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Palmdale Oil/CheathamClient#: 67371 PALOI DATE (MM/DD/YWY) AC�I�,�� CERTIFICATE OF LIABILITY INSURANCE siza�2ozz THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFI.CATE 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 REF�RESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the.. Tfi�� '1 r._�n lieu of such endorsement(s). PRODUCER . � „�- --1--�.� ° �� NAMEACT Michelle A. Kalicharan Acrisure dba Gulfshore Ins -SF j�.�'"v�� '`�,�� °,. aoNN , Ext : 239 435-7143 ac, No : 239 213-2803 4100 Goodlette Rd N ,/ R'` � �� ,r'� _a;�E•MAIL maklicharan ulfshoreinsurance.com . tr' ADDRESS: �9 Naples, FL 34103 ��"' R ��..- � � INSURER(S) AFFORDING COVERAGE NAIC # 239 261-3646 ;�'� � r''�`�� _ iNsuRER A: Houston Specialty Insurance Company 12936 INSURED Palmdale Oil Company, In 911 N 2nd St Fort Pierce, FL 34950 \ Ce�� COVERAGES CERTIFICATE NGMB'�R-:-��'' 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. NSR �- IADDL SUBR'. � POLICY EFF POLICY EXP _TR TYFE OF WSURANCE INSR WVO POLICY NUMBER _. _ (MM/DD/YYYY) (MM/DD/YYYV) LIMITS A XI COMMERCIAL GENERAL LIA8ILITY X X ECAP1 HSGL00000403 9/30/2021 09/30/202 EACH OCCURRENCE S i3OOO,OOO DAMAGE TO RENTED � CLAIMS-MADE � OCCUR PREMISES Ea occurrence I S � 00��00 GEN'LAGGREGATE LIMITAPPLIES PER: IPOLICY I I JEC�T I X I LOC OTHER: . . ,. -- ---- -- — - --- - p AUTOMOBILE LIABILITY X�'i ANYAUTO � OWNED SCHEDULED AUTOSONLY AUTOS X AUTOS ONLY X NON-OWNED AUTOS ONLY X MCS-90 X Poll. Liab. A UMBRELLA LIAB X OCCUR X EXCESS LIAB I CLAIMS-MADE ��" '°" y` ..: ��i�usuReR s: Great American Alliance Ins Co _ 26832 �� (� ""� NsurteR c: Certain Underwriters at Lloyds AA1122000 v ' ��,�. f�. iNsurtert o:�mperium Insurance Company 35408 � _.' \ :�l - �� 'y_., �' ' � INSURER E : ,',`. '�y� . . � ! � . . � .�� ` � INSURER F : MED EXP (Any one person) 5�J��O PERSONAL & ADV INJURY 5 ��OOO,OOO GENERALAGGREGATE $Z,OOO,OOO PRODUCTS-COMP/OPAGG $Z,OOO,OOO $ X � X � ECAP111CCA00000403 ECAP1 HSCX00000403 �_ I DED � JC � RETENTION $U B ' WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y � N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED9 �� N /A (G�ar.daten/ En MH) . If yes, describe under DESCRIPTION OF OPERATIONS belaw C Excess Liability X I WCE59979902 21 RENMA21000559016 $ OSI3O/2O2 X [gTATUTE �RH E.L EACH ACCIDENT $� OOO�OOO F� n�sFns=-EaEnnP�ovFF �1 Q00,000 E.L. DISEASE - POLICY LIMIT $� �OOO,OOO 09/30/202 $5,000,000 Limit DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Lots 7-12, Block 169, City of Okeechobee Alley Use Agreement Certificate Holder is included as Additional Insured in regard to General Liability only as required by written contract per form CG2010 0413, Completed Operations per form CG2037 0413, Primary and Non- Contributory status per form CGHIIG2019 0614, Waiver of Subrogation in favor of the Additional Insured per form CG2404 0509, Additional Insured in regard to Auto Liability only as required by written contract per (See Attached Descriptions) R City Of Okeechobee 55 S E 3rd Avenue Okeechobee, FL 34974 ACORD 25 (2016/03) 1 of 2 #S1844698/M1844203 c�x' ��:: �1�� c�.� w � , � � �,,. 9/30/2021 I 09/30/202 Le�accidentJ ��V�� _ g1 �D0��000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE I $ (Per accidenq 8 9/30/2021 09/30/202 EACH OCCURRENCE $4 0�� AGGREGATE $4.000.000 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE r� O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MAK SAGITTA 25.3 (2016/03) 2 of 2 #S1844698/M1844203 � Client#: 67371 PALOI y d'i��rm �,d�� p'��G6 -"�'Y � WJ� ��6�"l.�iLl� r ��76.8��1\7iJE DATE(MM/DDIYYYY) 6/18/2021 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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAMEACT Sarah Arizmendi Acrisure dba Gulfshore Ins -SF PHONE 239 430-7536 F"X 2 AIC No, Ext : A/C, No : 39 213-2803 4100 Goodlette Rd N E-MAIL SArizmendi ulfshoreinsurance.com ADDRESS: �g Naples, FL 34103 INSURER(5) AFFORDING COVERAGE NAIC # 239 261-3646 Houston S ecialty Insurance Com an 12936 INSURED Palmdale Oil Company, Inc. 911 N 2nd St Fort Pierce, FL 34950 INSURER A: P P Y INSURert e: Great American Alliance Ins Co 26832 iNsurtert c: Certain Underwriters at Lloyds AA1122000 iNsurtert �: Imperium Insurance Company ; 35408 CC.'!/ER.G��S CERTIFICATE I�UMBER: 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. INSR 7'ypE OF INSURANCE %�DDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY A X COMMERCIAL GENERAL LIABILITY X X ECAP1 HSGL00000402 9/30/2020 09/30/2021 EACH OCCURRENCE 5'I OOO OOO CLAIMS-MADE � OCCUR PREMISES� a occu ence 5 � OO,OOO MED EXP (Any one person) 5 � ��0 PERSONAL & ADV INJURY 5 ��OOO�OOO GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE SZ�OOO�OOO PRO- PRODUCTS - COMP/OP AGG SZ,OOO,OOO POLICY � JECT x LOC _._ _. OTHER: �' p AUTOMOBILE LIABILITY X X ECAP1 IICCA00000402 9/30/2020 09/30/2021 EO aBI�N�eD SINGLE LIMIT $,� �QQQ�OQ� X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE I 5 X, AUTOS ONLY X AUTOS ONLY Per accident X CS-90 X Pollution Lia � S A UMBRELLA UAB X OCCUR ECAP1 HSCX00000402 9/30/2020 09/30/2021 EACH OCCURRENCE � S4 �00 �� ( EXCESS LIAB CLAIMS-MADE AGGREGATE ' S4 OOO OOO DED X RETENTION $O $ B WORKERS COMPENSATION X WCE59979901 6/30/2021 06/30/202 i� PTAT TE E�RH AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Y� N E.L. EACH ACCIDENT $'I �OOO�OOO OFFICER/MEMBER EXCLUDED? � N I A -- (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $'I OOO OOO � If yes, describe under � DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $� �OOO�OOO C Excess Liability 20RENMA20000557012 9/30/2020 09/30/2021 $5,000,000 Limit DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 701, Additional Remarks Schedule, may be attached if more space is required) Re: Lots 7-12, Block 169, City of Okeechobee Alley Use Agreement Certificate Holder is included as Additional Insured in regard to General Liability only as required by written contract per form CG2010 0413, Completed Operations per form CG2037 0413, Primary and Non- Contributory status per form CGHIIG2019 0614, Waiver of Subrogation in favor of the Additional Insured per form CG2404 0509, Additional Insured in regard to Auto Liability only as required by written contract per (See Attached Descriptions) TION City Of Okeechobee SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 55 S E 3rd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Okeechobee, FL 34974 AUTHORIZED REPRESENTATIVE s�;,�� O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S1702703/M1702067 SLA18 SAGITTA 25.3 (2016/03) 2 of 2 #S1702703/M1702061 Client#: 67371 PALOI ACORD� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/25/2019 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: if the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms 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 coNracr Karla Castro NAME: Gulfshore Insurance - SFL PHONE 239 263-4527 Fax 2 4100 Goodlette Rd N _E A Lo, Ext : q/C, No : 39 213-2803 nooRess: kcastro@gulfshoreinsurance.com Naples, FL 34103 239 261-3646 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Houston Speciatty Insurance campany 12936 INSURED Palmdale Oil Company, Inc. 911 N 2nd St Fort Pierce, FL 34950 COVERAGES CERTIFICATE NUMBER: INSURER B• Amerisure Mutual Insurance Company INSURER C; Certain Underwriters at Lloyds INSURER D: Endurance Americaa Specialty Ins Co INSURER E : �mperium Insurance Company REVISION NUMBER: 23396 41718 35408 THiS IS TO CERTIFY THAT THE POLICfES OF INSURANCE LISTED BELO'vV HAVEBEEW iSSUED TO THE INSURED NAMED ABOVE FOR THE POLICY FERIOG 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 PO�ICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TypE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYV A GENERAL LIABILITY X X ECAP1 HSGL00000401 09/30/2019 09/30/202 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea oNcurrence $1 OO,OOO CLAIMS-MADE � OCCUR MED EXP (Any one person) $ � 0,0�0 PERSONAL & ADV INJURY $ � �OOO�OOO GENERALAGGREGATE $Z�OOO�OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Z,OOO,OOO X POLICY PR� LOC $ JECT E AUTOMOBILE LIABILITY X X� ECAP1 IICCA00000401 9/30/2079 09/30/202 Ea aBcideDtSINGLE LIMIT $1 �000�000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X CS-90 X Pollution Lia $ A UMBRELLA LIAB X OCCUR ECAP1 HSCX00000401 09/30/2019 09/30/2020 EACH OCCURRENCE $4 �0� �� ( EXCESS LIAB CLAIMS-MADE AGGREGATE $4 OOO OOO DED X RETENTION $O $ B WORKERS COMPENSATION X WC20740531102 06/30/2019 06/30/202 X W RYTLMIT E�RH AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE v� N E.L. EACH ACCIDENT � $� �OOO OOO OFFICER/MEMBER EXCLUDED? � N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $�,�0�� If yes, describe under- - DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $'I,OOO,OOO C Excess Liability 19RENMA180005570 09/30/2019 09/30/2020 $5,000,000 D Excess Liability ELD30000798501 9/30/2019 09/30/202 $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Lots 7-12, Block 169, City of Okeechobee Alley Use Agreement Certificate Holder is included as Additional Insured on a primary and noncontributory basis with respects to General Liability per form CG HIIG2019 0614; completed operations per form CG2037 0413 and ongoing operations per form CG2010 0413 only as required by written contract, Waiver of Subrogation per form CG2404 0509. Additional Insured in regards to the Auto Liability on a primary and noncontributory basis per form (See Attached Descriptions) CANCELLATION City Of Okeechobee 55 S E 3rd Avenue Okeechobee,FL 34974 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE � � ��,�-� ,��---- O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 Of 2 The ACORD name and logo are registered marks of ACORD #51473744/M1473500 KPA Client#: 67371 PALOI � ✓ � ACORD„A CERTIFICATE OF LIABILITY INSURANCE �� s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CE�71'FI�'1iTE�4iO�E�2. TF�IS 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 CE,�.T�P E-kiOLDER. IMPORTANT: If the certificate holder is an A I E, t e policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, ce ` ies may re ndorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorse eA ). PRODUCER �F��Q�, ., CONTACT � = �NAME: Karla Castro Gulfshore Insurance - SFL .� �� HONE 239 263-4527 _� FA" . 239 213-2803 4100 Goodlette Rd N , •� `.'�9,9� � -MAi��' Ext�: _ �ac, ��_ Naples, FL 34103 rl 5�,� 4' `' � ooRess: kcastro@gulfshoreinsurance.com ` (d� � � INSURER(S) AFFORDING COVERAGE NAIC # 239 261-3646 �� Houston Specialty Insurance Company � 29.36 '� � � � INSURER A : INSURED - 23396 �� / INSURER B:�+merisure Mutual Insurance Company Palmdale Oil Company, Inc. 3� ��/ - — - �� / INSURER C: ceAain Undereriters at Lloyds � 911 N 2nd St � t �V �'� �-" EnduranceAmerican5pecialtylnsCo �4�%�8 � l. INSURER D_ Fort Pierce, FL .349r'JO '-` — ImperiuminsuranceCompany I3�J408 INSURER E : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TNIS IS TO C�RTI�Y THAT THE POLICIES OF 1NSURANCE LISTEG BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABGVE FOR 7HE POLICY PERIUD 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. NSR ADDLSUBR POLICY EFF POLICY EXP _TR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY) {MM/DD/YYYY LIMITS A GENERAL LIABILITY � � X X ECAP1 HSGL00000400 09/3012018 09/30/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ � OO�OOO CLAIMS-MADE �_X_ OCCUR MED EXP (Any one person) $0 PERSONAL & ADV INJURY $ � ,OOO,OOO � A B E DESCRIPTION OF OPERATIONS I LOCATIONS ! VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Lots 7-12, Block 169, City of Okeechobee Alley Use Agreement Certificate Holder is included as Additional Insured on a primary and noncontributory basis with respects to General Liability per form CG HIIG2019 0614; completed operations per form CG2037 0413 and ongoing operations per form CG2010 0413 only as required by written contract, Waiver of Subrogation per form CG2404 0509. Additional Insured in regards to the Auto Liability on a primary and noncontributory basis per form (See Attached Descriptions) GEN'L AGGREGATE LIMIT APPLIES PER�. � POUCY�� PR� : LOC i JECT_ .. _ __ AUTOMOBILE LIABILITY X X ANY AUTO ALL OWNED I 1 SCHEDULED AUTOS U AUTOS ' NON-OWNED X HIRED AUTOS X AUTOS X CS-90 X Pollution Lia UMBRELLA LIAB X OCCUR �( EXCESS LIAB CLAIMS-MADE DED X RETENTION$O __ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFRCER/MEMBEREXCLUDED? I � NIA (Mandatory in NH) If yes, aescribe under DESCRIPTION OF OPERATIONS below Excess Liability Excess Liability X I ECAP111CCA00000400 ECAP1 HSCX00000400 X � WC207405310 18RENMA18000557042 ELD30000798500 GENERALAGGREGATE $Z�OOO�OOO PRODUCTS - COMP/OP AGG $Z,OOO,OOO $ �$ �9�3��20� COMBWED SINGLE LIMIT '� ,� (Ea accident) __. $ >��,00� � BODILY INJURY (Per person) � $ . - BODILY INJURY (Per accident) �I $ ' PROPERTY DAMAGE $ Per accident I �$ �S O9I3OIZO�9 EACH OCCURRENCE $4 000 000 �, AGGREGATE $4.000.000 19 I 06/30/2 18 09/30/201 18 09/30/201 I $-- X WC STATU- OTH- TORY LIMIT ER _ . E.LEACHACCIDENT $�,OC E.L. DISEASE - EA EMPLOYEE $�,OC E.LDISEASE-POLICYLIMIT $��OC $5,000,000 Occ 8� Aggreg $10,000,000 Occ & Aggre �00 �� 0 CERTIFICATE City Of Okeechobee THE U XP RATOIONH DATBE V THEREO FE NOTICEI WIBLL CBE CDEL VEREDO NE 55 S E 3rd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Okeechobee, FL 34974 -` � t � AUTHORIZED REPRESENTATIVE '�; , , .