CERTIFICATE OF INSURANCE (11)
Oakes & Associates Insurance
4111 Land 0' Lakes Blvd. #108
Land 0' Lakes FL 34639
..." -,--------, - --.,-- .,... -,." .., " , "...,,,, "..". ""-"",, - - - - -- -,.. .---.""",....",...."..."".".""""""",.....
,~CORDTM ,.GIEFl"IFlmA"T'EPfl.l~BI~tt'VINSl..J.NmE~Ix.~~f D~; (M;~D~~
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
'PRODUCER
Donald DeGain
Phone No. 813-996-4111 FexNo.
INSURED
COMPANY
A
Auto Owners Insurance Co
COMPANY
B
E. palomino Dairy, Inc.
Patsy Smith
12220 Garden Lake Circle
Odessa FL 33556
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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 AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
COMPANY
~-~--
I
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DD/VY1 DATE (MM/DD/VY)
LIMITS
A
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY 861912 20363781
CLAIMS MADE [i] OCCUR
OWNER'S & CONTRACTOR'S PROT
07/21/02
GENERAL AGGREGATE
07/21/03 PRODUCTS - COMP/OP AGG
PERSONAL & ADV INJURY
EACH OCCURRENCE $ 300000
$300000
FIRE DAMAGE (Anyone fire)
M ED EXP (Anyone person)
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
COMBINED SINGLE LIMIT
BODILY INJURY
(Per person)
HIRED AUTOS
NON-OWNED AUTOS
BODILY INJURY
(Per accident)
GARAGE LIABILITY
ANY AUTO
I PROPERTY DAMAGE
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
_EIVIPLOYERS~_l!.ABILI!!"_,_ ..
EACH OCCURRENCE
AGGREGATE
THE PROPRIETOR/
PARTN ERS/EXEC UTIVE
OFFICERS ARE:
OTHER
-.. --R EA€It--A€CI~IoiT
+-.'-..--
INCL
EXCL
EL DISEASE - POLICY LIMIT
, EL DISEASE - EA EMPLOYEE
DESCRIPTION OF OPERATIONS/LOCATlONSNEHlCLES/SPECIAL ITEMS
500 acres - section 17 thru 20, TWP
Hillsborough County, Florida
City of Clearwater, Fl is listed as
278., RGE 17E
additional insured.
CERTIFfCATE.'HOL.DER
CANCELlATION
..--..-.. ..REALEsor
Real Estate 8erviC~.~1 M~nager:
City of Clearwater.'. ," ".
Attn: Earl Barrett_
P.O. Box 4748
Clearwater FL 33758-4748'(1/ - 3 ""'-'1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
.1Q.... DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,