
City of Clearwater
P.O. Box 4748
Clearwater FL 33758
Donald De
c~: ~ 0~
f!- ( yfc.