CERTIFICATE OF LIABILITY INSURANCE (34) AC R CERTIFICATE OF LIABILITY' INSURANCE DATE(MMIDD YY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER..THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW/. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: I the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the term's and conditions of the Policy,certain Policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER GUNIAGI
NAME: Evelyn Boyd
R&E Insurance,Inc DBA Dain Street Insurers CONN,Ext: 717-384 5846 (AJC,No
7602 Congress Street LESS: evelyno ainstlnsurors clan - _
Sults;1 INSURERS)AFFORDING COVERAGE NAIL#
New Port Richey FL 34653 INSURER A: Western World Insurance
INSURED -__-- INSURER B: -.
DunnDee Farms,Inc INSURER C:
11677 Wild Cat Lane INSURER D:
INSURER E
New Port Richey FL 34654 INSURER F: I
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER.
—
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.
INSRADi3L`SITBR PO-iJCY EFS POLICY-ER}s?
LTR TYPE OF INSURANCE INSD%WVD POLICY NUMBER (MM/DDIYYYY) (MMfDDIYYYY) LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1000,000
.. ,,,... DAMA-G.ETD TIENTE'D `. .. -._--
Xi CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 100,000
... -_........ (MED EXP(Any one persarrl $ 5,000 .._..
-.
A - NPP8852689 7125/2922 1115/2923 PERSONAL&ADV INJURY $ 1,000,000
_ _..__..
GEN`L AGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE s 1,090,000
X POLICY JEC LOC � ( PRODUCTS•COMPIOP AGG $ 2,000,000
ECT
OTHER: $
AUTOMOBILE LIABILITY (Ea accident) $
ANY AUTO ., BODILY INJURY(Pur person) -, 5
ALL OWNED F__1 SCHEDULED -
BODILY INJURY Per accident)
�
HIRED AUTO'S AUTOS�-OWNED PROPERTY DAMAGE $
AUTOS i (Per accident)
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
I EXCESS LIAB CLAIMS-MADE s. � ( (AGGREGATE _.. 1..$ ...... ......_.._. .:
- -
DED I RETENTION$ _
WORKERS COMPENSATION - —-AND EMPLOYERS'LIABILITYY!N STATUTE -. ER
ANY PROPRIETORIPARTNERJEXECUTIVE' E.L.EACH ACCIDENT s
OFFICER/MEMBER EXCLUDED? NIA l- _--_ --
(Mandatary in NH) �', E.L.DISEASE-EA EMPLOYEE!, s
If yes,describe under
DESCRIPTION OF OPERATIONS below '' , E.L.DISEASE-POLICY LIMIT i, s
A Property NPP8776634 2/2012921 2129/2922 BPP-$50,009 Building-$260,000
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION GATE THEREOF,NOTICE WILL BE DELIVERED IN
Clcarwatl r Public Literary ACCORDANCE WITH THE POLICY PROVISIONS.
109 N Osceola Avenue
AUTHORIZED REPRESENTATIVE
Clearwater EL 33755 r2
- @ 9988-2014 ACORD CORPORATION. All rights reserved
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD