CERTIFICATE OF INSURANCE (14)
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A CORDTM ,'..'liJlIll_IUlrjj~'lIl......~B.....II~gJIkII~.....~~~~~.tR~
DATE (MMIDDfYY)
PRODUCER
06/Z8/01
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
Oakes & Associates Insurance
4111 Land 0' Lakes Blvd. #108
Land 0' Lakes FL 34639
Donald DeGain
Phone No. 813-996-4111
INSURED
Fax No.
COMPANY
A
Auto Owners Insurance Co
COMPANY
B
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 PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE ISSUED OR MA Y 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.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATIO
DATE (MMIDDfYY) DATE (MMIDDfYY)
LIMITS
_GENJ?-...R.U.. T TARn ITV___._______".__
~~Te--- $ 300eeo--
A X COMMERCIAL GENERAL LIABILITY 861912 20363781
CLAIMS MADE []J OCCUR
OWNER'S & CONTRACTOR'S PROT
07/21/01
07/21/02
PRODUCTS - COMP/OP AGG
PERSONAL & ADV INJURY
EACH OCCURRENCE $ 300000
FIRE DAMAGE (Anyone lire)
MED EXP (Anyone person)
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
COMBINED SINGLE LIMIT
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EACH ACCIDENT
AGGREGATE
EACH OCCURRENCE
AGGREGATE
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
I WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
cTHE PROPRIETOR! .-<-
PARTNERS/EXECUTIVE
OFFICERS ARE:
OTHER
INCL
EL DISEASE - POLICY LIMIT
EL DISEASE - EA EMPLOYEE $
EXCL
DESCRIPTION OF OPERA TIONSILOCA TIONSfYEIDCLES/SPECIAL ITEMS
~oola~res -hsection l~lth~? 20, TWP 27S., RGE 17E
11 sO r co nty, orl a ...
lty o~ e~~arwa~er, F lS lsted as addltlonal lnsured.
3 200lf ~i 1
-~
!,'.'H
JUL
CLEARWA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFlCATE HOLDER NAMED TO THE LEFT,
City of Clearwater
ATT: Earl Barrett
P.O. Box 4748
Clearwater FL 33758-4748