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Blk 168 City of Okee/Nelson-Okee Disc Drugs/AlleySASBI -1 OP ID: MB ,a►coRL7 CERTIFICATE OF LIABILITY INSURANCE �'� DATE 07 /14DD/YYYY) 07/14/2014 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 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 ISU Lawrence Insurance Agency PO Box 549 Okeechobee, FL 34973 Heath Lawrence NAMEACT Heath Lawrence PHONE FAX (A/C, No, Ext):863- 467 -0600 (A/C, No): 863- 467 -5142 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:American States Insurance Co 19704 INSURED S.A.S.B., Inc dba Okeechobee Discount Drugs 203 Sw Park Street Okeechobee, FL 34972 -4160 INSURER B : General Ins Co of America 24732 INSURER C : Bridgefield Employers Ins Co 10701 INSURER D : Am Casualty Company of Reading $ 1,000,000 INSURER E : Commerce & Industry Ins Co $ 1,000,000 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. INSR um L OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X 01C159534630 04/15/2014 04/15/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE X 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO JECT PER LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NOTOSWNED 01 C169337420 04/15/2014 04/15/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PER (Per t) ci TY DAMAGE $ $ E X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X 13E064762941 03/21/2014 04/15/2015 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ DED RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / N N / A 0196 -04342 04/15/2014 04/15/2015 X PER STATUTE 0TH - ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 A Professional Liab 01C159534630 04/15/2014 04/15/2015 Limit 1,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION CTYOKEE City of Okeechobee 55 S.E. 3rd Avenue Okeechobee, FL 34974 I 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 ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SASBI -1 OP ID: MB AiC. ---- CERTIFICATE OF LIABILITY INSURANCE DATE 09/242013Y) 09/24/2013 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 ve 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 Phone: 863-467 -0600 ISU Lawrence Insurance Agency PO Box 549 Fax: 863 - 467 -5142 Okeechobee, FL 34973 Heath Lawrence CONTACT PHONE FAX (A/C. No. Eat): (A/C, No): POLICY EXP tMM /DD/YYYY) E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Brldgefield Employers Ins Co INSURED S.A.S.B., Inc dba Okeechobee Discount Drugs 203 Sw Park Street Okeechobee, FL 34972 -4160 INSURER B : American States Insurance Co 19704 INSURER C : General Ins Co of America 24732 INSURER D : DAMAGE (RENTED PREMISES S {Ea occurrence) INSURER E : INSURER F : CLAIMS -MADE 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 LTR TYPE OF INSURANCE ADDL ,INSR SUBR MD POLICY NUMBER POLICY EFF IMM /DDIYYYYI POLICY EXP tMM /DD/YYYY) LIMITS B GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 01C159534620 04/15/2013 04/15 /2014 EACH OCCURRENCE $ 1,000,000 DAMAGE (RENTED PREMISES S {Ea occurrence) 1,000,000 $ r CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER ii POLICY n JF 0 [ LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ C AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS -- NON SCHEDULED AUTOS -OWNED AUTOS 24CC30216720 04/15/2013 04/15/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1 ,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB — OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 0196 -04342 04/15/2013 04/15/2014 X WC STATU- TORY LIMITS 0TH - ER E.L EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 B Professional Liabi 01C159534620 04/15/2013 04/15/2014 Limit 1,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION CTYOKEE 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 ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD GRANT OF LICENSE STATE OF FLORIDA COUNTY OF OKEECHOBEE THIS INDENTURE, made and entered into this 21' day of August, 2001, by and between the CITY OF OKEECHOBEE, FLORIDA, a municipal corporation existing under the laws of the State of Florida; GRANTORS, and STEVE NELSON, individually, and d /b /a OKEECHOBEE