� lj ,h�•��I�� ' '��ie�j /� - O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) � af 2 The ACORD name and logo are registered marks of ACORD #S1438933/M1438710 KPA Client#: 67371 PALOI DATE (MM/DD/YYW) ACORD,� CERTIFICATE OF LIABILITY INSURANCE 9/27/2018 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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms 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 coNracT Karla Castro NAME: Gulfshore Insurance, Inc - SFL PHONE 239 263-4527 2 4100 Goodlette Rd N �A Lo exc : ,vc, No : 39 213-2803 Naples, FL 34103 aooRess: kcastro@gulfshoreinsurance.com 239 261-3646 INSURER�S) AFFORDING COVERAGE NAIC # INSURED Palmdale Oil Company, Inc. 911 N 2nd St Fort Pierce, FL 34950 INSURER A• Houston SpecWky Insurance Company INSURER B• Amerisuro Mutual Insuranca Company INSURER C• �ertain Underv✓riters at Ltoyds INSURER D; Imperium Insunnca Company 12936 23396 23396 35408 � ' � INSURER F: ' I 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. INSR 7ypE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR INSR NND POLICY NUMBER MM/DDlYYYY MM/DD/YYYY A GENERAL LIABIUTY X X ECAP1 HSGL00000400 9/30/2018 09/30/201 EACH OCCURRENCE s 1 000 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea oNcu ence $ � OO OOO CLAIMS-MADE � OCCUR MED EXP (Any one person) $ 0 PERSONAL 8 ADV INJURY $'I �OOO�OOO GENERALAGGREGATE $Z�OOO�OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Z,OOO�OOO X POLICY PRO- E LOC $ p AUTOMOBILE LIABILITY X X ECAP111CCA00000400 9/30/2018 09/30/201 COMBINED SINGLE LIMIT Eaaccident $�i��r�� X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-ONMED PROPERTY DAMAGE $ AUTOS Per accident X CS-90 X Pollution Lla $ A UMBRELLA LIAB X occuR ECAP1 HSCX00000400 9/30/2018 09/30/201 EACH OCCURRENCE s4 000 000 �( EXCESS LIAB CLAIMS-MADE AGGREGATE $�i OOO OOO DED X RETENTION $O $ B WORKERS COMPENSATION X WC207405308 6/30/2018 06/30/201 X� STATU- OTH- AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y�N E.L. EACHACCIDENT $'I OOO OOO OFFICER/MEMBER EXCLUDED7 N N/ A — NTanaatory—in NH) = J � E.L. DISEASE - EA EMPLOYEE $'I DOO OOO If yes, describe under DESCRIPTION OF OPERATIONS beiow E.L. DISEASE - POLICY LIMIT $� �OOO,OOO C Excess Liability 18RENMA18000557042 9/30/2018 09/30/201 $5,000,000 Occ & Aggreg DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 107, Addidonal Remarks Schedule, It more apace is required) Re: Lots 7-12, Block 169, City of Okeechobee Alley Use Agreement Certificate Holder is included as Additional Insured on a primary and noncontributory basis with respects to General Liability per form CG HIIG2019 0614; completed operations per form CG2037 0413 and ongoing operations per form CG2010 0413 only as required by written contract, Waiver of Subrogation per form CG2404 0509. Additional Insured in regards to the Auto Liability on a primary and noncontributory basis per form (See Attached Descriptions) CERTIFICATE City Of Okeechobee THE u XPIRATOIONH DATE vTHER OFBE NOT�ICEIE�BL CBE CDEL VERED NE 55 S E 3rd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Okeechobee, FL 34974 AUTHORIZED REPRESENTATIVE Q7,�.�` � O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S1328467/M1328266 KPA Ciient#: 67371 PALOI ACORDTM CERTIFICATE OF LIABILITY INSURANCE -°ATE`MM,°°"'�", �. �1�01�d�� . THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICkTE HOLDER. THI�;' �' CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIGIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOf2fZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. �_ IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROG �1 IS INAIVED, subject to ,_ the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certific�,te.dpes not ciDnfer tighYs to the . certificate holder in lieu of such endorsement(s). PRODUCER NAMEACT Karla Castro "`=��.,.��-��. Gulfshore Insurance, Inc - SFL PHONe - ' �Fax '-� �A�c, No, E�: 239 263-4527 - -�,�c No�: 13 2$U3, ' p kcastro ulfshoreinsurance.ct�ctii ` `...� , � 0o e e e-nn,ai� � � Na les, FL 34103 ADDRESS: �g f ., �Y �_ �,;9 ,�1 _,;�a� WSURER(S) AFFORDING COVERAGE�`�,_'�`�� _,. �NAIC # _ INSURED Palmdale Oil Company, Inc. 911 N 2nd St Fort Pierce, FL 34950 uvsuaeRa: HDI Global Insurance Company " 41343 wsuReR B: Landmark American Insurance Com 33138 -- _ _ _ __ _ - -__ _-- - ----- - wsuReR c: Amerisure Mutual Insurance Comp 23396 - _ — _ --- I _ _ ir,suReR o: Certain Underwriters at Lloyds - -- — - - _ _- - - _ __ wsuReR e: Endurance American Specialty In 41718 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: i HIS iS TO CERTIFY TriAT i HE ?OLICIES vF iNSUR/'aNCc �iS i Eu E�ELOV�J H�=.'vE oE�iJ ISSUE^u Tv ThiE {�JSUREC yA��EC AEOV� FOR TNE RC�lCY RER10D INDICATED. NOTWITHSTAND�NG 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. NSR 7ypE OF INSURANCE� � A1DDL SUBR � POLICY EFF� POLICY EXP � GENERAL LIABILITY � � ___ MM/DDIYYY� LIMITS - - - �� - --- --- — .._-- --� TR _ _ INSR WVD POLICY NUMBER _ MMIDD/YYYY A X X EGGCD000015817 06/30/2017, 06/30/2018�EACH occuRReNCE �$2,000,000 JC COMMERCIAL GENERAL LIABILITY CLAIMS-MADE X��. OCCUR GEN'L AGGREGATE LIMIT APPLIES PER�. X POLICY � PRO- �� LOC — - _ _ _JECT 1— --- _ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED � � -I SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON-OWNED AUTOS X Drive Oth Car � B UMBRELLA LIAB X OCCUR �( EXCESS LIAB CLAIMS-MADE - - - - -- - --- _- - DAMAGE TO RENTED PREMISES(Eaoccurrence) $�00,�� MED EXP (Any one person) $ 0 PERSONAL & ADV INJURY $Z,OOO,OOO GENERALAGGREGATE '�� $Z,OOO,OOO PRODUCTS - COMP/OP AGG I$ 2,000,000 -_ __--- - X X EAGCD000015817 LHA079916 DED JC RETENTION $U -- .___ . . _- --------- ----- � - C WORKERS COMPENSATION AND EMPLOYERS' LIABILIN Y� N ANY PROPRIETOR/PARTNER/EXECUTNE --- - - OFFICER/MEMBER EXCLUDED? f N l N I A (Mandatory in NH) � ii yes. descnbe under DESCRIPTION OF OPERATIONS below D Excess E Excess _ .. __ ___. . X WC207405306 17RENMA16000557052 ELD30000390400 /2017'r-- - --- ___ _� —_ 'I06/30/2018��a ag�"�eo� i"��E umiT ', $2,000,000 BODILY INJURY (Per person) �. $ - --. _. . .l ___---_..... . �I BODILY INJURY (Per accldent) � $ $ �% OSI3O/ZO�H�''� EACH OCCURRENCE I$3,UUU,U�� , AGGREGATE $3.000.000 7� 06/30/201 6/30/2017 I 06/30/201 6I30/2017 06/30/201 XTORYTIMITS.1. IE�RH_��$ .... _--_ EL EACH ACCIDENT �' $��OOO�OOO .__-----... .._--� —___ ---- EL DISEASE - EA EMPLOYEE $�,OOO�OOO EL. DISEASE - POLICY LIMIT �I $�,OOO,OOO $5,000,000 Occ & Aggreg $10,000,000 Occ & Aggre DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Lots 7-12, Block 169, City of Okeechobee Alley Use Agreement Certificate Holder is included as Additional Insured on a primary and noncontributory basis with respects to General Liability per form ENAIPNC 0411; completed operations per form CG2037 0413 and ongoing operations per form CG2010 0413 only as required by written contract, Waiver of Subrogation per form CG2404 0509. Additional Insured in regards to the Auto Liability on a primary and noncontributory basis per form (See Attached Descriptions) CERTIFICATE IiOLDER CANCELLATION City Of Okeechobee SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 55 S E 3rd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Okeechobee,FL 34974 AUTHORIZED REPRESENTATIVE �� O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S1173763/M1173432 KPA SAGITTA 25.3 (2010/05) 2 Of 2 #S1173763/M1173432 Client#: 67371 PALOI ACORD,M CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIF CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUR REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATI [� the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate � certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Michelle A. Kalicharan NAME: Gulfshore Insurance - SFL PHONE 239 435-7143 AIC, No, Ext : 1560 Sawgrass Corporate Pkwy E-"'^�� mkalicharan ulfshoreinsurar F rt L d d I FL 33323 ' '' 1 20�� A��REss: @9 DATE (MMIDD/YYYY) �" 2��i�-._ k� 1�-D : THIS` i'..� ��( H� POLICIES ;AUTHORIY�E[�``�a ; �` WAI Q; subject 4a not confer FLt�h#s to the �,.,r- J � 1 5'w� sie ti,.�. 213-2852 � O 8U er a e, �� . O '�� INSURER(S) AFFORDING COVERAGE - � r- 1 1N 239 261-3646 iNsuRERA: HDI-Global Insurance Company iNsuReo iNsuReR s: Amerisure Insurance Company 19488 Palmdale Oil Company, Inc. ' Landmark American Insurance Com 33138 �i, INSURER C : 911 N 2nd St I INSURER D : Fort Pierce, FL 34950 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L�STED 6ELUW HAVE BEEN ISSUED TO THE INSURED NAMED A6�VE FOR THE ?OLICY 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. -- — — _ — - - INSR - ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR WVD � POLICY NUMBER (MM/DD/YYYY (MM/DD/YYYY _ .._-- --.. .. - - - �--- - --- -_.. _ - -- -- -- --_ __- - - _ �GENERALLIABILITY X X EGGCD000015816 sI3OI2O�G OSI3OI2O� �EACHOCCURRENCE $Z�OOO�OOO COMMERCIAL GENERAL LIABILIN �I'� CLAIMS-MADE �X OCCUR A A B GEN'L AGGREGATE LIMIT APPLIES PER XI POLICY� jECT _. _ LOC. �I . . - -- .— -- _ _ AUTOMOBILE LIABILITY X X EAGCD000015816 Ri ANY AUTO � —�'�.. ALL OWNED SCHEDULED _ AUTOS AUTOS NON-OWNED X'� HIRED AUTOS X AUTOS � � X�IIICS90 X Pollution Lia ' UMBRELLA LIAB X OCCUR ��'�, X EXCESS LIAB CLAIMS-MADE � DED X RETENTION $O __ � _._. __ _ __ ._ . _-- - . ._. WORKERS COMPENSATION ' AND EMPLOYERS' LIABILITY Y� N��, ANYPROPRIETOR/PARTNER/EXECUTNE,�--�� '� OFFICER/MEMBER EXCWDED? �, �I �I N I A (Mandatory in NH) I If yes, describe under I fIFSCRIPTION OF OPER.4TIONS below ��. C I Excess EXAGD000015816 . _ _.-- - � -- X WC207405306 LHA076147 PREMISES�EaoNcurr�ence $100,000 MED EXP (Any one person) $ Excluded PERSONAL&ADVINJURY $Z�OOO�OOO GENERALAGGREGATE $Z�OOO�OOO PRODUCTS - COMP/OP AGG $?,OOO�OOO $ - . _. __ .___ ._ _-_ COMBINED SINGLE LIMIT 16 06/30/201 Ea accide�t) g2,000�000 -- -_ ___ BODILY INJURY (Per person) $ - ---. _--- — _.. BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident S 6/30/2016 06/30/201 EACH OCCURRENCE $3 000 ��0 AGGREGATE $3 OOO OOO $ _.-- -- ._. -_ .__ .- I . - .___ _... 6/30/2016 06/30/201 X ORY LMITS_L E�RH — ___ E.L EACH ACCIDENT. _. $� �OOO�OOO E.L. DISEASE - EA EMPLOYEE $� �OOO�OOO � EL DISEASE - POLICY LIMIT $� ,OOO,OOO 6/30/2016 06/30/201 $15,000,000 Each Occur $15,000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Lots 7-12, Block 169, City of Okeechobee Alley Use Agreement Certificate Holder is included as Additional Insured on a primary and noncontributory basis with respects to General Liability per form ENAIPNC 0411; completed operations per form CG2037 0413 and ongoing operations per form CG2010 0413 only as required by written contract, Waiver of Subrogation per form CG2404 0509. Additional Insured in regards to the Auto Liability on a primary and noncontributory basis per form (See Attached Descriptions) CERTIFICATE HOLDER _ CANCELLATION City Of Okeechobee 55 S E 3rd Avenue Okeechobee, FL 34974 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I �„a� � 't�--- O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S1023505/M 1023375 MAK SAGITTA 25.3 (2010/05) 2 Of 2 #S1023505/M1023375 : � Client#: 67371 PALOI DATE (MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 12/04/2015 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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms 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 CONTACT Michelle A. Kalicharan NAME: Gulfshore Insurance - Naples PHONE 239 435-7143 F''" 239 213-2852 ,vc, No, Ext : A/C, No : 4100 Goodlette Road North E-MAIL mkalicharan ulfshoreinsurance.com ADDRESS: �9 Naples, FL 34103 -3303 INSURER(S) AFFORDING COVERAGE NAIC # 239 261-3646 HDI G I' A I C 41343 INSURED Palmdale Oil Company, Inc. 971 N 2nd St Fort Pierce, FL 34950 COVERAGES CERTIFICATE NUMBER: iNsuReRa: - er ing merica nsurance iNsuReR s: Amerisure Insurance Company 19488 �r,suReR c: Great American E&S Insurance Co 37532 INSURER D : INSURER E : 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. INSR TypE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMI�D/YY,YY MM/DD/YYYY -- -----...___.__. ---- -- — ---- --- -----__._---------- A GENERAL LIABILITY X X EGGCD000015814 12/31/2014 06/30/201 EACH OCCURRENCE $2,000 000 X COMMERCIAL GENERAL LIABILITY PREMISES� a occu ence S 1 OO,OOO �; CLAIMS-MADE � OCCUR ��, MED EXP (Any one person) $ Excluded � PERSONAL & ADV INJURY $Z�OOO�OOO ' GENERALAGGREGATE $Z�OOO�OOO GEN'L AGGREGATE LIMITAPPLIES PER: I�i PRODUCTS - COMP/OP AGG $Y�OOO�OOO X� POLICY �E� LOC � $ /� AUTOMOBILE LIABILITY X X EAGCD000015814 12/31/2014 06/30/201 COMBINED SINGLE LIMIT 2 000 000 �Ea accidentj _ .. $ --'------' __._ _. __ _ __. , X��i ANY AUTO BODILY INJURY (Per person) $ i,�ALL OWNED SCHEDULED ,I BODI�Y INJURY (Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident � X CS90 X Pollution Lia i $ A UMBRELLALIAB X occuR '� EXAGD000015814 72/31/2014 06/30/201 EACHOCCURRENCE $3000000 �( EXCESS LIAB CLAIMS-MADE:�'� AGGREGATE $3 OOO OOO DED X RETENTION $O $ �-- -- — --- _ __ _ _ — --- — B WORKERS COMPENSATION �, X WC207405304 12/31 /2015 06/30/201 X�I W RY LM T �RH AND EMPLOYERS' LIABILITY y� N ____.__ _ ANY PROPRIETOR/PARTNER/EXECUTIVE� ; E.L EACH ACCIDENT $� �OOO�OOO OFFICER/MEMBER EXCLUDED? '� ' N / A --- .(Mandatory in NH) �i EL DISEASF - EA FMP�OYFE $� ��QQ�O�� If yes, describe under I DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $� �OOO�OOO C�I Excess Liability � XS194403501 12/31/2014 06/30/201 $10,000,000 Each Occur $10,000,000 Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Lots 7-12, Block 169, City of Okeechobee Alley Use Agreement Certificate Holder is included as Additional Insured on a primary and noncontributory basis with respects to General Liability per form ENAIPNC 0411; completed operations per form CG2037 0413 and ongoing operations per form CG2010 0413 only as required by written contract, Waiver of Subrogation per form CG2404 0509. Additional Insured in regards to the Auto Liability on a primary and noncontributory basis per form (See Attached Descriptions) CERTIF Clt Of Okeechobee SHOULD ANY OF THE ABOVE DESCRIBED POIICIES BE CANCELLED BEFORE y 7HE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 55 S E 3rd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Okeechobee, FL 34974 AUTHORIZED REPRESENTATIVE �� O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S932130/M931992 MAK SAGITTA 25.3 (2010105) 2 of 2 #S932130/M931992 Client#: 67371 PALOI ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDM(YY) 7 2/30/2014 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 Of� PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the ce�tificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditians 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 CONTACT NnME: Michelle A. Kalicharan Gulfshore Insurance � Naples PHONE F,e,X ,vc No, eXe : 239 435-7143 ,vc, No : 239 213-2852 4100 Goodlette Road North ao�R�Ess: mkalicharan@gulfshoreinsurance.com Naples, FL 34103 -33p3 � INSURER(S) AFFORDING COVERAGE NAIC # 239 261-3646 INSURED Palmdale Oil Company, Inc. 911 N 2nd St Fort Pierce, FL 34950 iNsuReR n: HDI-Gerling America Insurance C 41343 �NsuReR s: Amerisure Insurance Company 19488 iNsuReR c: Great American E&S insurance Co 37532 INSURER D : INSURER E : INSURER F : covew4�es CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY TH�4T THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHST�INDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 19SUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONd,ITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE NSRL WVD POLICY NUMBER MM/DDY� MM/D�D/YYEYXYY LIMITS A GENERAL LIABILITY X X EGGCD000015814 12/31/2014 06/30/207 EACH OCCURRENCE $2,000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ � �� 0 CLAIMS-MADE � OCCUR MED EXP (Any one person) s Excluded �' � PERSONAL 8 ADV INJURY $Z�OOO�OOO � GENERALAGGREGATE $Z,OOO,OOO GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS - COMP/OP AGG $Z,OOO,OOO X POLICY PE � �, LOC $ A AUTOMOBILE LIABILITY X X EAGCD000015814 12/37/2014 06/30/201 E�a aBcdeDISINGLE LIMIT $y 000�000 X� ANY AUTO ' BODILY INJURY (Per person) $ ALL OWNED ' SCHEDULED BODILY INJURY Per accident $ AUTOS '�� AUTOS � ) X HIRED AUTOS X'�, NON-OWNED PROPERTY DAMAGE � AUTOS Per accident $ X CS90 X' Pollution Lia g q unnsRe�u►une 'X occuR EXAGD000015814 12/3112074 06/30/201 EACH OCCURRENCE $3 000 000 �( EXCESS LIAB CLAIMS-MADE AGGREGATE $3 OOO OOO DED X RETENTION $O $ B WORKERSCOMPENSATION X WC207405304 12/31/2014 12/31/201 X WCSTATU- OTH- AND EMPLOYERS' LIABILI'TY Y� N T RY LIMIT R ANY PROPRIETOR/PARTN R/EXECUTIVE�� E.L EACH ACCIDENT $'I OOO OOO OFFICER/MEMBER EXCW ED? i �1J I � N/ A i(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $�,do� �� , If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $� �OOO,OOO C Excess �iability XS194403501 12/31/2014 06/30/201 $10,000,000 Each Occur $10,000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (AtWch ACORD 701, Additional Remarks Schedule, if more space is required) Re: Lots 7-12, Block 169, City of Okeechobee Alley Use Agreement Certificate Holder is included as Additional Insured on a primary and noncontributory basis with respects to General Liability per form ENAIPNC 0411; compieted operations per form CG2037 0413 and ongoing operations per form C�2010 0413 only as required by written contract, Waiver of Subrogation per form CG2404 0509. Additional Insured in regards to the Auto Liability on a primary and noncontributory basis per form (See Attached Descript�ons) TION City Of Ok@echobee SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 55 S E 3rd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Okeechobee, FL 34974 AUTHORIZED REPRESENTATIVE �� T OO 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S818952/M818520 MAK Client#: 67371 PALOI ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) _- 12/24/2013 THIS CERTIFICATE IS �SSUED 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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms 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 CONTACT NAME: Michelle A. Kalicharan Gulfshore Insurance - Naples PHONE Fnx 4100 Goodlette Road North E�M No, ext): 239 435-7143 �ac No�• 239 213-2852 Naples, FL 34103 -3303 aooRess: mkalicharan@gulfshoreinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # 239 261-3646 i INSURED Palmdale Oii Company, Inc. 917 N 2nd St Fort Pierce, FL 34950 �r,suReRn: HDI-Gerling America Insurance C iNsuReR e: Amerisure Insurance Company �NsuReR c: Great American E&S Insurance Co INSURER D : INSURER E : INSURER F : 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. LTR TYPE OF INSURANCE �+DDL SUBR POLICY EFF POLICY EXP — INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY� LIMITS A GENERAL LIABILITY � X X EGGCD000015813 12/31/2013 12/31/201 ea,cH occuRReNce �00.000 COMMERCIAL GENERAL LIABILITY � CLAIMS-MADE ❑X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: X� POLICV PR� LOC _ JECT /� AUTOMOBILE LIABILITY � ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON-OWNED AUTOS X CS90 X Pollution Lia A i j UMBRELLA LIAB X OCCUR � ; XI EXCESS LIAB CLAIMS-MADE X I X I EAGCD000015813 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED� � N / A (Mandatory in NH) IIf yes, describe under II DESCRIPTION OF OPERATIONS below C i Excess Liability I EXAGD000015813 X I WC207405303 XS1944035 MED EXP (Any one person) PERSONAL & ADV INJURY GENERALAGGREGATE PRODUCTS-COMP/OPAGG 2/31 /2013 I 12/31 /201 LIMIT $100,000 $ Excluded $2��0�00� $2�0�� $2��00 $ �2,�0�,�0� BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident S 2/31/2013 12/37/201 EACH OCCURRENCE $3 000 000 AGGREGATE $3 OOO OOO $ 2/31 /2013 12/31 /201 X"�c sT,aru- oTH- --- T RY LIMIT� ER ___ E.L. EACH ACCIDENT $� OOO OOO E.L. DISEASE - EA EMPLOYEE $� �OOO OOO E.L. DISEASE - POLICY LIMIT $� �OOO�OOO 2/31/2013 12/31/201 $10,000,000 Each Occurr $10,000,000 Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (AtWch ACORD 101, Additional Remarks Schedule, if more space is required) Pollution Liability - Broadened Coverage for Covered Autos - CA9948. Re: Lots 7-12, Block 169, Cityof Okeechobee Alley Use Agreement Certificate Holder is Named as Additional Insured As Respects to General Liability per form CG 20 10 07 04. City Of Okeechobee SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 55 S E 3rd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Okeechobee, FL 34974 AUTHORIZED REPRESENTATIVE `�—+�ia,�j f� O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/OS) 1 of 1 The ACORD name and logo are registered marks of ACORD #S703950/M703690 MAK Client#: 67377 PALOI DATE (MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 12/26/2012 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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms 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 CONTACT Michelle Kalicharan NAME: Gulfshore Insurance - Naples PHONE 239 435-7143 F'4X 239 213-2852 4100 Goodlette Road North MAILo, e:t : ac, No : nooRess: mkalicharan@gulfshoreinsurance.com Naples, FL 34703 -3303 239 261-3646 INSURER(S) AFFORDING COVERAGE NAIC # HDI G 1' A 1 C INSURED Palmdale Oil Company, Inc. 911 N 2nd St Fort Pierce, FL 34950 COVERAGES CERTIFICATE NUMBER: iNsuReRa: - er ing merica ns. o. �r,suReR s: Amerisure Insurance Company ir,suReR c: Navigators Specialty Insurance INSURER D : INSURER F : 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. INSR 7ypE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR VWD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A GENERALLIABILITY EGGCD000015812 12/31/2072 12/31/201 EACHOCCURRENCE $2000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea oocu ence $1 OO OOO CLAIMS-MADE � OCCUR MED EXP (Any one person) $Excluded PERSONAL & ADV INJURY $'I ,OOO,OOO GENERALAGGREGATE $Z�OOO�OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $Z�OOO�OOO POLICY PR� LOC $ JECT /� AUTOMOBILELIABILITY EAGCD000015812 12/31/2012 72/37/207 COMBINEDSINGLE LIMIT 2 000 000 Ea accident $ � e X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident X CS-90 Incl X Pollution Lia $ /� UMBRELLA LIAB X OCCUR EXAGD000015812 12/31/2012 12/31/201 EACH OCCURRENCE $3 0�� ( EXCESS LIAB CLAIMS-MADE AGGREGATE $3 OOO OOO DED X RETENTION $O $ B WORKERSCOMPENSATION WC207405302 12/31/2012 12/31/201 X WCSTATU- OTH- AND EMPLOYERS' LIABILITY T RY IMIT R ANY PROPRIETOR/PARTNER/EXECUTIVE Y� N E.L. EACH ACCIDENT $� OOO OOO OFFICER/MEMBER EXCLUDED? � N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $� ��1 �� If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $� �OOO�OOO C Excess Liability NYI2EXC7193121C 12/31/2012 12/31/201 $7,000,000 Limit Each Occurrence DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Pollution Liability - Broadened Coverage for Covered Autos - CA 9948. Re: Lots 7-72, Block 769, Cityof Okeechobee Alley Use Agreement Certificate Holder is Named as Additional Insured As Respects to General Liability per form CG 20 10 07 04. City Of Okeechobee 55 S E 3rd Avenue Okeechobee, FL 34974 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I C—+��,_� � ,i}��.�....- � �..ar�-w �� O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S605132/M604736 IPG Client#: 67371 PALOI ACORD,� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY� 12/23/2011 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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the tertns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate dces not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER N�EACT Elia R. Labra, ACSR Gulfshore Insurance, I►1C. PHONE 239 430-7546 239 213-2830 4100 Goodlette Road North E�ia� E� : ac No : nooRess: elabra@guifshoreinsurance.com Naples, FL 34103 -3303 239 261-3646 INSURER(5) AFFORDING COVERAGE NAIC # INSURED Palmdale Oil Company, Inc. 911 N 2nd St Fort Pierce, FL 34950 iNsuReRa: HDI-Gerling America Insurance C 41343 iNsuReR s: Navigators Specialty Insurance 42307 iNsuReRc: �erisure Insurance Company 19488 INSURER D : INSURER E: INSURER F : COVERAGES CERTIFICATE NLMBER: 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. �7� TYPE OF INSURANCE �DL SUB POLICY EFF POLICY EXP LIMITS INSR NND POLICV Nl1MBER MM/DD MM/DD A GENERALLIABILITY EGGCD000015811 2/31/2011 12/31/201 EACHOCCURRENCE $1000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ee o�rrence $ � OO OOO CLAIMSMADE � OCCUR MED EXP (My one person) $ S OOO PERSONAL & ADV INJURY $ i �OOO,OOO GENERALAGGREGATE $Z�OOO�OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Z,OOO�OOO POLICY PR� LOC $ JECT A AUTOMOBILE LIABILITY EAGCD000015811 2/31/2011 12/31/201 COMBINED SINGLE LIMIT Ee acddent $1,��,�� X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY Peracciderrt $ AUTOS AUTOS ( � NON-OWNED PROPERN DAMAGE X HIREDAUTOS X AUTOS Peraccident $ X C590 X Pollutfon Lia $ B UMBRELLA LIAB occuR NY11 EXC7193121C 2/31/2011 12/31/201 EACH OCCURRENCE s10 000 000 X EXCE55 LIAB CLAIMSMADE AGGREGATE $� O OOO OOO DED X RETENTION $O $ C WORKERS COMPENSATION WC207405300 2/31 /2011 12/31/201 X WC STATU- OTH- AND EMPLOYERS' LIABILITY �, � N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $� OOO OOO OFFICER/MEMBER EXCLUDED9 � N / A (MandaMry in NH) E.I.. DISEASE - EA EMPLOYEE $i OOO OOO If yes, desaibe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $� �OOO�OOO DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES �Attach ACORD 101, Additional Ramarks Sehedule, if more apace is requirod) Re: Lots 7-12, Block 169, Cityof Okeechobee Alley Use Agreement Certificate Holder is Named as Additional Insured As Respects to General Liability per form CG 2010 07 04. CERTIFICATE HOLDER r_eNr_Fi i eT�nN City Of Okeechobee SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 55 S E 3rd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Okeechobee, FL 34974 AUTHORIZED REPRESENTATIVE -=;,a� � O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S523045/M523017 ERL AGREEMENT . . /'�,�� This agreement entered into this l3'� day of �v.S�Q,�� ,�9a9, by and iaetween �h� CITIT OF OREECHOBEE, a municipal corpor�tion, hezeinafter referred t� as "CITY", ��nd i��1ILI�IAM CHEATHAi�! & ENID CHEATHAM, AND PALMDALE OIL, COhiPAN�, INC. hereinafter referred to as "PROPERTY OWNERS", W I T N E S S E T H: WHEREAS the City Council of Okeechobee, in regular session an the 21st day of March, 1989, approved a request to: �xtend the existinQ fence and instalt c�ates across th allevwav in Block 169, City of Okeechobee. The legal description of the property involved is: Lots 7.8,9 and 10 of Block 169 - William & Enid Cheatham, own�r�. Lots 11 and 1?_ nf R1 nrk 7� Q _ n� i�,,,a� i e n; i �,.m........ ��—�.�:�i_�c �� zv—�-.. [. � l-i�i■�:lSS=� �!!L [l1��Z�C•,��.��l��Z�� ' • • ► • t • � • � • ' • � � r r ..._1___ � ._ � �i:1 :5 �r �' 2, i+� t� ",� 4;:i 2 T __.� ��._.�_� t_._ �_.�t...� �-� _ .�t�,z. j _�..� �_.._r_. ..�' � , ��I, (�c�,�r:-;� ;aja�Q ,� � " _ ' � l_ � _.__�_ .� _.) � ..1___ � _ � _ .___� _. _�__ _ __.__.___ �.._i f � ; � :f:i9 4'��7� 9I '£3'9 4 3?. 1; r_�� __�, � � - � � f�B�;'� 11I�t,�, �7� t3 � I1 .__��1__�_._ �a l__�__�.__ � 4 3 2 i j'� � D 4 J 2 t� 0, 4 J 2 1 6 5 4 J 2 1 1 � -"`"J � .. ----_. _.�! 7 a� t�� z' ,�� s s� t:: i� '� ^+ a �t y� � _ !._.i_w.i : _ . ;,,. sx � :� __�_.�_._-� s:w..-�� s�. � - 7T � �- ��T T1 a� � e��<32 t� e�a a'�2It� 432 t, � � 20fi � 10 �7 a fl� 11 ,�7;e 9 11 i 8 9 11 ,z _ � � WHEREAS, the PROPERTY OWNERS may use this ,]�,�_f� all�v riaht-of-way which runs between thg lot 7. 8. 9, 1p, �1 and 12 of Block 16A pursuant to the terms and conditions of this agreements as herein set out: �he Citv herehv qrants it� approval for use of the a11Pv r iaht-of-way �-- with the understanding the PROPERTY UWNERS will maintaiti the alley right-of-way and should it ever b�come necessary to remove the fence and/or Qates. or anv improvement thereon in order to allow either the installation, or maintenance of water, se�aer, or other utility lines or any other type o� installation or construction, or for any ather reason chosen by the CITX, the the fence and/or C��tpS or anv improvem�na thereon, will be removed by the FROPERTY OWNERS cr LhEiz agents and/or assigns at thP PRpPERTY OWNER� experse within thirty (30) days of being notified by the CITY in wri*�ing. � zr��o; sr �, �3�5 4 3 2 1 `7 8 fl 11 � 3�G�ST � 7. . j9HEREAS, PROPERTY OWNERS agree to contact tneir insurance company and require a rider be added to their insurance policy with a certificate furnished to the CITY showing the �5 feet alley riaht-of-way as herein described to be used by them insures the CITY against any liability arising out of alleged injuries or oth�r activities which may occur within the 15 �t alle� riqht-of-w�v. In any event, PROPERTY O4TNERS agree and shall hold the CITX harmless for any and all action, suit, claim, injury or cause of action of any nature arising out of this permissive use, and indemnify CITY for such, including costs and attorney tees. PaITNESS: �T/ - - •--..• � f,. � a �� / Accepted for the City: t Bonnie S. Thomas, Ch9C City Clerk Approved as to f rm: \/� n R. Cook, Esquire City Attorney William Cheatham Enid Cheatham �-- � �//�%Cc�-,�-z-.--1//�-�'�' C.C/ . Officer, Palmdale Oil Co. � �� Oakland R. Chapm , Mayor i !•iaL�ii c1, 17t3y � 3. ?�iotion to pay a ��a.rtial pay request to Denr2is L. Smith for street striping in the amoun� of • $11,744.90 - Director of Public t�Jurks - (Fxhibit 3). � 4. :�otion to approve the �ra�sfer of $13,750 from the improvement ana re�lace�sr�t fun� to the water plant construction .fund - Director of Publie Utilities (Exhibit 4). �. °� � �-:: t�r. ri. �,�)1_I1i�,1 L1�f'�'.�� .0 5 �F��T �i'i r �� * VOTE �SEr�iT 1liJ , �� + r�7at.�on bl Councal �:an :Cirk �o pay a p��rtial pay � reques't to Dennis L. Smith for srree�_ �triping in the amoun� of $11,7an,90, secon,;ed by Councilman Coilins. Director of Public ;vorks Charles vid�=rs informed Council tnat 5mith is 90-95� finished G•�ith the striping. The $b,000.00 which has been held back should be suff�icient to cover anlr outstandinc work to be performed, according to �tr, Elders. � Chapman Collins Kirk Thomas P�atford p Motion Carried. Motion tc approve the transfer of $13,750.G�0 from the improver.�ent and re�lacer;�ent i�und to the ; .vater plant construction fund to cover the ' balance owed for engineerir�g fees for che wa��r plant expansion, by Councilman s,Tatta�d, seconded - by Councilr:an Kirk. A�ter discu�sion, Chapman Collins Kirk Thomas F�atford "Iotion Carried. �e 1'� X X • t�arch "ll F 19�39_: , � 6. L�iscuss water allocation for Seminole Cove with Faye 6�illiamson. �- RECESS: 3:12 P.M. :�!ayor Chapman called the meeting back to order at 3;25 P.P1. 7. Update of items of interest to the city from County Commissioner Jack ti�7illiamson. fi. COUNCIL REPORTS AND/OR REOUESTS: l. Councilman Collins: COUNC I II`;?�.MBER S/ACI' i 0� ` � .�A�� c�-��at� b��w�s�3� ��cf�lmat� :W�tfor��: Mrs. 6�Tilliamson did not appear� Nothing to report at this time. a; Clarified a sicuation wi.th Cc�un�.v Commissioner t��illiamson regardinc rn� ?;'7/�39 request for water and sew�r ailoc��ic>r-: tor th praposed Okeechobe� Con�r��ns Apartment :;o;-,plex statinq that the City had not yiv�n an allocation to the deve:loper b�at had tabled the matter. �. P�i ,Si�; � -----_---------- � VOI'E �'�iS��Ni � �J� ---�0 From: Gulfshore Insurance, Inc. To: Lane Gamiotea Page: 2/2 Date: 2/2/L011 2:47:56 PM Client#: 67371 PALOI ACORDTN CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DO/YYW} otia2no� � THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY 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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subjeet to the terms 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 NTA Elia R. Labra, ACSR NAME: Gulfshore Insurance, IIIC. PMONE 239 430-7546 FAX 239 213-2830 4100 Goodlette Road North E � w �� Ext : A/C No�: wooRess: elabra@gulfshoreinsurance.com Naples, FL 34103 -3303 VR ou ER 239 261-3646 CUSTOMER ID �: INSURER(3) AFFOROWG COVERAGE NAIC M INSURED Patmdale Oil Company, Inc. 911 N 2nd Street Fort Pierce, FL 34950 INSURERA: Nat10�1a� �Ilt@iSYiltB msuReRe: Navigators Specialty Ins insuReR c: Amerisure Insurance Company INSURER D : INSURER E : �IVSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POlIC1ES 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. INSR TYPE OF INSURANCE DOL UBR OUCY EFF POLICY EXP LTR NS POLICYNUMBER MMfDDfYYVY MM/DO/YYYY LIMffS A GENERALUABILRY EFD483024700 2/31/2070 12/31/2011 EACHOCCURRENCE $� d0��0� X COMMERC IAL GENERAL LIAB ILITV DAMA E TO RENTED PREMISES Ea occuRence 5100 OOQ CLAIMS-MAOE � OCCUft MED EXP (Any one personj grJ�O�� PERSONAL d ADV INJURY $'I �OOO�OOO GENERALAGGREGATE $Z�OUO�OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPlOP AGG $Y OOO�OOO POLICV PR� LOC S A AUTOMOBILE LIABILRY EFD48302470d 2/31/2010 12/3112011 COMBINED SINGLE LIMIT X ANV AUTO (Ea accident) $1 000 000 BODILV INJURY (Perperson) $ ALL OWNED AUTOS BOOILY INJURV (Per acddenQ $ SCHEDULED AUTOS PROPERTV DAMAGE $ X HIRED AUTOS (Per accideM) X NON-0WNED AUTOS $ $ B UMBRELLA L�AB occuR NY7 OEXC7193121V 2/31/2010 12/31/2011 EACH OCCURRENCE s10 000 000 �( EXCESSLIAB CLAIMS-MADE AGGREGATE $�O�OQO�OOO DEDUCTIBLE S X RETENTION O f C ANDEMPLO ERS'LUBILOI V �,�N WC'2074a53 12/31/2010 12/31/2011 X W R�TA�U- O�TM• ANY PROPRIETOR/PARTNER/EXECUTNE E.L. EACH ACCI�ENT $� OOO OOO OFFICERIMEMBER EXCLUOED? a N/A (Mandatory in NH) E.L. OISEASE - EA EMPLOYEE $� OOQ�OOO If yes, descrbe under DESCRIPTION OF OPERATIONS below E.L. OISEASE • POLICV LIMIT $��OOO,OOO DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICIES (Atlach ACORD 101, Additional Remarks Schedule, ii mwe space is requi�ed) Re: Lots 7-12, Block 169, Cityof Okeechobee Alley Use Agreement Certificate Holder is Named as Additional Insured As Respects to General Liability per form CG 20 10 07 04. CERTIFICATE HOLDER ceNCF� � erinN City Of Okeechobee SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 55 S E 3rd Avenue TFIE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Okeechobee, FL 34974 AUTHOftQED REPRESENTATNE �� m 198&2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) 1 of 1 The ACORD name and logo are registered marks of ACORD #S464567/M460953 ERL Cert ID 19771 ACORD�, CERTIFICATE OF LIABILITY INSURANCE DATE�MMIDDIYYYY) 12/26/2008 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Seitlin �nsurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6700 rr rndrews �.venue #300 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Fort t.auderdale FL 33309 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (954) 938-8788 (954) 938-8566 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: Illinois National InsurBnce Co 23817 Yalmdale Oil Company, Inc INSURERB: National Union Fire Ins Co 19445 911 N. 2nd Street INSURERC: Ins Com an of the State of PA 19429 Fort Pierce FL 34950 INSURERD: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INT R DD' POLICY NUMBER POLICY EFFECTIVE POLIT Y AXPIRATION LIMITS GENERAL LIABILIFY EACH OCCURRENCE $ 1 000 000 A X COMMERCIALGENERALLIABILITY GL2802877 12/31/2008 12/31/2009 pR MSES�aoccurence $ 100,000 CLAIMS MADE ❑X OCCUR MED EXP (Any one person) $ 5, 000 PERSONALBADVINJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/0P AGG $ 2, 000 � 000 X POLICY PR� LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A X ANYAUTO CA4806795 12/31/2008 12/31/2009 (Eaaccident) $ 1,000,000 ALl OWNED AUTOS BODILY INJURY $ I SCHEDULED AUTOS (Per person) ' HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) X AUTO POLLUTION PROPERTY DAMAGE $ X MCS 90 (Per accidenq GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN � ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 5, 000 , 000 B X OCCUR � CLAIMSMADE BE6592932 12/31/2008 12/31/2009 AGGREGATE $ 5,000,000 $ � -- � � DEDUCTIBLE I � $ X RETENTION $ 10,000 $ C WORKERSCOMPENSATIONAND WC1591113 12/31/2008 12/31/2009 X WCSTATU- OTH- T RV MIT R � EMPLOYERS' LIABILITY E.L EACH ACCIDENT $ 1, 000 � 000 i ANY PROPRIETOR/PARTNERlEXECUTIVE � OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ 1, 000 , 000 ' If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1, 000 , 000 � OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS *10 days notice of cancellation for non-payment. Certificate Holder as Designated Organization is an Additional Insured as respects General Liability when required by written contract subject to the terms, conditions, and exclusions of the policy. RTIFICATE HOLDER City Of Okeechobee 55 S E 3rd Avenue Okeechobee FL 34974 ACORD 25 (2001/O8) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE � C�-�-b�.� OO ACORD CORPORATION 1988 Page 1 of 1 , , , _ � �+�, ' � � � �' ' � � �; DATE IMM/DDIYY) � ACORDTM X.r�RT,�FI��cT� �F; L..��L�T� �I�I�U��c�� ; ;; .; 11/06/07 i: ,;, ;:. ,. ,. , rRo�uceR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FEDERATED MUTUAL INSURANCE COMPANY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Home Office: P.O. Box 328 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Owatonna, MN 55060 COMPANIES AFFORDING COVERAGE Phone: 1-888-333-4949 COMPANV FEDERATED MUTUAL INSURANCE COMPANY OR Home Office: Owatonna, MN 55060 A FEDERATED SERVICE INSURANCE COMPANY INSURED 1�-B5i>-H COMPANY PALMDALE OIL CO INC B 911 NORTH 2ND STREET - -------- FORT PIERCE FL 34950 COMPANV C COMPANY D �LQY��i�ES <' . I , ; , ; ... 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. C� TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MMIDD/VY) DATE (MMIDDIYY) GENERAL LIABILITY GENERAL AGGREGATE S Z,OOO OOO X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG S 2�000�000 A CLAIMS MADE � OCCUR 9206671 01/01/08 01/01/09 PERSONAL & ADV INJURY S ��000�00� OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE S_� OOO,OOO _ FIRE DAMAGE (Any one fire) S 10�,�� MED EXP IAny one persoN S AUTOMOBILE IIABILITY X ANY AUTO COMBINED SINGLE LIMIT S 1,OOO�OOO ALL OWNED AUTOS BODILY INJURY S A SCHEDULEDAUTOS 9206671 01/01/08 01/01/09 (Perperson) X HIRED AUTOS BODILY INJURY i� NON-OWNED AUTOS (Per accident) $ - PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY - EA ACCIDENT '$ — — ._-_._._---- ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT ��S --- � - --- -.. . .. AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE $ _ .. _ _ _ _ UMBRELLA FOFiM AGGREGATE S OTHER THAN UMBRELLA FORM S WC STATU- OTH- � WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY EL EACH :,CCICENT $ THE PROPRIETOR/ INCL El DISEASE - POLICY LIMIT S PARTNERS/EXECUTIVE — OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE S OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESISPECIAL ITEMS CERTIFICATEHOLDER IS AN ADDITIONAL INSURED FOR GENERAL LIABILITY PER CG 20 11. RE: INSURED USES AN ALLEYWAY THE CITY OWNS. GERT[�1C�LT� N{;3LR�Fi :::: i C�NC£�.I.AtTI�TI ,; ,. -., ,::. ;:.: _ ..; , ,: 1346568�� 3 SHOUID ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF OKEECHOBEE 55 S E 3RD AVENUE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL OKEECHOBEE FL 34974 �Q_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHAL� IMPOSE NO OBLIGATION OR LIABILITY OF ANV KIND UPON THE COMP , ITS AGE TS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIV J PRE�1 . -� .. #�GCk1�l]::�� 5 f7:f��1 >:: > . > ' OA�QFtD:�G1k�F�CJi�A'�'It3M 7:�8�' ACORD,� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12 16 2007 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Seitlin xnsurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6700 N Aadrews Avenue #300 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Fort Lauderdale FL 33309 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (954) 938-8788 (954) 938-B566 INSURERS AFFORDING COVERAGE NAIC # INSURED InISURERA: Illiaois Natioaal Insurance Co 23817 Palmdale Oil Company, Inc INSURERB: N8t10II31 Union Fire Ias Co 19445 911 N. 2nd Street iNSURERC: Ias Com aa of the State of PA 19429 Fort Pierce FL 34950 INSURERD: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L POLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 000 000 A % COMMERCIALGENERALLIABILITY GL2B02877 12/31/2007 12/31/2008 PREMISES Eaoccurence $ 100,000 CLAIMS MADE �% OCCUR MED EXP (Any one person) $ 5, 000 PERSONAL & ADV INJURY $ 1, 000, 000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2, 000, 000 X POLICV PR� LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A % ANYAUTO CA4806795 12/31/2007 12/31/2006 (Eaaccident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILV INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN �+ ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5, 000, 000 8 8 OCCUR � CLAIMSMADE B$6542932 12/31/2007 12/31/2008 AGGREGATE $ 5,000,000 8 DEDUCTIBLE $ R RETENTION $ 10,000 $ C WORKERSCOMPENSATIONAND iPC1591113 12/31/2007 12/31/2008 g WC1STATU- OTH- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERlEXECUTIVE E.L. EACH ACCIDENT $ 1, 000, 000 OFFICEWMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ 1, 000, 000 If Yes, describe under E.L. DISEASE - POLICY LIMIT $ 1, 000 , 000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS *10 days aotice of caacellatioa for aon-paymeat. Certificate Holder as Deaignated Orgaaization is an Additional Insured as respects 6eaeral Liability when required by writtea contract subject to the terms, conditions, and exclusions of the policy. CERTIFICATE HOLDER _ CANCELLATION City Of Okeechobee 55 S E 3rd Avenue Okeechobee FL 34974 ACORD 25 (2001/08) SHOUlO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE �-�--b�- / �O ACORD CORPORATION 1988 ' ... ,; : .y:::>:. . <.,.: ;::><::: ::>, ..::>::., , :., , ;: ;: ;:: `.>.. `:::' :: ` .> : ...:.;.,,.. . ..:., ... . ..:::. : ...:.><;:::::: >::::>:; :. , � .i � : :: . ,: . : ■: ::. '.f :: ::i`:i:E::ii:: � �.;:i:i:i:":i::�.. .:.,.':.^ii�:..`:.. DATE IMM/DD/YYl ..� A CORD ■ �: >�>:::�� ::�:��";Y`::::�I'�:�:�:�� :::::::::: :: ::::: : ::::::::::::::::: >: TM :i::::�:�.�� F.�.. ::... � .....:..:....:.......................................................................................................................:.. :...:..:.:.:..:. ::::.. �:::: 10/25/06 ..PRODUCER: � » :............................................................................................................................. �::::::::.� :::::::::::::::::::::::::::::.::::::::::: :.::::::::::.�::::::::::::::::::::..:...:.................................�..............................................................................:.....:.:.:::::.::::: :..::.:::. ::: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FEDERATED MUTUAL INSURANCE COMPANY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 20 Perimeter Summit Blvd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Atlanta, GA 30319 COMPANIES AFFORDING COVERAGE Phone: 1-888-333-4949 COMPANY FEDERATED MUTUAL INSURANCE COMPANY OR Home Office: Owatonna, MN 55060 A FEDERATED SERVICE INSURANCE COMPANY INSURED 134-656-8 COMPANY PALMDALE OIL CO INC B 911 NORTH 2ND STREET FORT PIERCE FL 34950 COMPANY C COMPANY D ; . . .: . .:.. .::. . . . .... ;:.;:.;::.:: . : . ..: ..::::::.:: :. . . ;:.;:.;:.;:.;:.;:.;:.;:.: : . ;:;:...;.::.;:.;:.;:.;:.;::.;:.;:.;:: .;:.;:::: :: ; :.:.::.: ...:..::.::::::::::.. ��tA E :>.: ;::.>.: : ;;::. :::: >:.;::.>::: : .::>:.; . .. >:::..: ....;:::.:.: :..;:.;:.;:.:: :::.;:.;:.; :.::.. .. ...::.:.::. ::: :. ...:.::.:;.;:.;:.;:.;:.;:..::..::.:.::.;::.;::::: :::; ;:.;> �Q....... ....C�...r.r :..................................................:::::..:...::..:...::::...... ::.:,.:.:..::::::..::::::::::::.:.:.::::::::.::.:.:.:::::::::::.::.:::: :.:::. ,:.. ::....:..:.................................................................................................... ,,,.:. _ :,.,:, ,.:,..., ,.: ,,, ,. .. „ . ::....... . . .... ;. ,. : _:.. ;.:; .. ... .;: :. ;: . .:: . ;:,. 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MMlDD/YY) DATE (MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE S 2 OOO OOO X COMMERCIAL GENERAL LIABILITY PRODUCTS COMP/OP AGG S 2 OOO OOO A". CLAIMSMADE �OCCUR 9206671 �1�0��% 01/01/08 PERSONAL&ADVINJURY S 1 �Q�Q�Q OWNER'S & CONTqACTOR'S PROT EACH OCCURRENCE S 1 OOO OOO FIRE DAMAGE (Any one fire) S � QQ 000 MED EXP IAny one person) S AUTOMOBILE LIABILITY X ANY AUTO COMBINED SINGLE LIMIT $ ��OOO�OOO ALL OWNED AUTOS BODILY INJURY S A SCHEDULEDAUTOS 9206671 0��01�0% 01/01/08 �Perperson) X HIRED AUTOS BODILY INJURY S i� NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT S AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE S 4lOOO�OOO A i� UMBRELLA FORM 736715 01 /01 /07 01 /01 /08 AGGREGATE S 4 OQ� ��Q OTHER THAN UMBRELLA FOFM S WC STATU- OTH- WORKERS COMPENSATION AND I TORY LIMITS ER EMPLOVERS' LIABILITV EL EACH ACCIDENT � 5 THE PROPRIETOR/ INCL EL DISEASE - POLICY LIMIT S PARTNERS/EXECUTI V E .. OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE S OTHER DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLES/SPECIAL ITEMS CERTIFICATEHOLDER IS AN ADDITIONAL INSURED FOR GENERAL LIABILITY PER CG 20 11. RE: INSURED USES AN ALLEYWAY THE CITY OWNS. �'�i7`tF1:GA7 ; ;. ;: <.,:,>.>::: ; ,;:: ':' '::>::'::: :::<:>::: :::':;::;:::<:::>:[>:»::::>::::>: >;:::<:::::>:::>;::»::::>:: :::<:::::::<:::::>::::>:;<: :::<:: >::':::>:'::<::«:> :;' :`:,., >„.. ..:: :: > : '::::><:::>::>;::>:<:::::: <:::;:>::::::>::: :::<:::::<::::::>::>::»»::>::::<;:::>:>:>:>::>:::i<:::>::>:::::>::::>::>::>::>::>:::::::::::<::<:::>::»::>::::>::::»::>::::: � H�#�.�3�1# .,;:. ;:.;:.::.:;:.;:.::.. :..;:.;:. . ........ . C#N��1�.�.�"Itin�:.;:.; . :.;:.;:.;: .: ::.;:.;:.; .: .::..::::..:.., ..•:.:. •:::.:.....:. .: .:::.;:.;:.;:.;: .. ;::.;::.;::.;::... ::: ,:. ; ..........................................................:::.:::.:.:.::.:..:...:.::::::.:.::::::::::::.:::::::::...::.::::::::::;:..:..<:..:>::.::.;::::;;:.;:.;;:.;::.::;.;;;;;;:;.;:.;:.;:.;;:.;:.;;: 1346568 �3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF OKEECHOBEE 55 S E 3RD AVENUE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL OKEECHOBEE FL 34974 �_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILUHE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITV OF ANY KIND UPON THE COMP , ITS AGE TS OR REPRESENTATIVES. AUTHORI2ED REPRESENTATIV :;.:.:: ,::..:::.; :.::.; :.:::.;� ::.:: :: :. :.:: <::: :.;:.; :;;;;:«.::.:: � ;:.;;;;;:<.::.:»>:;;:: ;;;;;::. � :::::::::: ::::.:::::::::::: ::.. :.::. � :::::::::: :.::::::::::::.::: :.. ::................................................... . >::>::>:RR� T::>:> ::::.:::::: ::::.;::;:;,.:,. :. ::.;:. ;..;. .:;::.;::.;.;::.;:.;:.:: idK+�i�Ri�:: . � ::: > f . ::::::> �1 ��.5 . '� t. ..9�►...;:::»:>:<:>::::::;::::>::>:»:<:::::<::::>::: »>::>::>::s:<::::::>::::>::>::>::;::::<::::::«:::>::>::>::>::<::: ::::>::::>:<:::»:::::::;::::>::::>::>::>::>::>::::::<::::::>::;::>::::>::::::::::<:>:::>::::<::>::::>::::>:::«:::>::<> ::::::::::. ::::::::::::. :.::.: : .. . ;; ;:<.>:.;:.;:.;::.:::.;::<:<.;:.;:.: :.::.::.::.::::.;:.;:.;:.;:.;:.;;:.: .;:.;:<.>:.;:.;:.;:.;: :;::;:;:.;:.;:.;:<: :.;:.;:.;:.;:.;:.;;;;>;:.;:.;:.;:.:::.;:«.;::.;:.;:.;:.;:.:.;�: ::: ��tt#�� :�t3i�p�4�#'i'I4N.;:'E�#�8:: OCT. 4.2006 12:47PM ' `" /l YOI �Y......Yk'k::��'ll:k:a:<\��.�k.: :�.� 5:;� � . (.� k�! '�'� �i.i n� ..�:�E! ''�si��i� �, f?:a;aa;x:o.-�..,�� r.�:c.:.<::�:�>:w:r'a?� .�'<:>��:k?Gk�::� f:.'��'Li oann� �rcn ��. � INSURED REVISED FEDERATEb INUTUA� INSURANCE COMPANY 20 Perimeter Summit Blvd Atlanta, GA 30319 phone: 1-888-333-4949 Mome Office: Owatonna, MN 55060 PALMDALE O1L CO INC 911 NORTH 2ND STREET FORT PIERCE �L 34950 uo.0706 P. 2/2 ��r�.E _ .i,. . �� •� :..n..�.�..... :..r��,:k,,.i;::::.s.�xei� ":. L■kkt ;i ,i$. •.��'��.�: � �•�� ^ ;x;��x;�kr:��Y.idr�'i�;:o'��n�� 'F'ra.:k�k OATE (MM/DDlYYI ...1..5^�.C-��"1 1�!!.�I. ��:T/`:TfMZx?:�i{��k�.�i''L%:. y'f.�... K`i'�.k� :.k:.�.:: L:<w. ...�..i.Y.�+i�.ii ��.. �.Pi.�nYi"� �>"�., kj. Y:,.�k\�.1�<ifO`�(�`�• .:..>:��,�s,.,. • ...:,....x..<.. .;�:;;;z.,::u:<:,:.,.........x,:�,.;�:,:._,n.;.:,,�.....�.>: 10/04/06 THtS CFqTIFICATE IS ISSUED AS A MqTTER OF INFORMA710N ONLY AND CONFERS NO RiGHTS UPON TNE CERTfFICATE HOLDER. 7NIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER 7HE COV�RAGE AFFORDEp BY 7HE POLIC1fS 6ELOW. COMPANIES AFFORDING COVERAOE COMPANY F�DEfaA7ED MUTUA! INSUHANCE COMPANY OR A FEDERqTED SEFIVICE INSURANCE COMPANY 134-��8 COMPANV B COMPANV C COMPANY D THIS IS To CERTIFY TNA7 7HE POUC�ES OF INSURANCE LfSTEO BELOW HAV� BEEN ISSUED,70 xTHE INSUR�I� ��k��%"� .�x,�� ,�R��;��`�k�'<:;<:��x�n�rK';`<;:;;:x ED NAMEO ABOVE FOH THE POLICV PERID� INDICATED, NOTWITHSTANDING ANY REQUIREMEN7, TERM OR CONDITION OF ANY CONTRACT DR OTHER �OCUMENT WITH RESPECT TO WHICH 7HiS CERTfFICATE MAY BE ISSUED OR MAY PERTAtN, THE INSuRANCE AFFORDE� BY iHE POLICIES bESCRIBED HEAEIN IS sUe,lECT TO ALL THE TERMS, EXCLUSIONS AND CONbITIONs OF SUCH POLlC1E5. LIMITS SHOWN MAY HAVE BHEN FEDUCEO BY PAID CLAIMS. CO TIPE OF INSURANCE POLICr NUMBER %��CY EFFECTNE POLICY EXPIqqTIQN LTR DATE (MMJDD/yrJ DATE (1NM/DO/Yh LIMRS GENERAL UABIl1T7 X COMMERCIAL GENERAL LIABIIITV A CLAIMS MAOE � OCCUA OWNEfl'S & COnfrRACTOR'S PROT AVTOMO&lE UABILITY X ANY AU70 ALL OWNEO AUTOS A' �� SCMEDULED AU705 X MIriED AUTOS � NON-OWNEfl AUTOS 11GE LIABIUTY AM' AUTO EXCESS LIABILI7Y A X UMBRF,uA PORM OTMERTMAN UM8Rd1A FOfiM wowcEns coMaF.�SqnoN nNo EMPLOYEAS' LIABIUTY A ThiE PFlOPRIETOR/ INCL PARTNEji$/p(ECUTIVE oFFlCEpS ARE: E7c�� OTHEfl 9206671 9206671 736715 9316340 DE3CAIPTION OF OPERATIONS/LOCATIONSN��ClE6lSPECIAL ITEMS CEfiTfFiCATEHOLDER IS AN AOD��ONAL IHSURED FOR t�ENEAu uAB1uTv PER CG zo ��. HE: INSURED U9Es AN /utEyyyAV THE CITY oWNs. CITY OF OKEECHOBEE 55 S E 3RD AVENUE --% OKEECHOBEE FL 34974 01 /01 /06 GENERAL AGGFIEGATF 0 � PRODUCTS - COMP/OP AGG 8 � O�/O�/O% PEHSONAL 8 ADV ��I,)URY 8 � E4CH QCCUFRENCE g 1 F�RE DAMAGE 44ny one tirs� 8 MED EXP (Arry pr�g pg�eoN + 01 /01 /06 I a 1 /01 /07 01 /01 /06 ) 01 /01 /07 07/01 /06 I 07/01 /07 COM6INED SINGLE IIMIT ' e 1�OOO�OQO BODIW IMJVRY � 9 IPer pereon) BOOILY IN�UqV I S lPer acclCenq �OPERTV DAMAGE 8 AUTO ON�y - EA ACCIOENT : OTiiEfi TMAN q�J'j0 ONLY' � � . EACH ACCIDENT 8 AGGREGATE 8 EaCN ocCUaRENCE 3 4 OOO OOO AGaREGATE 8 4,000�000 e X 1NC STATU- oTM- ' Y lIM1T � EACH ACdOENT S �jOO OOO EL D1SEq5E - POUCY lIM1T 5OO OOO EL DISEASE • EA EMp�OYflE 8 rJ' OO.Oi�I� 13 SHOUID aNY pf THE ABOVE DESC1u8ED ppuCIES BE CAnICEU.ED BEfOHE TME E](�Rq710N DATE TMEPEOF. THE 159UING COMPM�y yy��J, Hyp@pypq TO MAIL �Q_ CAv6 WairreN NanCE TO TnE cEnnFicnre HOIDER Nnmen To ryE IEFT, BIJT FAI�UFiE 70 MAIL SUCN NOTICE SHALL IMPOSE NO OBUOATION OR LIABItJTY OF /WT KiNO UpON TFiE COMP , ITS AO TS ON REPf1ESEN7ATNES. AUTt10RIZED NEPRESeuTanva i � ><'.rt>:::<::<:>::>::>::>::>::>::>::>:<>:>::>::: «<:<:><:<:»::>:::«:>:::>:;:»::;:::::::_>::»»::»:<:>::»>:<:»::::::>::»>::>::>::>::>:>::>::»::»>::»:;:<:»>:<:>::>::>;.::>::»:»:::>::>:»::>::>::>::>::;::»::>:::::>::»>:>::>::> :::::::::::::.::::::::::.:.:.:::::. : .. ;:::>. ;::: ..,.,:: -.:: ;. . .> :. .:: : ..:::.. ..::: . . >::..;::: ::....:; :::..:.. ... . ..::.:>:::>;:.:.. ....:>:.:;::.;: . .:.::: .. .:....:>:.. ,:.;:: . ... A CORD : <; .�i" DATE (MM/DDlYY) � : ,.:., : : :::��1��"�''`�::::�:�:::::�::�:��:�:�::��"'�::::::I:�:�:1�:�;�r:�l. :::� : ::.: ..::: . :: . .. : : .M ::.: �..��:�� .....:...:....:...:........................................ :. ::::::. :.. ::::::::. :.:: :. :::.: ::::. ::.::::::: . ::.: :.:: :.: ::.: :::..: :.:::::::: :.::::::::::::::::::::::::::::::::::::::: :.::::::::: .. 11 /09/99 � PRODUC�ER:;;;:� ................................................................................................. _..... _ ....... _......... �:.� :::::::::::::.�:::::.�:::::::.:�:::::::::.�.:�:::::::.:�::: :.:::::::.�:::::::::::::.:�::::::::::.:�.�:::::.::::::.�:::.:.::�:::......:........................................::..:......:.:::.:..:.......:......:..::.:...�...:..�.:..:. THIS CERTIFICATE IS ISSUED A MATTER OF INFORMATION ONLY AND CONFERS NO RI UPON THE CERTIFICATE FEDERATED MUTUAL INSURANCE COMPANY HOLDER. THIS CERTIFICATE N A END, EXTEND OR 5887 Glenridge Drive, N.E. ALTER THE COVERAGE AFF DED B TH POLICIES BELOW. Atlanta, GA 30328 COMPANIES AFFORDING O RAGE Phone: 404-257-1511 COMPANY FEDERATED MUTUAL INSURANCE COM Y'O�" Home Office: Owatonna, MN 55060 A FEDERATED SERVICE INSURANCE COMPANY ''�+ INSURED 134-656-8 COMBPANY PALMDALE OIL CO INC LAKE OIL COMPANY & PALMCO INC 911 NORTH 2ND STREET COMPANY FORT PIERCE FL 34950 � COMPANY D >Ct��A' <'a�S ..... : ... . .... . ;.:.: .;. .: .. , _ ,:: _ _.. <. : .,.., ,.. . ..: <:;,, ,. ,..,. „ „ , ,...:, . ,..::. ::.:. .:.. . :.. , _ _ .... . 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. CO I POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE (MMlDD/YY) DATE (MM/DDNY) LIMITS GENERAL LIABILITV GENERAL AGGREGATE S G,OOO,OOO X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMPlOP AGG 5 G�OOO,OOO A CLAIMS MADE � OCCUR 9206671 � I�Q� �� 01 �� Q I PERSONAL & ADV INJURY S �,QOQ,�� OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE S �,OOO,OOO FIRE DAMAGE (Any one fire) S I ��,�� MED EXP (Any one person) S AUTOMOBILE LIABILITY X ANY AUTO COMBINED SINGLE LIMIT 5 1,OOO,OOO ALL OWNED AUTOS BODILV INJURY S A sCHEDULED AUTOS 9206671 O1 /Ol /00 Ol /O1 /Ol (Per person) X HIRED AUTOS BODILY INJURY S X NON-OWNED AUTOS (Per accident) PROPERTV DAMAGE 5 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT S AGGfiEGATE S EXCESS LIABILITY EACH OCCURRENCE 5 4,000,000 A i� UMBRELLA FORM 9206672 �� Q 0� �0 1�� AGGREGATE S 4,000,0�� OTHER THAN UMBRELLA FORM 5 WORKERS CQI'APENSATION AND X WC STATU- OTH- . EMPLOYERS' LIABILITY TORY LIMIT ER �� ,",,, A THE PROPRIETOR/ 9336007 �1 �� 01 �01 �01 EL EACH ACCIDENT S ,.7�� PARTNERS/EXECUTIVE INCL EL DISEASE - POLICY LIMIT S JOO,OOO OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE S JOO,OOO OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS ;:�;.