|
COlW,. CEHTIFICATE OF Ll /\l::HLITY IN!:iUHANCE 11 1\11 jMf,III IIUtq
<br />ICJ/Jr,/1111
<br />1100UCFR
<br />,anier Upshaw,
<br />L '<; US llwy 98
<br />I IH'.
<br />SouLh
<br />Box 468
<br />,akeland, FL 33002
<br />~· neo
<br />r i Sure Corporation
<br />>.o. Box 653
<br />\11 bur ndale, FL 33823 -06 5 ~
<br />I IIIS Cr:it lll'ICI\I C is iS SLJFU /IH /I M/1 11 Flt Of IPlfUiiiA.-i IION
<br />UNI Y /\Nil CONrEllS NO RI GIIIS 111'014 lllC CERllflC/\l C
<br />IIOLOCn. 1111S CF.ll TIFIC/\l E llOES t/Of /\IA CNll, EXlEtlO Oil
<br />.
<br />:T. ~2~VOOEO D AI.ICII lllE coy~g !lr!OllUCU DY_~IIE POLICIES BEi.OW.
<br />1 INSUnEnS /\ffOllUll'G COVf:11/\Gll
<br />i,,.,•,u11u1A /\111 c 1·i c n11 E111pJ uyP L s
<br />m•.u11111 n<.:0111111 e r c ial Urd o n l11sura11t:c
<br />1'111s1111tt"' 1-'CC l l11sura11cc C o 111pa11y
<br />jm~UIUI\IJ
<br />l IN'olllll.llt
<br />1>VERAGES
<br />ll<E l'OllCIESOf INSUll/\NCI: LISI Ell nEI O W 11/IVI Ill.I II ISSUI U '" 1111 Ul5UIU II IIAl.11 IJ /111',VI I 0 1111,r l'O1";Y l'I 11')1) 11 11),CMI II 11r 111•11111s11111uum
<br />I • llEOUIV"M(Nf, THIM on COUl>IIIOU or J\IIY COUII\I\C t (.111 O lllf II ()(JCUt.11 llf Wllll IIJ ~rr r , IQ WIUC II Ult": ti fll ll k.:l\lr t.11\Y ur l'iSUI U 0 11
<br />I ( l'ERI/IIN, IIIE 11SUIW1Cl /lffOlll)fl) IIV lllf l'OI ICl"S I ll SIIINII I) Ill I U v, IS Sllfl ~ t"I l tl /Il l "" II m.,c.. 1 1,;11,~•~l~/lllllf:Clflllll lOIISOr SlJCII
<br />r _.ICIES. I\COIIEO/IIE UM II S SIIOWN W\Y 11/IVI Ill fN 111.IIUCI ll llV l 'lllltt;t lllfJS
<br />'1Wl t YPEOF INSUnANCl! --·• -· l'OLIOYNUMllr 1, jrnA1,1~",U,~MiU~.~1'.''<t,~~:~[M~~ihJ:~{:. . LIMII C ,. ___ _
<br />fl OENERAlll/\OllllY AZW/'./.;).090 ! U'//01 /00 i (J'//01 /0 l :c,1:11 oi:c:u1111u1cr-,•1, 000, 000
<br />X co~MCRcw..oENERALLU\Ul.llY I f j rinrn11MflUC (r'\•1v011 e l •e slOO , 000 I I Cl/llMSMAOEI X I OCCU'l P.OC O ()(l'Cllny one "'"""' s5, 000
<br />I PERSOtllll&AOV INJ UnY sl,000,000
<br />j j ocNrn111 .110011eo111e s2 , 000, 000 I : l'ltOUIJC I S-COMl'IOl'AOO ,2 , 000, 000
<br />-J..!..>=.!.L.-'-""-""-'-~'4f---------·---!-'-----l--------------------
<br />1
<br />0 ·1 /01/UO 1
<br />1
<br />07/01/01 coo,11111r n smolCt 11011
<br />l 0 EN1.11oone:0~1etIMn AN"'l.Icsrtn :
<br />I POLICY I I ~~gj I I' n~
<br />!AZl\X07939F 1
<br />I
<br />IIUIOMOOllE ll/\OILITY
<br />Ix ANY IIUIO
<br />All OWNED IIVIOS
<br />sc11e out~O AUTOS
<br />I~ IHREO/IUTOS
<br />NON -OWNED AUIOS
<br />X Drive Other Car
<br />I OAHA.08 l1AOIUTY I /\NHUTO
<br />B I excess u1101L1TY
<br />X] occun I t Cl,.,IMS MI\OE
<br />C ZO~I S J 202
<br />I DEOUC IIOLE 1 X nEIENIION 110000
<br />WORKERS COMPENSATION AIIU
<br />EMPL01CRS-LIABILITY
<br />OOHIC:OOM2919
<br />omen Leased/ IAZR'/22090
<br />"jRent al Equipme nL i
<br />!Ins tall FloaL ~.i.:__1 __
<br />I I
<br />I I
<br />I
<br />CEa&«ldt nll 11,000 , UUQ
<br />000/L 'I' INJUIIY crcr P(fSOU)
<br />OOO•L., nuvnr
<br />(Per ac:chJrnlJ
<br />rnorcn,, OAYAOE
<br />("et I CCldcnlJ I '
<br />hUIO OUlV • (AACCIU(UI I
<br />OIHCU 11•/\r,
<br />I\U100Nl V
<br />€11•c c s
<br />/IO U I
<br />07 /01/00 07 /01/01 c•c11 occunnrncr 12 ,000, 000
<br />1 1
<br />M, .. ,,." r 0 0 •• 000
<br />06/0J/OO ~0 6 /01/01 'WCSI MIJ · I"''' I l 10 1tY LIMII S t 111 i
<br />, t L EAc11•cc,oru1 ,,5 00, 000
<br />I le 1 .0 ,slASr F AC'-"'10,c r 1500, 000
<br />·---------· ·---~l)l~l•§.~OLICY_t,JM.!!:J500 , OOQ_
<br />1 07/01/00 :O'l/01/01 1 Limil:
<br />' I $100 ,0 0 0 w /$1000 Oe d
<br />_; $I OU , 000 w/$ 1000_ Oe<.l
<br />J :rnr JIOH o r OPE nAttON6 1lOCA I ION';IVE l i lC l r s,r>eC L USlOH ~ AOUl' IJ "' ruuo 11srM r NI l ';P(Cfl\L ''flU YIC.ION t;
<br />\ : Dixie lle iS:jhLH Wat c 1 /\r:r;es nt11!'11l l'roj N:l lllJ\•19 1 JIii).',
<br />lolder i s shown a s u ddili o 11a l .i 11 m 1re rJ wiLl1 1 r•qa1di~ L o Lia bi Ii I y •·uv<!r ayes
<br />: ~•,rrCA rc IIOWEn I AllDIIIOtlAI lWiUllf o,•~•~CIH.C_l_ll ll ____ GA~~s:tLLA • •2~
<br />m.Jian River Cuu 11t y
<br />•e;25 l 9 L h J\venul"!
<br />J l"O Heilch, Fl, 17.9r.o
<br />·--~l(UM,ror u1r liUU\'\ hl r-,e;,r nrUl'CJIIC"III •,111 l"I\W~ Ill UOI ft,111 Utr l M i,\AIK.)tl
<br />111\l(flHrHtJf u o 1r;ru1·mn<1'iUnt l\WIIIIUIH AVOOtO,•A11 \U ,A'f'':¥,JllllllU
<br />MJlf'f 1011.-t frU f lC,\0 l '(JtOCnN.AtJ'ff)l(>II I lf t t ,n u,ruuw 10DOOOr.ttAt l
<br />,., ... \r.!. ,.u u :11 WJI\HU·~ l,U l 'I\Cl'l llf OIi ,.,..., 111 •1 0 ur,..,., O lf 1•1",JII[ f\llSAGl"Hl'-.Cll
<br />ffl 11H '•' tlt"tllt •.
<br />A1/ll•Oll•/1 ')11' • H I 'i' Nll\'1,,,.1
<br />.t_,. -r· , ...: /h &.:,~ ,
|