CERTIFICATE OF LIABILITY INSURANCE
MIrtIa GIll
C8tJ*1W ~ Inc DBA
25 ~ EIMI.
aeen.aa. Belch R. smn
INSUAI:A A:
MiURER I;
~SURER ~
IHSUAERD:
IN9JRER E:
07-27-01 14:32
"4~4.111t. C
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AU.EY REHBAUM & CN'ES
ASSURANCE, INC.
P. O. BOX 4820
CLEARWAlISR R. SS768
FROM-ALLEY IREHBBAUM CAPES
+727-797-8605
T-926 P01/01
iJREQ
: POLICIES OF INSIJRANCE USTED 6E~OW HAVE IiI:t:N IS$IS) YO THE INSuAEO NAMED ABOVE FOR THE POlICV PERIOO It-.DICATED. NOTWITHSTANDING
'( REQUIRaIENT, TERM OR CONDITION OF mY CONTRACT OR OTI1ER DOCIMENT WITH ReSPEtT TO WHICH THIS Ct:RTIACATE MAY BE ISSUED OR
'( PERTAIN. THE INSURANCE AFFORDED BY THE8~IC1ES DESCRIBED HEREIN 1$ SI.l8JECT TO AU THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
L1CIES. AGGI1EGATE LIMITS SHOWN MAY MAVE REDUCED BY PAlO ClAIMS. ~ ~
FI TIP! OF INsuRANCe POuCV ,",uMBER , I.JolrTS
GEtlERAL UABIUTY PAS031850139 07/25/01 07/25/02 EAot OCOJRRENCE S 1,000,000
-=:-
X COMMERCIAl. GEt.leRAL L1ABIUTY ARE DAMAGE Wri QClO .,,) $ 1,000,000
I CLAIIolS MADE (!] OCCVR t.El) EXP (Any OlIO l*Slll\) $ 10.000
I- PERSONAL & ADV INJURY S ',000,000
GENERAL AGGAEGA TE S 2,000,000
GENt. AGGREGATE LIMit APPLIES PER; PROOUCTS . COMPIOP AGG S 2,000,000
11 POtJCY n ~~ n.lDC
~OMOIILE l.IA8IUlY COMlllNt:O SlHOLl UMIT $
Nt( AlSTO (Eaaeclllenll
-
AU. OWNED AUTOS BODl~ Y INJJRY
- ,
SCHeOUlfD AuTOS "'pmonl
-
tflAEO AUTOS BOOIL Y lUll\'
- $
NOH-owNW AUTOS fw acr.idMII
-
PROPESlTY 0t\ICAGl! $
~ tcl*lelIIl
GARAGE LlAIlUTY AUTO 0Nl.. Y . fA ACCIDE~ S
1 At.lY MlTO OTHeR TIM EA~ $
AUTO ONLY: AOO $
EXCESS UABlUTY ~ OCCUAAfNCE $
::IOCQIR o OJJMS MA!)1i AGGReGAll $
$
=i~0UCT~ $
ReTiNTION $ X~I $
\t/ORI(ER& COMPENSA lION AHP I'W
l!MPUWEAS' UABIl.ITY 35197 07/25/01 07/25/02 f-l. &.Ctt ACClDENT $ 100,000
LL. PISi4Sli . I:A fMP\.OYEl! S 500,000
E.L. lllSEASf . PQjJCV ulllT . 100,000
cmteR
3CR1PT1OH OF OPERATIOftSil.OCATION&'VEHlCLiiIiXQ.&J$lON$ ADlllOO By eNOOASEwENTISPECIAl PROVISIONS
rtificate Holder is Add" Insured for General Liability only Cancellation NotIce for Workers Camp
is 30 Days
iR11FlCATE HOlDER I I ADOfTIONAl. INSURe!); INSUAEA ~R: .__u
SHOuLD AI(( OF TliE ABOVE DESCRIBE:) POUCles Ie CANCaw> iIl!rotll! THl! EXPlM TIOM
HBrtamI8IIr Ol'TE THEREOF, ThE I66UlNG INSURal WU ENDEAVOR TO IlAJ,. 10 DA.YS WIlITTEN
CIty fA CI8arWIIlV I<<>T1CE TO TIE CERTflCATE 11000ER IlAMEO TO l'l1I: lHT, M FAlWRE TO 00 so SHAl.L
25 C8uIewIJ BM1 IUP09E NO OllUGATION OA 1.IA1IIUTY 01' ~ KIND uPON THE INSURER, ITS AGENTS OR
CIolnIIDr FL 3!.1m
REPRESEWT A nve5.
~I.ITH01lfZl;P REPRESfS!'A1IYf ~ /lA /~- J
I . 'Af
:oRD &S (lfd1) , ,_ _. _ 110N llM1S
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