DISCOUNT DRUGS INC., a for profit corporation, by and through its authorized officers; GRANTEES; WHEREAS, GRANTOR is possessed of an open alleyway running in an East -to- West direction between Southwest 2nd Avenue and Southwest 3rd Avenue, in Block 168, City of Okeechobee, Florida, as found at plat book 1, page 10, public records, Okeechobee County, Florida; and WHEREAS, the GRANTEES operate a business that extends on both the North and South side of the alleyway between Lots 1, 11 and 12, Block 168, at 203 Southwest Park Street, and have requested permission to use the alley or right of way and to make improvements thereon, such as paving, concrete, or structures; and WHEREAS, GRANTOR has the right to grant licenses, to permit such uses, and has the authority to execute such permissions, and the GRANTEE agrees to act in accordance with this license; and WHEREAS, GRANTOR has agreed in consideration of the sum of Ten Dollars ($10.00) and other valuable considerations, the sufficiency of which is herein acknowledged, to grant to GRANTEE this permission for the purposes and in the manner expressed below: NOW, THIS INDENTURE WITNESSETH: The GRANTEES are granted a license for full and free right and liberty for them and their guests, agents, employees, and invitees, in common with all persons having the like right, at all times hereafter, for all purposes connected with the use and enjoyment of the land of the GRANTEE and those likely situated for whatever purpose the land from time to time lawfully may be used and enjoyed, to cross and re -cross the alleyway between Lots 1, 11 and 12, Block 168, City of Okeechobee; to make improvements thereon; to lay asphalt pavement, concrete or other roadway across the alley; so long as same is under the supervision and in compliance with the codes of the City, and does not otherwise interfere with utility service, or access to and from the alley. Further, that GRANTEES understand that the alleyway must remain unobstructed and open for use by the general public at all times; that GRANTEES shall cause the removal of any improvement or surface to the alley at any time, at his own expense, upon demand of the City for whatever reason the City deems to be in the public interest, with the additional understanding that any improvement that is impractical to remove at the termination of this license shall be considered the property of the City of Okeechobee. During the period of time that this license is in effect, GRANTEES, at their sole expense, shall be responsible for any maintenance, repair, upkeep or other necessary alterations to the alley due to any improvements to the alley caused or created by GRANTEES. TO HAVE AND TO HOLD the license as granted unto GRANTEE, its successors in interest and those likely situated as described above, for a period in perpetuity, unless earlier terminated as hereinafter set forth. Page 1 of 2 In return for this grant of license, the GRANTEE shall assume all responsibility and liability for the improvements or structures or personal property placed or left on the alley, and shall hold the City of Okeechobee, its assigns, or successors in interest harmless from any claim, demand, action or suit which alleges bodily injury or loss of life or property damage arising out of alleged defects caused or created by GRANTEES and the use of the designated portion of the real property by the GRANTEE, its agents, employees. In addition, GRANTEES shall obtain liability and casualty insurance in an amount acceptable to the City which names the City of Okeechobee as additional named insured in the event of any demand or suit. This license and permission to use the property shall not be unreasonably restricted or terminated by the GRANTOR; however, GRANTOR or its assigns or successors in interest reserves the right to terminate this license and the described uses upon actual public necessity or for valid Municipal purposes upon 45 days advance notice. The City reserves the right to require removal of improvements or structures at any time, and any such removal shall be at the sole obligation and