<.;:.;:.,;:<�>:`'.:��'::::: �.::::� �:�:�'�' � � �. ��::::;:::':2::;;:::;::::::::;::;::;:::::i::::::::i:::;:::::i::;::::;:::':::::;:::;::';::::::::;::::;:::;::;:::; ::::::::::::::::::i:;::;;::;;:::::::;::::i�::::i::::i::::':.._,.:.;..:.:...:::>.:..;;::::`':".�.':�.'�::;:;::;::;::::::::;;;::i::;::;::::::::;::::;::::;::::::;::;.::;::::;:::i::::::::':::::i:::::::;;;::i::; �:;;::�::>::ii::::::::::::<::::ii::::;:::::::::i>:::»::;i::: EitTfF��1TE M�LDER :; :.. ... .....: : :.::. :. ,.::: . . . ... ..:..:. . C;�XN�C£i.E�TIbNI ,. ;:.;:.: .;::.. .. . :::: ,. 1346568 CITY OF OKEECHOBEE 13 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 55 S E 3RD AVENUE EXPIRATION DATE THEREOF, THE ISSUING COMPANV WILL ENDEAVOR TO MAIL OKEECHOBEE FL 34974 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMP ITS AGE TS OR REPRESENTATIVES. AUTHORI2ED REPRESENTATIV ::.:::::::::::::::::.�::: �::::::::::::::::::.:�::::.:�::.�:::::::::: :.::::::::::::::::::::::::::::::::::::::.�::::.:.:::::................:.......... ........................................................... . ...................................................................... ;:.... :> ::.: > : :<:<:<:;::<::;;::;;;;<;;:.;:.:;;:.;::.;:««.:::::: :<. .;:<.;:.;:.;: ;;:;;:.;;;:.:.;:.;:::::::;.;:.;<:::;:<::;;:<::<::: ::«::<::<:::>:<:>:<:»>::»»:;:::>;:><::<::::<::::::<;;:;;;::>:<:>:«:::»:»»:< :>::>::>::><:f?R��u![�. lVT:<:.;::::.;.:;...;..:...;:.;...;...; ..:...:...:...;...:....: :.:.:;:::.;..::::::.; i�i�Qii�: . - ;: ; ,. �s.�.. �.�� ::>::.::.::::«:»» «::::::<<<:::::>:::>::: ::>::>:::::»::»»>::>«««:<:::<::>::::::>:;::>:>::>::>::>::>::>::>::: >:::»::»» »<::::<::::»::>:::::;::>::>::>:::>::::< :>:«:««<:<.:<:::<: :«:.;;::<:: ;.:;;:: .;;:.:_ ; . t.... . .� : :.:::::::::.::::::::::::::::.: �.�cc�� r��pa��a�::��s$: :: : :: ..::::::::. :.:..... ::::. ..:::.:;::;::>:::<:>::>::>:.:<.>::>:.>::>::>:.>:.:<:>::>.:..:<;.>::>::>:.>;:.>:.>:.>::>::>::>:<::::<;:>::>::>::>::;::>::>:::;::<;:>::>::>::>::>::>::>::: :::<::<:>::>::>::>::>::>::>::>::>::>::>::>::>::>::>:::;:>::>::>::>::>::>::>;:<:>::>::>::>::>::>::;::>::»::>;::»»»»;::»»::»>;: >;::»>: ::::»:::<:> :<:;:. :::::::::. . :::::::::::::::::::::.:<:: �iiii:�:�: DATE MM/DD/YY �:�?: l 1 A RD CO <.. . ... ::: : : . .... .: . : : .. .. .. . :::: ...>....::::>: :::> >:. .. .... , : ::< :> .:<. ;.::: >..:....:..,. ..: .::..: ... :.::....:<.. .:. .:. ..:.. ..,.::::::::::::>:;:.:::::>::»>:.:::::>:::::;:::::::::: �T. �I.� �....�: TM . �� . . � . . �7"�..#�F...Lt�i►�. � T�.:�:�: �::U��°1�:��:::::::.::`:::::::.:::::::::::'::::':::::::'.:`:::: : ::PRODU CER:o::�: ........................................................................................................................... � . ::::::::::::::::::::::::::::::. ::::::::::::::::::. :::::::::::::::. :::::::::::. 11 /18/98 ...:..:...:::::.::.:�.:::..�:.::::::::::::::::..�::::::::.�:::::::..�::::::::::::::.�::::::::.::::::::::..::::.:::::::.�.::;>:::::.:::::::::::::::::::::.:: :.:::::::: :.: :.:.�::,::::::::,::::::::::::::::::::::::::::::.�::::::::::::::::::. ::: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FEDERATED MUTUAL INSURANCE COMPANY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5887 Glenridge Drive, N.E. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Atlanta, GA 30328 COMPANIES AFFORDING COVERAGE Phone: 404-257-1511 COMPANY FEDERATED MUTUAL INSURANCE COMPANY OR Home Office: Owatonna, MN 55060 A FEDERATED SERVICE INSURANCE COMPANY INSURED 134-656-8 COMPANY PALMDALE OIL CO INC LAKE OIL B COMPANY 8� PALMCO INC P O BOX 11298 COMPANY RIVIERA BEACH FL 33419 � COMPANY D .: .... .. .... .. G�UE#t�4��S : ,: > _ _ : . . .. : . . ..:.. . _: .. ,, : ,... ::. ., . . ..., ,,,,: .. . .... ..... , .. , . ::.. ,.: ,,.,, : , .. ,. .. 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. ____ _ CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS �Tp DATE IMM/DD/YY) DATE (MMlDD/VY) GENERAL LIABILITY GENERAL AGGREGATE S G,OOO,OOO X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG S 2,000,000 i� � CLAIMS MADE � OCCUR 9206671 01 /01 /99 01 �� PERSONAL & ADV INJURY S 1,��,�� OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE S �,OOO,OOO FIRE DAMAGE (Any one fire) S 'rJ�,��O MED EXP (Any one person) S AUTOMOBILE LIABILITY X ANY AUTO COMBINED SINGLE LIMIT S 1�OOO,OOO ALL OWNED AUTOS BODILY INJURY S A sCHEDULED AUTOS 9206671 01 /01 /99 01 /01 /00 �Per personl X HIRED AUTOS BODILY INJURY S X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT 5 AGGREGATE S EXCESS UABILITY . EACH OCCURRENCE S J�OOO,OOO A� i� UMBRELLA FORM 9206672 01 /01 /99 0� �� AGGREGATE S 3,��0,��0 OTHER THAN UMBFELLA FORM S X WC STATU- OTH- WORKERS COMPENSATION AND T RY LtMIT ER EMPLOYERS' LIABILITY EL EACH ACCIDENT S JOO�OOO A THE PROPRIETOR/ INCL 9336007 O1 /01 /99 01 /01 /00 EL DISEASE - POLICY LIMIT S 'rJ��,�� PAflTNERS/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE S �JOO,OOO OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESlSPECIAL ITEMS �'.'�'''��F .'�'�'t� .'�. :: ..:::' �''',: :.: . ,': �'. ..:::';:::':;�:::;::::::;:::::;:::;:::i:::::::3:::::::::::::::;::;:::::;:: ;:::;;::::::::;�::::: �:;::::::;:::::i:::::::::i::::::i:::::::::;:::':::::;::::;::::;::::;:::;::;::::'.::':::..:.>.<..:�.. ;;::::'';:";.. ".�..:::::;:;::i::::::::::::::i:::i�:::::::::::;:':::;::::;::;::::;::::;::::::;::;;:::::::::::;:::::::::i:::::::::':;::;::;::;::::::;::;::;:::::::::::;�:: � ::;:::`:::;:::::;:`:;::`�:�: i;.. �1'i`� h[4Li3ER:.;::. . . . ..... .,. :.. . : :.;;; . ��4N�C�#:I.i1ET1i3111 ... .. ::::::... .. . . ;.. •::. ;:.>::: . . .. . .. ....... . . .. .:..... : 1346568 CITY OF OKEECHOBEE 13 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 55 S E 3RD AVENUE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL OKEECHOBEE FL 34974 3� DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON T E COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORI2ED REPRESENTATIVE -,, �` � ::::::::::: :.::::::::::: �::::::::._:::::::::::::::::.:�:::: :.:::::::::::::.�::::::::::::.�:: ::.:::::::::.�:.�:.�:::::::::::: :...:.::.:.:............ ................................................. . • >::»:;:�►�s�a a+�� : ::: : : ::>::>::::>::::: :::::<:: ::<:::>::::::>::::::>::::>::>::::>:> :>::::::>:>::::;::::>::::>::::>::::>::::>:::>:::::>:::::<><:;<:::::<:::<:::>::>::::>::::>::::;::>::::::>:::::::;>:>:;:::<:::::>::»::><::>::>::::>:::>::>:::>:::<::<:::>.:::>::> :::::. .: :::::: : :: :: : >",> >:.:: . .;, ;>::;.: .::.;:.:; ...; .;:.;,>:.,,;.:<:.,:.: ��: �� .�s��.:..: .::: . . ::::,::.:.::::.;:::.::..; :::.: ...:. : . .: : ::.::.::: :.::. .. '��c��n::��p�t�a�r�� :��s:. ACORDn� ��#�� E�� V�� L�i�)mATE1MM/DD/YY1 ' � :;;::.;:.ro� :.::>:..:r�;:::�;::::::.� : � ...... . ..: ..: �: �:.:....: � :.. :..�.: �.:.: �. . �:.: :� . .... ::.:....; : �::»::� :: � .-_.:.. . ............. .. ... .. _ _. . . . .. . .._. -. . .. . .. . _:��;: PRODUCER DANZEY MICHAEL J- 6-211 �� THIS CERTIFICATE IS ISSUED A A ER F INFORMATION � ONLY AND CONFERS NO RI UP N HE CE IFICATE FEDERATED MUTUAL INSURANCE COMPANY HOLDER. THIS CERTIFICA7E DOES NO A ND, OR 5887 Gienridge Drive, N.E. ALTER THE COVERAGE AFFORDED BY THE ICI ELOW. Atlanta, CiA 30328 COMPA1N9�3`�ORDING COVERAGE Phone: 404-257-1511 COMPANV FEDERATED TUAC � NCE COMPANY OR Home Office: Owatonna, MN 55060 A FEDERATED�RVICE I NCE COMPANY INSURED �'�'�6-8 I B 'y�( !1 �9 '�'\` I COMPANY ` U.T.S. Inc. � �'w `� Palmdale Oil Inc. , Lake Oil Compan coMPAr,v & Palmco Inc. � � PO �O�t �. 1 Z9H . COMPANV - Ri,viera Beach, FL 33419 � � I CrJ LTR A THIS IS TO CERTIFY THAT THE POIICIES 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 PEATAIN, THE INSURANCE AFFORDED BY THE POLIC�ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONOfTIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I POLiCY =_�PECTWE POLICY IXPk7ATICTi LIMfTS I TYPE OP INSURANCE POLICY Nl/MBER I DATE (MM/DD/YY) DATE (MMlDD/Y'f) '�. GENERAL LIABIL7TY GENERAL AGGREGATE I S G,OOO,OOO X COMMERCIAL GENERAI LIABILITY . PRODUCTS - COMP/OP AGG I S 2,000,000 CLAIMS MADE � OCCUR 9206671 Ol /01 /98 O1 !O1 /99 PERSONAL & ADV INJURY I S �,��,�� _ I OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE 5 �,OOO,OOO I I FIRE DAMAGE IAny one firel 5 'rJ0,00� � I MED EXP (Any one persoN 5 ��AUT�OMOBILE LIABIUTY �ANY AUTD COMBINED SINGLE LIMIT 5 1�OOO,OOO ALL OWNED AUTOS A SCHEDULED AUTOS '� HIRED AUTOS . i X NON-OWNED AUTOS GARAGE LIABILfTY � ANY AUTO � EXCESS LIABILITY r� A �UMBRELLA FORM i OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLDYERS' LIABILITY A THE PROPRIETOR/ � �NCL PARTNERS/IXECUTIVE i OFFICERS ARE� EXCL I OTHER DESCRIPTION OF OPERATIONS/LOCATONSNEHICLES/SPECIAL Renew? (Y/N): Y City of Okeechobee 55 SE 3rd Ave. Okeechobes, FL 34974 9206671 9206672 9336007 BODILY INJURY O1 /01 /98 O1 /01 /99 fPer person) BODIIY INJURY (Per accidenU O1/O1/98 I O1/O1/99 05/23/97 I 05/23/98 S � PROPERTY DAMAGE S AUTO ONLY - EA ACCIDENT I S OTHER THAN AUTO ONLY: '� >�' EACH ACCIDENT I S � AGGREGATE S EACH OCCURRENCE I S 3,000,000 AGGREGATE � 5 3.000,000 i S • � WC STATU- I OTH-1 X TORY LIMITS I I Er7 I EL EACH ACCIDENT S rJOO,OOO EL DISEASE - POLICY IIMIT S �JOO,OOO EL DISEASE - EA EMPLOYEE 5 �JOO.00O SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE D(PIRATION DATE THEREOF, THE ISSUINCa COMPANY WILL ENDEAVOR TO MAIL 3 O DAYS WRfTTEN N6TICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFf, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINO UPON T E COMPANY, RS AGENTS OR REPRESENTATNES. AUTHORIZED REPRESENTATNE -,/ . /�_ ....... .. :::::<:::::;: �: ::�DATE : MM ::::::::::::.. ,, ...,,.. .....................:. . ...::2:i:::i:::::;:::;::::::i::::i:::i::::5::::i::i:::::i::::i;:;:: � ;:::;:::::::::::::::::::i::::5::::i::::: � :::;::::i::i;:;:;;::;:::::::::::;:i::::i::::i::::::::::::::i::i::';;::::;:::::::i::::5::::i:::::::::i:i::::::;:::;:::::::::i::::::::::::::i::iii::i::;:';::::;:::;:::::::::::::::i::i:;;::::;::;::::;:;::;:::::::;:::: ::t:: <:>:< . ...: :::.. ...::.. . ..::: ::: :...::>:...,:::: :. :. .>:<> .. :: : ::>::: � �:::>:..::: ...,>: . : : :>:: :: � ::: �:; :.>::>.. , .:. ..: .: .. . ., : ..::: a: ::; .. � �r :: .>::::>::::::::>;>:>::<::<::::<:::>::::>::>::::>:::::az:>;: ronnv ;;.: � � A CORD >::::: >:>�:: .::: .; :::; :::: . ::: :: :::.: .;:. .: ... :.::. :. . : .M :::.:�.� .: :: ::: : ::::: ::..::�:: :. ��:> :::: .�::::::. ��: :: ::::<:::::: .::.: : :: < .. �: : �:�> » <:::::: ::::>::: : :: :...:: ��: �::: : .> :� : �:: :: � :. >::��: ::::::::;::: :::::::::::::::::::::::::::>::::>::::::::::::::::::::::::::>::;::: i::. ::::.�:::::.�: ��:��I��.�:��.:: ��.��:::��.�.�.��.�:�.�..� ::::::: :.::::::::::::::::.�::::::: :.: :..�::. ... :.PRO DU C ER :: ::............................................................................................................................ 07/22/97 .................................... . . :«� .. ... ................................................................................::::..:::::::: :.::::.:�:::::::::::::::::.� ::::.::::::.�:.�::::::::::: ::::.: :.:::::::::.�::::::::::::.�::::::>:�. REVISED THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FEDERATED MUTUAL INSURANCE COMPANY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5887 Glenridge Drive, N.E. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Atlanta, GA 30328 COMPANIES AFFORDING COVERAGE Phone: 404-257-1511 COMPANY FEDERATED MUTUAL INSURANCE COMPANY OR Home Office: Owatonna, MN 55060 A FEDERATED SERVICE INSURANCE COMPANY INSURED 134-656-5 COMPANY PALMDALE OIL CO INC LAKE OIL B COMPANY 8 PALMCO INC P 0 BOX 11298 COMPANV RIVIERA BEACH FL 33419 � COMPANY D >Ct�...:.::,.,: ;:;::.; :;:<:<:::::::>::: ::::::::>::>:>:>:';::: ::>::::>:>:::<:::::::>:' ::::«::<:::<;:::';:;:::::>::::::>:€:::>::::::[:>:<:;: <::>;:<:::>«:::::::>::::::>::::>::::::<::>;;;::;;;:`«<:»<::::::> :::::::::::::«::::[>;::;;;:<:;:::<: <:;::>::::>:<:>::::::>:::::::i:>::::::>;:«::;`::>::::::>::::::>::::::>::;::::::>::::::>::':::::>;<:::: ::;:::>::::>::::::»::::>::::::>z::::::>:::<:>::::::>::::::>::::::>:::>::><:::::>::[:::: ��$ .... _. ,::., ,_ :::::::::::.:..::.. ,.:._ . .....,..,:::.:.;.:.;:,;.,.; ..... . ;:.;:.