expense of the GRANTEE. IN WITNESS WHEREOF, GRANTOR and GRANTEE have set their hand and seal on the day and year above written. es E. Kirk, Mayor ATTEST: 7_ Bonnie Bonnie S. Thomas, CMC, City Clerk Approved for Legal Sufficiency: John R. Cook, City Attorney Steve Nelson, Okeechobee Okeechobee Discount Drugs, Inc. WITNESS: Page 2 of 2 Print Na r e /CA )LVA/ SASBI -1 OP ID: MB A �°,R° CERTIFICATE OF LIABILITY INSURANCE DATE 09 /24 /2013Y) 09/24/2013 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 Phone: 863 -467 -0600 ISU Lawrence Insurance Agency PO Box 549 Fax: 863 - 467 -5142 Okeechobee, FL 34973 Heath Lawrence NAMEACT PHOE FAX (A/C, NNo, Ext): (A /C, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Bridgefield Employers Ins Co LIABILITY COMMERCIAL GENERAL LIABILITY INSURED S.A.S.B., Inc dba Okeechobee Discount Drugs 203 Sw Park Street Okeechobee, FL 34972 -4160 INSURER B American States Insurance Co 19704 INSURER C : General Ins Co of America 24732 INSURER D : $ 1,000,000 INSURER E : $ 1 > 000 > 000 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS B GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 01C159534620 04/15/2013 04/15/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREMISES (Ea a o oc rED currence) c $ 1 > 000 > 000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1 ,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES j.T PER LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ C AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS 24CC30216720 04/15/2013 04/15/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000 000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A 0196 -04342 04/15/2013 04/15/2014 X WC STATU- TORY LIMITS OTH- ER EL EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 B Professional Liabi 01C159534620 04/15/2013 04/15/2014 Limit 1,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION 1 CTYOKEE 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 /t----2d1;■Kle-f---- ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SASBI -1 OP ID: MB A4i. -- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/10/12 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 863 - 467 -0600 ISU PO Box 549 863-467-5142 Insurance Agency 863- 467 -5142 Okeechobee, FL 34973 Heath Lawrence NAME: (p/C. No, Ext): (A FAX /C, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC 0 INSURER A : Bridgefield Employers Ins Co LIABILITY COMMERCIAL GENERAL LIABILITY INSURED S.A.S.B., Inc dba Okeechobee Discount Drugs 203 Sw Park Street Okeechobee, FL 34972 -4160 INSURER B: American States Insurance Co 19704 INSURER C : General Ins Co of America 24732 INSURER D : $ 1,000,000 INSURER E : $ 1,000,000 INSURER F : $ 10,000 CERTIFICATE NUMBER: REVISION NUMBER: vTHIS•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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD /YYYY) POLICY EXP (MM /DD /YYYY) LIMITS B GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 01C159534610 04/15/12 04/15/13 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 10,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES PRO- J T PER LOC $ C AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ X SCHEDULED AUTOS NON -OWNED AUTOS 24CC30216710 04/15/12 04/15/13 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Derr accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 01SU2012415 04/15/12 04/15/13 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 $ DED X RETENTION $ 10000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A 0196 -04342 04/15/12 04/15/13 X WC STATU- TORY LIMITS OTH- ER E.L EACH ACCIDENT $ 500,000 E L DISEASE - EA EMPLOYEE $ 500,000 E L DISEASE - POLICY LIMIT $ 500,000 B Professional Liabi 01C159534610 04/15/12 04/15/13 Limit 1,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required) CANCELLATION 1 CTYOKEE 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 ACORD 25 (2010/05) © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Apr. 21. 2011 10: 54AM CERTIFICATE OF LIABILITY INSURANCE No. 8776 P. 2 DATE (IIIMIDONYYY) 04/12/11 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: It the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) 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 (his certificate does not confer rights to the certIflcate holder In lieu of such endorsement(e). PRODUCER Lawrence insurance Agency, inc. PO Box 649 Okeechobee, FL 34973 Phone (863) 467 -0600 Fax (863) 467 -5142 INSURED S.A.S.B., Ino dba Okeechobee Discount Drug Okeechobee Discount Drugs 203 Sw Park Street Okeechobee, FL 34972 -4160 COVERAGES CERTIFICATE NUMBER: CO ACT M eft (883) 467 -0600 ADORFSS- rnarleneelawrenoelns.cOm INSURERIj AFFORDING CW ERAOE —1 �A I. Mel' (883) 487 -5142 INSURE Assurance Company or Ametica NATO s 19305 INSURER d • Bridgeleld Insurance Compan)r INSURER C : INSURER D : INSIatER C. INSURES!: REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEOABOVE 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. INBR ADOI 5UBR POLK:Y EFP POLICY EXP LIMITS LTR TYPE OF INSURANCE WSR WVo. POLICY NUMBER fMTNIDDrYYYY) (MMIDDIYYYY) GENERAL LIABILITY EACH OCCURRENCE 1 000 000.0O DA ® COMMERCIAL GENERAL LIABILITY PREMISES E oomu ante) S 1'O,�'00 A ❑ ❑ CLAIMS -MADE Q (C=UR PAS036229832 MED EXP (Any one person) S 10,000.00 ❑ 04115!2011 04/152012 PERSONAL &ADVPIJURY S 1,000.000.00 U GEML AGGREGATE LIMIT APPLIES PER: 97 POLICY ❑ ❑ Lot B A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED ❑ AUTOS HIRED AUTOS ❑ ❑ ASlTLEO NON.OWNED BC AUTOS El PAS038229632 04(15/2011 04/16/2012 GENERAL AGGREGATE PRODUCTS . COMP/OP AGO MEINED OLEUMIT (.:. ouden BODILY INJURY (Per person) BODILY INJURY (Per accident ER AMAGE e0Pr sec ER n $ 2,000,000.00 s 2,000000.00 $ 1,000,000.00 $ S $ • UMBRELLA UAB Q OCCUR ❑ EXCESS UAE ❑ CLNMSMADE ❑ DEO RFIENTION $ PAS036229632 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR,PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NNI If yyeess describe under DESCRIPTION OF OPERATIONS bele I I NIA 0196.04342 04/15/2011 04/15/2011 04/15/2012 04/15/2012 EACH OCCURRENCE AGGREGATE 5 S $ 2,000.000.00 s 2,000 000.00 S WC TORY S eERR EL. EACH ACCIDENT $ 500,000.00 E.L. DISEASE - EA EMPLOYE $ 500,000 00 E.L. DISEASE - POLICY LIMIT s 500,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space la required) •'30 Day WC /10 AO Other 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 0 1988.2018 ACORD CORPORATION. All rights reserved. ACORD 28 (2010/05) QF The ACORD name and logo are registered marks of ACORD u'Apr. 19. 2010 6:55PMAA 1iOkeechbee Discount DrugsAgencY No. 1522 IP. 2/004 ACORC71a CERTIFICATE OF LIABILITY INSURANCE PRODUCER (863) 467 -0600 PAX: (B63) 467 -5142 Lawrence Insurance 2020 5 Parrott Ave PO Box 549 Okeechobee FL 34974 DATE IMMIDOIYYY1 4/1/2010 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. INSURERS AFFORDING COVERAGE NAIC # INSURED S.A.S.B. INC DBA OKEECHOBEE DISCOUNT DRUG 203 SW PARK ST OKEECHOBEE FL 34972 -4160 INSURER A: Assurance Company of America 19305 INSURER 6: riorida Retail federation SIP INSURER C INSURER b INSURER 5: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREC NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWfTHSTAN DING 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. INd % LTR ADO'L NaRD TYPE OF INSURANCE POLICY NUMBER unman EPFECTryE DATE1NMID�'WYYI POLICY EXPIRATION OA'EJMII 1YYYY) LIMITS A / GENERAL X 'ABILITY COMMEROAL GENERALLIAaLITY PAs036229632 4/15 /2010 4/15/2011 EACH OCCURRENCE S 1, 000 , 000 PREMISES IEaEmartenee0 $ 1,000,000 I CLAWS MADE X OCCUR MED E)P (Anyoneperson) 10,000 PERSONAL & AOV IN,AIRY 6 1,000,000 S 2, 000, 000 GENERAL AGGREGATE GENI AGGREGATE LIMIT APPLIES PER: i] oucvf s& Fl Loc RP ODUCTS • COMP /OP AGG 6 2 000 000 A AUTOMOBILE X — _ X X LIABILITY ANY AUTO ALL OWNEO AUTOS SCHEDULED AUTOS HIRED AUTOS NON•OYYNEO AUYOA PAS036229632 4/15/2010 4/15/2011 COMBNEO SINGLE LIMIT (Eseccidenq 5 1,000,000 BODILY INJURY (Per person) BODILY INJURY (PH to ccddent) PROPERTY DAMAGE (Pet accident) $ GARAGE �—' LIABILITY ANY AUTO AUTO ONLY - GA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS:LMBRELLALIABILITY I ___I PA6036229632 4/15/2010 4/15/2011 EACH OCCURRENCE S 2,000,000 OCCUR X CLAIMS MAOE DEDUCTIBLE RETENTION 5 AGGREGATE 6 2,000,000 $ 5 B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETCAPARYNERIF QITIYE n OFPICER/hENEEP EXCLUDED') OT I I (MandIoyln NH) Il ye S. deemse under SPECIAL PROY1StONS MON 0196 -04342 4/15/2010 WCSTATU, I X 10T 0TH• TORY LIMITS ER E.L. EACH ACCIDENT 5 500, 000 4/15/2011 E.L. DISEASE - EA EMPLOYEE $ 500, 000 E.L. DISEASE - POLICY LIMIT 5 500,000 OTF I' 1 DESCRIPTION Or OPERATIONS I LOCATIONS I VEHICLES I EKC WsIDNS ADDEo BY ENDORSEMENT I SPECIAL PROVISIONS A *30 Day Tic /10 All Other CANCELLATION frz 3L/97�' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, TIE ISLAND INSURER WILL ENDEAVOR TO MAIL t E DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT', BUT FAILURE TO DO 30 SWILL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, 1T3 AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATNE Heath Lawrence /MHB ACORD 25 (2009101) IN5025 (2009D1) ®1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORO Apr 0,8 2009 3:25PM Okeechobee Discount Drugs 863 - 763 -8556 ..v�ca cut,c £U agency 7G 5Ii p.2 1001/001 _ ACORD CERTIFICATE OF UA61t_tTY INSURANCE I 323/ 20 n' PROOMER (863) 467 -0600 Tax (963) 467 -5142 Lawrence Insurance 2020 S Parrott Ave PO Box 549 Okeechobee FL 34974 ' 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. INSURERS AFFORDING COVERAGE NAIC 0 IPSUEO S.A. S. B. INC DEA OKEECKOBEE DISCOUNT DWG 203 SW ARK ST 203 SW Park Street OK ECHOBEE FL 34972 -4160 INsURERAASBnrance Company of 19305 INSuRERB: Florida Retail Federation INSURER c INSURER D. INSURERE ;OVERAGES THE POLICES REQUIREMENT, THE INSURANCE OF NSURANCE LISTED BELOW TERM OR CONDITION OF ANY AFFORDED BY THE POLICIES TE LIMITS SHOWN MAY HAVE LSE HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY' CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. DESCRIBED HEREIN IS SUBJECT TO AU. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POUCY NUMBER rI O RATE t1MDY POUCY (I WO1fYYY) DANS L LIMITS A GEERM.LIABA?TY PAS036229632 4/15/2009 4/15/2010 EACH OCCURRENCE S 1, 000, 000 X COMMERCIAL GENERAL .ITT DAMAGE PREM S Ee occurrence) nce) S 1,000,000 1 CLAIMS MADE X OCCUR NEDEXP(Any DIN Palrson) S 10,000 PERSONAL 6 AOvINJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GENT. AGGREGATE UNIT APPLIES PER' ' ( 1 J POLICY I T fl L04 PRODUCTS - COMPOOP ',Gs i 2,000,000 A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS RAS036229632 4/15/2009 4/15/2010 ♦ COMBINED SINGLE LIMIT (Ea aosdeoO $ 1,000,000 BODILY INJURY (Pm person) BODILY INJURY • (Pr Accident) PROPERTY DAMAGE (PIn accident) GARAGE immure 7 ANY AUTO AUTO ONLY -- EA ACCIDENT $ OTHER THAN EA ACC i AUTO ONLY' AGO 5 A ,] EXCESSAMMBRELLA LIABILITY X j occuR CL AIMS MADE DEDUCTIBLE RETENTION $ PASO36229632 04/15/2009 04/15/2010 UCH OCCURRENCE t 2,000,000 AGGREGATE i 2,000,000 i i i B W V RKERS CO OPERSAT10N AND EMPLOY®ILY LIABILITY ANY PROPRIET'ORRARTNER/EXECUTIVE OFFICER/MEMBER E X C L U D E D ? II yes. dos atm endow SPECIAL PROVISIONS Wow 0196 -04342 04/15/2009 04/15/2010 yyr';$7 �'�y I TORY L W ITS 1 X 1 E E.L. EACH ACOOENT I 500,000 E.L. DISEASE. EA EMPLOYEE I 500 , 000 E.L. DISEASE- POLICY UMT i 5004000 OTHER DESCRIrfON OF OrERATW16LDCAT10rismalCLEDEXCLUS10 $T.4 ADDEO BY ENDORSEMENT/SPECIAL PROVISONS * *30 bay NC /10 AL1 Other CERTIFICATE HOLDER CANCELLATION SHOULD ANN OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER MALL ENDEAVOR TO MAIL * * DAYS NATTER NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FNLURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABLRY OF AN F KIND UPON THE INSURER, ITS AGENTS DR REPRESENTAYIVES. AUTHORIZED REPRESENTATIVE Heath Lawrence /I*IB ACOfiD 25 (2001/08) INS025 (OIDe) °ea 0 ACOR D CO RPORATION 1988 Page for 2 A.CORD CERTIFICATE OF LIABILITY INSURANCE PRODUCER (863)467 -0600 FAX (863)467 -5142 Lawrence Insurance Agency, Inc P. 0• Rol. 949 2020 S Parrott Ave Okeechobee, FL 34973 -0549 INSURED S.A.S.B. INC DBA OKEECHOBEE DISCOUNT DRUG 203 SW PARK ST 203 Sw Park Street OKEECHOBEE, FL 34972 -4160 COVERAGES 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. I DATE (MM/DD/YYYY) 11/02/2006 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Assurance Company of America INSURER B: Florida Retail Federation SIF INSURER C: INSURER D: INSURER E: 19305 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' LTR NSR • TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION GENERAL LIABILITY DATE (MWDD/YY) _ DATE (MM /DD/YY) PAS036229632 04/15/2006 04/15/2007 B A COMMERCIAL GENERAL LIABILITY CLAIMS MADE I X I OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JT n LOC OLICY [1 EC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY ANY AUTO PAS036229632 04/15/2006 1 04/15/2007 EACH OCCURRENCE LIMITS DAMAGE TO REN I ED PREMISES (Ea occurence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP /OP AGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) 1,000,000 1,000,000 10,000 1,000,000 $ 2,000,000 $ 2,000,000 1,000,000 EXCESS/UMBRELLA LIABILITY OCCUR I I CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER rofessional Liability PASO36229632 0196 -04342 PAS036229632 04/15/2006 (04/15/2007 04/15/2006 04/15/2007 04/15/2006 1 04/15/2007 IESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS 30 Day WC /10 All Other :ERTIFICATE HOLDER AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: EACH OCCURRENCE AGGREGATE EA ACC AGG 01H- TORY LIMITS I X I ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE POLICY LIMIT 2,000,000 $ 2,000,000 $ 500,000 500,000 500,000 Limit $1,000,000 Aggregate $1,000,000 City of Okeechobee Attn: Lane Gamiotea 55 SE 3rd Ave Okeechobee, FL 34974 CORD 25 (2001/08) FAX: (863) 763 -1686 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ** 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 INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENT —r HU ATIV Jd €%Heath Lawrence / COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSI IRFn NAMFn ARM /c GnD Tuc Dni iry ©ACORD CORPORATION 1988 ACORD CERTIFICATE OF LIABILITY INSURANCE PRODUCER (863)467 -0600 FAX (863)467 -5142 Lawrence Insurance Agency, Inc P. 0. Box 549 2020 S Parrott Ave Okeechobee, FL 34973 -0549 INSURED S.A.S.B. INC DBA OKEECHOBEE DISCOUNT DRUG 203 SW PARK ST 203 Sw Park Street OKEECHOBEE, FL 34972 -4160 COVERAGES I DATE (MM /DD/YYYY) 01/18/2005 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORM ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXT ALTER THE COVERAGE AFFORDED BY THE POLICI INSURERS AFFORDING COVERAGE ION E D OR BELOW. NAIC # INSURER A: Assurance Company of Americ INSURER B: Fl INSURER C: 19305 orida Retail Federation .IF INSURER D INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY '•ERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH T S CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADD'L NSRC INSR LTR TYPE OF INSURANCE GENERAL LIABILITY X POLICY NUMBER COMMERCIAL GENERAL LIABILITY CLAIMS MADE X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: —1 POLICY I I JECOT [7 LOC B AUTOMOBILE LIABILITY X PAS036229632 POLICY EFFECTIVE DATE (MM /DD/YY) 04/15/2004 ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS /UMBRELLA LIABILITY OCCUR I CLAIMS MADE IDEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIO PAS036229632 POLICY EXPIRATIO DATE (MM /DD 04/15/2 04/15/20'4 °30 Day WC /10 All Ot er 0196 -04342 5 LIMITS EACH OCCURRENCE DAMAGEIO RENTED PREMISES (Ea occurence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP /OP AGG 1,000,000 1,000,000 10,000 1,000,000 2,000,000 2,000,000 04/15/2005 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) 1,000,000 BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: EA ACC AGG 04/15/2004 04/15/2005 S / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HO ' ER ty of Okeechobee 5 SE 3rd Ave Okeechobee, FL 34974 ACORD 25 (2001/08) FAX: (863)763 -1686 CANCELLATION EACH OCCURRENCE AGGREGATE X WC SI ATU- -0TH- TORY LIMITS I ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE 500,000 500,000 E.L. DISEASE - POLICY LIMI U 500,000 SHOULD ANY OF THE ABOVE DESCR'E. P • ES BE CAN - . �EFORE THE EXPIRATION DATE THEREOF, THE ISSUING INS I2 R WILL'S D ^' VOR TO MAIL '. " 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 INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Heath Lawrence