<.:;;.;>;:.;:.; ;:;>;>;:.;:..::.;>;:.;: .. . _ ::..:;.;:>:>;;;:;.;>;:.;:.;:.;:.;:.;:.;:.;:.;;:.;:.;:.;:.;: 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR DATE (MM/DDlYY) DATE (MM/DD/YY1 LIMITS GENERAL LIABILITY GENERAL AGGREGATE S 2,000,000 X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG S 2,000,000 A'�' CLAIMS MADE � OCCUR 9206671 �� 97 01 /Ol /98 PERSONAL & ADV INJURY S �,QO��O OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE 5 �,OOO,OOO FIRE DAMAGE (Any one fire) S 5�,0�0 MED EXP (Any one person) S 5,00� AUTOMOBILE LIABILITY X ANY AUTO COMBINED SINGLE LIMIT S ��OOO,OOO ALL OWNED AUTOS 1 1 BODILY INJUflY S A SCHEDULED AUTOS 9206671 Q I�� 1�97 01 /01 /98 (Per person) X HIRED AUTOS BODILY INJURY S i� NON-OWNED AUTOS IPer accident) PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT S AGGREGATE S EXCESS LIABILITY EACH OCCUFRENCE S 3,000,000 A i� UMBRELLA FORM 9206672 �� 0� �9% 01 /01 /98 AGGREGATE 6 3,��,�� OTHER THAN UMBRELLA FORM S X WC STATU- OTH- WORKERS COMPENSATION AND TORY LIMIT ER EMPLOYERS' LIABILRY EL EACH ACCIDENT S SOO�OOO � A THE PROPRIETOR! INCL 9336007 05/23/97 05/23/98 EL DISEASE - POLICY LIMIT S 'rJO�,�� PARTNERS/EXECUTIVE �p OFFICERS ARE: EXCL EL DISEASE - EA L Y�Ei � S� OO,OOO OTHEH �,,�-- � "� ♦, �� A.: i ` �� W� . �.�- � DESCRIPTION OF OPERATIONS/IOCATIONSNEHICLES/SPECIAL ITEMS � � �� ..: t 1 � .i � . � ;��`�FT.',r.: : :. ,,.>.;:;'':' „`.< " ::::>:::[::::>::>[::<:>::::<:::::>:;::[::::::>:[::::>::>::[:>:::::;:::<:::::>:::::::<:::>::::>::::>:<::::<:::::>:::[>::::>:[::[:>::::>:::[::>::;::i<>:>:::;[:::[>:::':..';:._ ..: : ;:>::. .::::..,'>;` `'"':><::>:::[>[:::[:>::::>::<:;>:::::<:>::::>::::>:::[>:[::[ :>:<:[:>::<::>::> <::<: .'.>';:z: ;:;" »:<; "'.:>: <:<. ::::;. ::; ::>::::>:<:>:::<:::: :::€:::[:>::::>:: ,..�,d1�`� 1�k)Lt?E�t .:...:::.: .:::::.. :::: : .:.:. ....::::.:.::::::.:::: .;:::::::::::.: .:...:.....:. 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AUTHORIZED REPRESENTATIVE -,/ . /ti:. • ;::.::::.:::.:�: : �:.;;:::.r:.:�::.:::.>;:.;�:;.::.::>:.::.»:.::.;::;.;::::.;�:.: � ::::::::::: ::.:::::::::. � ::::::: :.::::::::::::::::::::. � : :::.::::::::::::::::::::::. :::... :........................................... ............ .. .. . .:. ::. :: . .. ......... . .......... �::;::i::;::� ;;:»:::::::::;:.;:.;:;:;>;:::;::;:::>:<::::>:::<:::>:>::;:::»::>:::>:::::>::::»::>:::<:»::>::::>::::>::::>:<:::>::::>::::><:>::>::»:::>::>::>::>:::::::>::::>::::>::>:<:::>::>:<:>:::::<:>::>:<::;:::>:::::<::::>::::::<:::>::>::>::>.:>::; ::............ . . a . . ::.:,:.:> <:::. ;;;;:.:>:.:::.;:.;>.:::.;;.:, :.:::.;.;�:>:.;::;.;:.;.;;: �t�r� . :; . : >: ; :: ,;:.:. :::::;:;::.;:.;:.;:. .::::.;:::::.:.;:;:.:;. < ::............. ............................ . R�:��:�.�'#.t�� .............................................::::.:::::::::::.........................:.:::::::::::::::::::::::::::::::::::::::::::.>;:.>::.;:.;;:.;:.:;.;:.;;::.;::..::..:::::::::.:.::::::..: : ..:.. ..:: ;.. ; .....� ..................... .......................................::::::::::::::::::::::. :. ::::.::::::::::::::::::::::::.:::::::::::::::::.::.::. :. :::::::::.::«.>: :.;:.;:.;:.;:.;:.;. «.;:.;��4�i3�tC�:<C#3t�.1��.1��`�#�hl.;:��.�:.: , ACOR�M CERTI�FICATE OF LIABILITY INSURANCE TTc 7394 03%28/96 PRODUCEfi 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 PHOENIX RISK SERVICES ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 709 BROOKPARK ROAD COMPANIES AFFORDING COVERAGE CLEVELAND, OHIO 44109 INSURED T.T.C. ILLINOIS, INC. FIFTY MEADOWVIEW CENTER KANKAKEE, ILLINOIS 60901 COMPANY A TIG PREMIER INSURANCE COMPANY COMPANY B COMPANV C COMPANY D 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MMlDD/YY) DATE (MM/DD/YY) GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR OWNER'S & CONTRACTOR'S PROT AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GENERALAGGREGATE $ PRODUCTS - COMP/OP AGG $ PERSONAL & ADV INJURY $ EACH OCCURRENCE $ FIRE DAMAGE (Any one tire) $ MED EXP (Any one person) $ COMBINED SINGLE LIMIT $ BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO EXCESS IIABILITV UMBRELLAFORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND A EMPLOYERS' LIABILITV THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE OFFICERS ARE: EXCL OTHER AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EACH OCCURRENCE $ AGGREGATE $ $ WC STATU- OTH- TORY LIMITS ER wCN 8�42 0632 05/01/95 05/O1/98 ELEACHACCIDENT $ 1��i00� ELDISEASE-POLICYLIMIT $ SOO�OOO EL DISEASE - EA EMPLOYEE $ 1 O O� O O O DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS RE: PALMDALE OIL COMPANY, INC. CERTI�iCA7E HOLDER CITY OF OBEECHOLIEE 55 SE 3RD AVENUE OBEECHOLIEE, FLORIDA 34972 ACORD 25-5 (1/95) __ CANCELLATION TA054 6 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 3 O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF AN UPON THE COMPANV, ITS AGENTS OR REPRESE TIV S. AUTHO REPRESENT IVE � � ACORD COR pN 1988 . . ... . �:::::.:�:,:: :MM�DD'.�.Y:.�::.�::: :::2 : :: .: .: .. :..: � . � :::::::::. � ::::::: ::�.:::i::i�:i�i::::�:::i�::i:::::;:::::::;::::;�:::i:::"::<::::�:::::::i::::i::::i::::;:::;:::::��::::::i::i�:i:::::#::i:::::i''''::i::'i::::i:::::;:::::: ;::;:::::::::::::::::::i::::i::i::i�'�::::i�::i�:::::: �:::i:::i::::;:'::::,_::;::i::i::::i�?:::::::::::::::::::i:::::::i::i:::::i:::::;:;:�::i:�:`:::i::::i::::::i::::i:::::::::k:::::i::::::i::::i::::::�;: �. �;::: :.r: ::..: ��: � ;:.: :::: : .�.: : �:..;'� . ':::. ;:: ��::; ::. :::: :: :::: : ' . . ...; ...::.::..:.�.;::i::;:::::;�::�::i:.:'::'::::'::.:::;:::.::.::.:..: DATE ( / /Y 1 :: ::. A RD >::: ::::: .::: :. .:;: :;: : :.:.> :: .:: : .. :> : :::: :::::: :. : ::.:::::: .::.: : .. . .: : :<: :<: ::::::: :::;::;: :. : �:. : :.: : :. :� :. : .: :. : :::.::.::.:;:::::::::::::::::::::::::::»:.::>::>::>:.::.>::>::<::: i�i � TM :.;:.>��. `"��.�.�.�..�i,�� '".:. �. ..�. :�.�,��.�:��:��:.;:.�:�.�`�.�.�E.�:�i:��,. '"; :.:::.:::.::. :. :::::. ::::::::. ::::: ::.:::.: 02/15/96 '::>: ............................................................................................ INFORMATION . . �vRoouceA T I ISSUED AS A MATTER OF REVISED ON YCANDF'CONFERS NO RIGHTS UPON THE CERTIFICATE FEDERATED MUTUAL INSURANCE COMPANY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5887 Glenridge Drive, N.E. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Atlanta, GA 30328 COMPANIES AFFORDING COVERAGE Phone: 404-257-1511 COMPANV Home Office: Owatonna, MN 55060 A FEDERATED MUTUAL INSURANCE COMPANY INSURED 134-656-8 COMPANY PALMDALE OIL CO INC LAKE OIL B COMPANY & PALMCO INC 5770 N MILITARY TRAIL COMPANY WEST PALM BEACH FL 33407 � COMPANY D '.':�€`rQ1�llC�i�S:::::>::::::>::;:::>::::::;':::;;::::>`::::><::[::<:::[:>:::::::<:::>:::::::<: :::::::::>;;'::;:'.<':::<::::<:::::> :::::::::::::::>::::::>:::::::; :<: »<:z:>[:>:::::<:::::::::z:;:<::::::::::>::<:'::':<:':'.«::>::>:::::::::>::::::[:>[[:<:::::::>:>i:<::[:<z::::::::;::::::;'::::::::>:'.i::>>[::<>i:<::::::>[:::::::>;[:::[<::::[>::::>:::::::>;<:<:::<::;;:;:«::::>:::::[::<:;::::::>'::::;:;::;::;:::;:;:::'>:::::'::::;> �`<::<:::<:[ ,:,., ............ .::. ................. ,. ,::. ,,:,. ,_ ...... .. .___.. _.. __ ...... _.... 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. �p POLICY EFFECTIVE POLICY EXPIRATION lTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DDJVv) . DATE (MM/DD/VYI LIMITS CaENERAL LIABILITY GENERAL AGGREGATE S 1,OOO,OOO X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG S �,OOO,OOO %, CLAIMS MADE � OCCUR 9206671 01 /01 /96 01 /01 /97 PERSONAL & ADV INJURY S 'rJ��,�� OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE S 'rJOO,OOO FIRE DAMAGE (Any one fire) S 5�,�� MED EXP (Any one person) $ 5,�� AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 'rjOO,OOO X ANV AUTO ALL OWNED AUTOS BODILY INJURY 8 SCHEDULED AUTOS 9206671 Q� �Q� �9Fj Q� �Q� �97 fPer personl X HIRED AUTOS BODILY INJURY i� NON-OWNED AUTOS (Per accident) s PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 5 ANY AUTO OTHER THAN AUTO ONLY: � EACH ACCIDENT S AGGREGATE S EXCESS LIABILITY � EACH OCCURRENCE S 2,'rJOO,OOO i, i� UMBREILA FORM 9206672 01 /01 /96 �� 97 AGGREGATE S 2,�J��,�� OTHER THAN UMBRELLA FORM S WC STATU- OTH- VJORKSRS CO�I".PE!:F.ATi�\ t.�ti ; TUkY UNIi i� EH EMPLOVERS' LIABILITY EL EACH ACCIDENT S THE PROPRIETOR/ INCL EL DISEASE - POLICY LIMIT S PARTNERS/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE S OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESlSPECIAL ITEMS ;; : .: . :. ::... :... :<.:::.::: . :..>:::::: ;:.:: .:::::::.:i::i:::;:i::i:::::i::i::i:;:::i:;::;:::;::::<::ii:;:;::::5::::::'t;;ii::i::>::i:;:i::::::::i:::k:i::i::i::i::i::i::i::;::i::::;:::;:Y::::iii;::i::::; �:. �::: ......:............:.....:::::::.: �::::::::::.: �::::::::. � :::::. �: :.:::::. � ::::::::::::::::::>:::::::::.: �:::::::::::: :.::::::::::::::::::. ;.;:<.::::.;:.:;.;;:.>:.>:;;:>::>:.;;:.;:::;:.;:.;:.;:.;::<::;::<::<::<:::>:: :«:>:<»<:::::<:;>::::>::::>:::<:::>:::«:::>::::>::::>:::<::<::<::<::;�AN��3�E'I'I�N:::[:>::>:::i::<:::>::[:>::>::::>:::::':>::[:><::::::>::::>::::::`:::>;::::::r<:::::>:::::::s::>::::::>::::»:::::<:::::::>;::>;::':;::::> ::::::::::::::>:::;::::::>:::;:;::::>::>::>::>: G�#'�`#�t�A'1`�:::H#kL�iER ::::::::::::::::.:.::...::::::.::::::::::............................. .. .. ..................................................................................................... ::::::::::::::::.: ::::::::. :::::::. :::::.: ::. :::::::::::::::::::::::::::: :.::::::::.: :::::. :. ::::::::::.: :::::::::::::: ::..:.:. ......... ..................................................................................................................................................... CITY OF OKEECHOBEE 13 SHOULD ANY OF THE ABOVE DESCRIBED VOLICIES BE CANCELLED BEFORE THE 55 S E 3RD AVENUE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL OKEECHOBEE FL 34974 JO DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBIIGATION OR LIABILITY OF ANV KIND UPON T E COMPANY, ITS AGENTS OR REPRESENTATIVES. 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Atlanta, GA 30328 Phone: 404-257-1511 Home Office: Owatonna, MN 55060 INSURED PALMDALE OIL CO INC LAKE OIL COMPANY & PALMCO INC 5TT0 N MILITARY TRAIL WEST PALM BEACH FL 33407 9206671 � 01 /01 /95 � O 1/01 /96 COMPANY E IETTER CO .TR A TFIIS IS TO CERTIFY TfiAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TFiE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIFiEMENT, TERM OR CONDITION OF ANY CONTflACT OR OTHER DOCUMENT WITfi RESPECT TO WFIICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED FIEREIN IS SUBJECT TO ALL THE TERMS, DCCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN flEDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY IXPIRATION LIMITS DATE (MM/DD/YY) DATE (MM/�D/YY) OENERAL LIABILITY GENERAL AGGREGATE 3 �,OOO,OOO X COMMERC�AL GENERAL LIABILITY PRODUCTS-COMP/OP AG6. S �,OOO,OOO `?:}•,`y+;: CLAIMS MADEaOCCUR. 9`z0667� O1/01/95 01/O1/96 PERSONAL & ADV, INJURY a 500,�0� OWNEH'9 & CONTRACTOR'S PROT. EACH OCCURRENCE a 500,000 I AUTOMOBILE LIABtLITY �( ANY AUTO ALL OWNED AUTOS A SCHEDULE� AUT03 X HIRED AUT09 X NON-0WNED AUTOS 6ARAOE LIABILITY EXCESS LIABILITY A UMBRELLA FOHM OTHER THAN UMBREILA FORM WORKER'S COMPENSATION B AND EMPLOYEHS' LIA8ILITY � OTHER 9206672 � 01 /Ol /95 � Ol /01 /96 ISSUE DATE !neM!DD/YY) 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 COMPANY A FEDERATED MUTUAL INSURANCE COMPANY LETTER COMPANY g ASSOCIATED INDUSTRIES OF FLORIDA LETTER COMPANY `+ LEITER COMPANY D LETTER FIRE DAMAGE (Any one fira) S MED. EXPENSE (Any one person� t COMBINED SINGIE s uMir BODILY INJURY a (Per pereon) BODILY INJURY a (Per eccidenq PROPERTY DAMAGE S r EACN OCCURRENCE S � AGGREGATE S � 500,000 I STATUTORY LIMITS ;+. EACH ACr_.�pENT S 9 5 2 31 18 91 U 2/ 15 / 9 5 I 0 2/ 15 / 9 6 DISEASE---POLICY LIMIT a DISEASE---EACH EMP DESCRIPTION OF OPERATIONS/LOCATIONSryEHICLESlSPECIAL ITEMS RenewZ (Y/N): � CITY OF OREECAOBEE 55 SE 3RD AVE OREECHOBEE, FL 34974 � �� , � � r � SHOULD ANY OF TNE ABOVE DESCFlIBED POLICIES �°"—..�'�,':"'�D BEFORE TFIE IXPIRATION DATE THEREOF, THE ISSUINO COMPANY WILL ENDEAVOR TO MAIL 3o DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFf, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLICiATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AQENTS OR REPRESENTATNES. AUTNORIZED REPRESENTATIVE / � V. � IRFlIOENT ; ...: : .i:.. :" . ':i}. ::: , � �:$'f,:}Yi �:::•' .: .. C: 'f:' ::} ::: ! :v:: :: ' �. r'' ... `:: :: ;:: a ��i� �.�� :....�.� :. "�"�:�:�.��:� ..�.. »:<s••»::>•»:,:::::•::.: �::•:.>:>::;.: • ••>:<::� •: . %::y •:.R,•. •:.C•:: .. i::.Y;S .............. .................. . rRor.:;cea��.. �4��DANZEY.MICHAEL�J��-��6-211 FEDERATED MUTUAL INSURANCE COMPANY 5887 Glenridge Drive, N.E. Atlanta, GA 30328 Phone: 404-257-1511 Home Office: Owatonna, MN 55060 iNsunao PALMDALE OIL CO INC LAKE OIL COMPANY & PALMCO INC 5770 N MILITARY TRAIL WEST PALM BEACH FL 33407 :,'vi':9�� }s:�r {'r,}•}?:+�4� I:•i:ti`ti�:i�:y:•`y,'•:i:ti;:::,v•:,i• }:'i:?:. �r.:.}:�.i>r...�....�.. .: .. }....�....n...� ..�4.....� :.�.iv.: .�. :$;Y.SG+n�..rr:: r::: rr ...•r..{..•.... .. . 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TH13 CERTIFICATE DOES NOT AMEND, EXTEND OR AITER THE COVERAQE AFFORDED BY THE O I COMPANIES AFFORDING COVERAGE COMPANY A FEDERATED MUTUAL INSURANCE COMPANY LETTER CpMPANY B 134-868-8 LETTEF COMPANV `+ LETfER COMPANY D LETTER COMPANY E LETTER THI3 13 TO CERTIFY THAT THE POI.ICIE3 OF INSURANCE L.13TED BELOW HAVE BEEN IS3UED TO THE IN8URED NAMED A8 / ERIOD INDICATEp, NOTWITH3TANDINQ ANY REQUIREMENT, TERM OR COND�TION OF ANY CONTRACT OR OTHER P�CUMENT WITH ICH THI9 CERTIFICATE MAY BE 133UED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DEBCRIBED HEHEIN 18 9UBJEC THE TERM8, EXCLU810N3 AND CONDITION3 OF 8UCH POLICIE3. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID ClA1M9. CO Typ! OF INSURANC! POLICY NUM6lR P��CY EFFECTIVE POUCY E%PIRATION LIMITf �Tp DATE (MM/00/YY) DAT! (MMlDD/YY) . O!NlRAL LIASILITY QENERA� AQOREQAT� 8 1 Q�0 �OQ �( COMMERCIAL OENERAL LIABIIITY PRODUCT9-COMP/OP AQa. 5 1 OOO�OOO A;?;;y?;,?; CLAIMB MADEaOCCUR. 9'ZO6(j7� 01/01/94 01/01/95 PERBONAL & ADV. INJURY S �j��,0�0 OWNER'8 6 CONTRACTOR'S PROT. EACH OCCURRENCE � 'SOO�OOO AUTOMOBILE LIABILITY �( ANY AUTO AlL pwyEp 4U709 A BCHEDULED AUT09 HIFED AUTOB NON•OWNED AUTOB pARA4E LIABILITY EXCE88 11ABILITY A X UMBREILA FORM OTHER THAN UMBRELLA FORM WORKER'3 COMPENSATION I AND EMPLOYER'S LIABILITY OTHER Renew? (Y/N): � 9206671 9206672 ITEMS CITY OF OKEECHOBEE 55 SE Third Avenue Okeechobee, FL 34974-2932 i: 01 /01 /94 e 01/01/94 FIRE DAMAOE�Anyoneflrs) B �j �� MHD.EXPENBE(Anyonepenon) S rj�Q�Q COMBINED 81NQ�E � cjOO�OOO LIMIT ROOIIY IN.IURV 01 /01 /95 (P�r penon) m _ BODILY INJURV e (P�r �ecld�nq PROPERTY DAMAOE 8 EACH OCCURRENCE B 2�'rJOO�OOO 01/01/95 AQOREOATE 5 2�'rJ0�,�00 I BTATUTORY LIMITB F;;t EACH ACCIDENT � � I DISEASE--F'OUCY LIiN1T ffi DI9EA9E-••EACH EMPLOYEE t � SHOULD ANY �� II11= ABOVE UESCRBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DnTE Tf-IEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL �d DAYS WRIITEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIQATION OR LIABI�ITY OF ANY KIND UPON THE COMPANY, ITS AQENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE �_ / PRESIDENT _ �-- _ ' : � ,�iti 7��: �t. i�l101'✓CER:.. . . .. .. i:i►;lr+Ni11'74:::�. i� �'�,�i�Ar"4, i lii�w::;:1�i! 14 �#�I�wir!*ir,;�k,.�r:-:�e:.�:wwr;w�u _ .:':::';::><>`;:»» c ;: . .. .. :.. .:.:.. ::: ... ... . .. .. ...... .... ... ... ... .... .. . . . OS/ 10 � .. ..: , ,: . ,, _ ,:.: DANZEY MICHAEL J- 6-211 THIS CERTIFICATE IS ISSUED AS A MATTER �F INFUHM�iION GN�Y F�iJ� CONFERS NO RI(1HTS UPON THE CERTIFICATE HOLUER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAQE AFFORDED BY THE PO�.I�� "�' OW FEDERA7ED MUTUAL INSURANCE COMPANY 5887 Glenridye Drive, N.E. Atlanta, GA 30328 Phone: 4U4-257-1511 Hotne Of(ice: Owatonna, MN 55060 iNauReo PALMDALE OIL CO INC ` LAKE 011. COMPANY & PALMCO INC 5770 N MILITARY TRAIL WEST PALM BEACH FL 33407 CO _TR �� COMPANIES AFFORDING COVERAQE cvMrnNv A FEDE lEf1ER CpMPANY B � 134-868-9 �ETTER COMFANV `+ lE1TER COMPANV D �ETiER COMPANY E LEffEii AUTOMOBILE LIABILITY �( ANV AUTO ALL OWNE� AUT09 A BCHEDULED AU109 HIRED AUT09 NON-OWNED AUT09 QARAOE U/1BILIIY 01/01/94 � 01/01/95 ...._.. ........ ..____ .__.. T1113 13 TO CFfiTIFY TIiAT TIIE POI,ICIE3 OF IN3URANCE 1.�97�U BELOW HAVE BFEN IS9UED 7 SURED NAMED ABOVE FOR TIIE POUCY _FlO INDICnTEP, NoTWi711gfANDINO �NY FlEQUIIiEMENi, TEFlM OR CONUITION OP ANY CON(R�CT OR OTH@R UOCUMENT WITH RESPEC7 TO WIIICH TI119 CERfIPICnTE MnY 8E 193UEU OR MAY PFRTAIN, THE IN8UFlANCE AFfOf10EU BY Tf1E FOUCIES DE8CFlIBFD HEREIN 19 9UBJECT TO ALL 7HE TERM9, EXCIUSION8 AND CONDITIONS OF 3UCH POLICIE3. lIM1T8 SHOWN MAY IIAVE BEEN REDUCED BY FAID CLAIM3. TVP! OP INSURANCR POLICY NUMSlR P��CV lfFECTiv! POIICY EXP�11AilON IIMITb OATE (MM/ODIVY) DATE (MM/DD/YY) QE�lERAL LIABILITY QENERAL AOOFlEOATE S 1�OOO OOO �( COMMEf;CIAL OENERAL LIABILITV PRODUCTS-COMPlOP A00. 9 1 OOO�OQO CLAIM9 MADE�OCCUR. g'ZQ6(j71 01/01/94 ��D1�9�J FER80NAL 6 ADV. INJURV g ,�j00�0�0 +..'� OWNER�9 & CONTRACTOR'9 PROT. EACH OCCURRENCE � ��JOO�OOO 9206671 e EXCESS LIABILITY A X UMBRELLA FORM OT!-IEIi TItAN UMBFlEILA FORM WOAKER'S COMPENSATION AND EMPLOYER'9 LIABILITY OTHER 9206672 01/01/94 � 01/01/95 INSURANCE COMPANY FIRE DAMAC;E (Any one 11re) S • �j��0�0 MED. EXPENSE (Any one penon) S 'rJ�OUO COMBINED 81NQlE a S��QQO LIMIT BODILY INJURY = (Psr penon) BODILY INJURY � (Per �oaldmt) PROPERTY DAMAOE 8 EACH OCCURRENCE t Z�'�JOO�OOQ AOOfiEQATE 6 Z��JOO�OOO 9TATUiORY IIM�TB cnr.�l ^cr�p�ra; S ' DI9EA8E---POIICY IIMIT 6 Ui9EA9E---EACfI EMPIOYEE � DEBCAIPTION OF OPERATIONSlLO� Renew? (Y/N): �, � --,,:�:-:..--:-•; .......::�.>:�.:;::.:::..... _... . .: . . : ... . . .:. ... . ,. . .. ... . .. :>` SfIOULU �NY ��I 1111 �OOVE f�ESGHIUFU i'�_�LICIES f3E CI�NCEILED BEFOIlE TFIE City Of Okeechobee '':> Exr�ir��i ioN f 1� I F I I IERFOf, TIiF_ ISSUIIJ�3 COMPANY WILL ENDEAVOR TO 55 S.E. Third Avenue :<:> Mn�� 3� DAYS WRITTEN N0710E TO 11IE CERTIFICAIE HOLDER NAMED 70 THE Okeechobee, FL 34974-2932 :::: �EFT, BUT FAILUfiE TO M/�l� SUCH NOTICE SHALL IMPOSE NO OBLIOATION OR %+'>: LIABILITY OF ANY KIND UPON TFIE COMPANY, ►TS AQENT3 OR REPRE3ENTA7IVES. ��:? AUTHOR�ZED FlEPRESENTATIVE :;:i; . s::•. #ii#: PRESI�ENT � �r "" ��^. �. •_�.' .�.r. ..� �.,... ..� .�'—."^-*"—''�— .— ��". '.�.."�. . . . — . �R.'@yp""a`�'e% ., .� . ��,�1��L ' . • . . ISSUE DATE (MM/DD/W) � . g :c;r�ez. ,.,, ....�_. . �s...;�''� � �:,. . _ ��.., e � t� -L". .. .. . � 1 f ! ?�..� PRODUCER � THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS �.,. -, :�; r.�' NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POIICIES BELOW � U i" 3 rt � � S 5 t' i 1:1 I t`i + ? f` i: . � "'�_ • �� °� ' � ` �' COMPANIES AFFORDING COVERAGE � T? �� '� ;? F�� i rJ ��. 1 �. COMPANY A IETTER r nn v " _-- _. _. _ ��___ ._.._. _ ��__� � _i � I � � �. _ _ �...a_+�,_ _ � `_?__5_. _�_._-_.� .�, _m_.� _ _ _.__ ..----__ _ ___ _ .__ __ -_.- -- __��---._�_______.___.� INSURED .��R B P A C 1 r I C r�p, P C_ t: Y�_ �. � _____�. �.__...,��.___�.._.._.._....�..._� . .�.� F A L"' U ti L'r_ t", 1 L C 0 h? P �3 N Y I P1 C ; cor,nPANY �-��-.. ._.e_e._ �_ �.. _�..�..._� . �_.��_._ D9� LAKE ;;I� CiluPAhY '�rreR C PdCI�?C E'qPLl.YtRS I�i i'� � i, .: rJ i'j ?� ��' N L A fy � :__ COMPANY .�..._.___ ...._._..._....s.., - ._...�...d,..,.�.�. �..�...,..�_.....,...� �EST PAl.h: 3FIsCH F� 33=�11-3779 `��ER � �! or i da Chamber Fun�� COMPANY E LETTER �<:�c.,�. , . .. . . . . . THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POL.ICY PERIOD IN.^,!�.4TED, NO1 WITHSTANDING 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 POLJCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONOITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO �� TYPE �OP INSURANCE� � � POLICY NUMBER �� POLICY EFFECTIVE � POUCY EXPIRATION R � ALL UMITS IN THOUSANDS �� DATE (MM/DD/YY) � DATE (MM/DD/YY) ; ._��„GENERAI LIABILITY U L C S ��.' `J �% u Z/ �� I`' � }IL;..j �.� I��I� .. �:: RAL AGGFiEGATE � S Z O J�. � � i(� COMMERCIAL GENERAL LIABILITY � ', PRODUCTS-COMP/OPS AGGREGATE ' $ Z {� O (� � ��' CIAIMS MADE �� I Q�CUR � � � '�PERSONAL 8 ADVERTISING INIURY�$ � Q(� � . '� OWNER'S 8 CONTRACTOR'S PROT. J EACH OCCURRENCE �$ e1 �} � ._.� .�..__ ._._.._.,��.n. ' � ...--.3..�. � � �. �'; FlRE DAMAGE (Ary one tire) �$ ;( j _ _.�._�___ ___. .... .__ � _ ,____. MEDICAL EXPENSE (Ary one person) j y j � v� AUTOMOBILE LIABILITY � H t� 3 2 4 7 ti 5�+ 2� 1 rj � g �.�� ,:�..: BJED � � ., � �� , ��.nNY auro � ,. �� ., . ; .��Nc�e s 10 e 0 • �� k�� ALL OWNED AUTOS ! BODILY �r �.�;;��; �. �� ' � ;� �+ a � n�,xx,av a �: � SCHEDULED AUTOS ! j (per pe�) � � ��f �t' � �'� � a'� HIRED AUTOS � � ; 80DILY § .f,.� � T �NON-OWNED AUTOS j � � �� $ '' � � z � 3, (Per accident) I .�.,�� • � GARAGE UABILfTY ; ' � � " . �, _ � i �PROPERTY � � i DAMAGE � $ ��`�*��-�� ' ` � 'k ,,:;�- � . {� ��_.--..--.. " ��E%CES3 LIABILITY t g j�(} �(� z� 1�'j I C� � y�n s�z,�j, s� EACH F AGGREGATE ��r� � OCCURRENCE _ v.._ I '°' �.�� `$ 10 Q$ 1 i; Q C OTHER THAN UMBRELLA FORM � � '� � ie'�.x��c�i�� WORKER'S COMPENSATON � � 3 � � �� -' � � � ' STATUTORY <':" .� .� � � $ ' 1 {'� OIEACH ACCIDENT) . AND� _� ____�...,._.,,._. i $ �j � d(DISEASE-POIJCY LJMIT) , EMPLOYERS' UABILITY - ? — �-- . E _... ', �.�... _ w�,��- -- . . ;� $ 1 � �(OISEASE-EACH EMPLOYEE) i OTHER �. - - .�.. ..w.,�.�.�.� _ o..,_.... _,._. t � ,, _,_ � .. . � , � � _ . .. .,.-� ,. . . . w ....: . .,. ,_ . ... .. .. . ., . , _ . .E. . . . .. .,.... .. . .. : . :.::, ., ,.. . . ....,.._� . . . .,. .. . rt,� . . �.�� , ,;:_� . F M1^ ��, �� : , , . ,. . .. .. ,,.,. . .. .:; . , .A, :.., ., . . �,, . . . .t :..; . ., ... . : .--, ... . . � ,-..r.. , � �.,� . .. ... ... .. '�.- .�. �,. a;,:,, r - ....�.,.� � .. : . .. r .,. �. A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE 'THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO :. I T`! `, F '.I K E E C H Q P E c MAIL 3 � DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE ' 5 'i .�. = i-{ j��' S T K E E T LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR �r.t K[ E C N i! S C� 1 F L j 4 9 7 4 �,Bi�in OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE � 7. l�iICHAEI. RJSIER ::.; :.; :.:::::.....:...::::...:....:::::.:::.:;.:::.:»:;�:.;:::.::.>�:::.,::>;::;:::>:::.:.:>::.:.::>:::::<:::::..::>�: :;:::.:<:: ;_.::::;:::>:: �:.::::..:;...:;..::.:.;.:::.::::::>::::::>:::«<:::;::>::>::::>::>:<::«::::::>::>:::;>:<:«:<:>:;::>::::»: � »:s»:<:>::>:::>�;;>;�:.;.....; � ui:uan� vv �;::.<:: ;.;: ;.:;:.;• . . . ... : . ;: ;.. .: :.;<.;:.;:: :. . ...;;;;:.;: ;; . :.; :: . : .. ::.;:.:;.:.;::;;.;;::.:�:.;:.;:.;:;;.:�>; :.::.::.::.:.;:.;:::.::.;;.;;;;:.;:.;:;:<.;:.;:.;;;: oA�C ) .:. ;:. � >: :`::�:':: :::>: ::.: . �`:::: ::[ : ::>: :>:.. . 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CLEARWATER , FL 34618 COMPANIES AFFORDING COVERAGE COMPANV 813-447-6481 A Comme ce Mutual In . Co. COAPANv Authorized Management, Inc. B 14802 N. Da I e Mabry co►�arry Suite 100 C Tampa FL 33618 co�aNv D q�4i'i��;::::;:<:>::::::::::<::<:::::>::<:>::::;::>;::>:::::<:: �:»:«: � <::«:::>::::»;:<:: �:<:::>:<:::;::;[:;:: �:<:<:::«;:<:;::::>:'':::::<:>:;:;:< :::::::::::::>:::<: :::<:>:<�%�:«:':::»»:<:<::<:::;::<::::::>:::<:>:<_:::::«:::'>::::>:<:_:::�:;::;::>:<::::::>:::«<:>::;<::� ::::>:::»::>::«<:;;:::>::::<:<:><::<:<:>::<:?»:�:::':�s:::>::;:::«r:::'<::::::>:::�:_:::<:: .......:. :.: ... .::... ...::::: . :::::::. :::::.: .........:::::::::::::::..... ....::.�:.� :.:::::::::.�.:�:.:........�:.:�:..:......:._::::::..........:.._::::.............. . »;»: : z:>::;>:.;:.;:::;.;: � ;;;;;;: ;;:: ;:.: : :.;;;:.; :.: : . . . . . . . . . . . . . . . . . . . . . . . . THISISTOCERTIFY THATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIO INDICATED.NOTWITHSTANDINGANYREOUIREMENT.TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENT WITHRESPECTTO WHICHTHIS CERTIFICATE MAY BE ISSUED OR MAY PERT AIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LMITS SHOWNMAY HAVE BEEN REDUCED BV PAID CLAMS. �� TYPEOf INiURANCE pp��y�y�p ��YEFFECTIVE POLIOYEXPWATIO LIMtTS �Tp DATE (MMIDWYY) DAiE (MMIDWYY) 6ENERALUABILITY GE�RAL AGC�REGATE S COMbERCIALGE�ERALLIABILITV PRODUCTS-COIIP/OP AGG : CLAIMS MADE � OCCUR PERSONAL g ADV IN,AIRV = OW�R'S B� CONTRACTOR'S PROi EACH OCCURRENCE f FIRE DAMAOE (Arry one lire) i MED EXP (My one person) _ AYTOMOBLE LIABLRY COA61rED SINCiLE LIMIT = ANV AUiO ALL OW�D AUTOS BODILV IN,IURV = SCFiEDULED AUTOS �P� �5�� HIRED AUTOS BODILV IN,JURV = NON-OWNED AUTOS (Pe� accident) PROPERTV DAMAOE _ GARAGE LIABILITY AUTO OPLV � EA ACCIDENT = ANV AUTO OTFfR THAN AUTO ON.V: : EACH ACCIDENT = AG(3REOATE f EXCESfL1ABLITY EACH OCCURRENCE f UA6RELLA FOF2M AGGREGATE _ OiFER THAN UA6RELLA FORM : WORKERY OOMPENtAT10N AND STATUTORV LIMITS EMPLOYERS"LIABLITY A 03678 11/15/94 11/15/95 EACH ACCIDENT f 'IOOOOO TFE PROPRIETOR/ �� DISEASE - POLICV LIMIT f PARTFERS/EXECUTIVE S OO O O O OFFICERS ARE: EXCL DISEASE • EACH EbPLOvEE t 1 OOOOO OTHER See remarks for mJP additional info DE L A ECI EMS Only those employees leased to but not subeontractors of: Palmdale Oil Company Inc. effeetive 3/25/95 »:;;:......................,..........................:.................................................................................... :....................:.................................................. ::.......,....................::.».:eefoWe :r►iE:. ::. .;;;;::.;:.;:.;:.;:.;:<.;;; .::.::.:::.::�;;;:.;:.;:.;:.;:.: ::::<.:;.;;:.;:.;;;;;::.::.:. ::::::.� :.: ::.::::::::::::::::::::::: ::.::::::::::.�.�::::::::.::.::�::::.::::::::::::.:._::::.::::::. :.................... ................... ...... .................... fHOYLD ANY OF THE ABOVE DESCRIBED POLICIES BE OANCELLED EXPIRATION DATE THEREOF, TME I:SUWO OOMPANY WLL ENDEAVOR TO MAL C I t y O f 0 k e e c h o b e e e ( P� 3 � DA YS WRITTEN NOTICE TO THE CERTMICATE MOLDER NAMED TO TH! LE►T, 5 5 $E 3 r d EiV @ n U 0 BYT FAILURE TO MAL fUCH NOTICE SHALL IMPOSE NO OBLIGATION ON LIABLRY Okeeehobee , F I 34974 oF rwr Kwu UPON THE co�.war�r. Rs noeNrs Oil RFPRE�ITATNEt. " " 033400000 1 ............................................................................... .........:..... .:..::::::. ::::::::.:::::.�: :::::::::::::. :.�:::::::::::. :. ::::��:::::::: :;:..:......:....:;. .:..: ...:. .:..: .: : . .:.:. .:.: :: ..:............:......: .: . . . :>::»:<::<::<:>::;.; :>::»::: �::>::>::: ::»::>;:::«:>:<:»::;::>::>::;::;::>::»:<;::::: ::»»::;::>::>::;::;>:.;::;.;:.:<.;:.: �:.;:.;::>:::>::»:..;:;:<:»:<:>::>::>;:::>:<::::::;::>:<:>:<:>::::>::::»>;:>::»>::;::>::>::>::::: �:«:>;::: . .. . .. . . ; . .. :. . :. .. : . . . . . �t��ltit]:::�AR�Giltlk: : �}1�t::'��:::; 2 :. :..3i 3:;.;::;;;:.;;:.;:.;:.;:.;:.;:.;::;.;:<.;:;�;;::.;:.:;;;:.;:.;;:;.;;;:<.;>;:�:>::;>:.;:.;:.;:.;:.;:.;:<.;:::;.;;;;:.;::;:::>::>:::«:;:::;.;:.;;:�;:.;:.::.;:.;:.;;::;;.>::;:�;:.;:.;:.;;:.;:.:::.;::.;:.;:;:.;:.;:.;:.;:.;:.;:.;:<.::;� .::..:.::::::::..::::::::::.: :.:::::::::::::::::::::::. <A�E�Rt>:,.: �-�.�::::�::.� :::. :::: ::.:::.: :.:::.:.:::::::::::: :.::::::::.�::::::::. ::::::::.�:::::::::::. :::: :.::.:....................................................................................