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Nunez/4 Girls EnterprLICENSE AGREEMENT FILE Kl NUN ._�'�_u:14J:,,. ,761 1.1 00S29 PG 1486 SHARON ROBERTSON, CLERK OF CIRCUIT COURT OKEECHOBEE COUNTY, FL RECORDED 04/26/2004 01 :15:31 RECORDING FEES 10.50 RECORDED BY R O'Neill THIS AGREEMENT, BY AND BETWEEN THE CITY OF OKEECHOBEE, FLORIDA, a Florida Municipal corporation (hereinafter "CITY "), D & A SOD LANDSCAPING INC. (hereinafter "OWNER(S) "), dated this 21st day of April , 2004. WHEREAS, OWNER (S) hold fee simple title to the following described real property in Okeechobee County, Florida, to wit: Lots 3, 4, and 5 Block 77, CITY OF OKEECHOBEE, Public Records of Okeechobee County, Florida; and WHEREAS, the OWNER(S) desire to make certain improvements in the form of paving or concreting and maintaining only the Northern fifteen by one hundred forty feet (15'x140') of the alleyway located between the Lots 4 and 5, and Lot 3 of said Block 77, and installation of parking lot striping, located, within the right -of -way and alley as described which is an open, unimproved right -of -way. Which right -of -way is own ed by the CITY. NOW, THEREFORE, in consideration of the mutual promises and covenants set forth herein, the parties agree as follows: date. 1. The CITY hereby grants this revocable license for use of the right -of -way with the understanding the OWNER(S) will maintain the right -of -way and should it ever become necessary to remove a fence, paving, concrete, structure or any improvement thereon, in order to allow either the installation, or maintenance of water, sewer, or other utility lines or any other type of installation or construction, or for any other reason chosen by the CITY, the fence, or any improvement thereon, will be removed by the OWNER(S) or their agents and /or assigns at the OWNER(S) expense within seven days of receipt of written request by the CITY for such removal. Should the CITY, for valid reasons, require the removal of the fence, or any improvements thereon less than seven days notice, the OWNER agrees to exercise reasonable efforts to comply with such requests. 2. OWNER(S) agree to contact their insurance company and require a rider be added to their insurance policy with a certificate furnished to the CITY showing the portion of the alleyway as herein described, to be used by them, insures the CITY against any liability arising out of alleged injuries or other activities which may occur within the right -of -way. In any event, OWNER(S) agree and shall hold the CITY harmless for any and all action, suit, claim, injury or cause of action of any nature arising out of owner's permissive use, and indemnify CITY for such, including costs and attorney fees. 3. That OWNER(S) shall not, by such improvements made to that described alley, obstruct, close or otherwise restrict access to the alley for travel thereon by the CITY or the general public. 4. That the OWNER(S) agree that this license is non - assignable without the express written consent of the CITY; and if transferred, the covenants herein shall bind themselves, their heirs and assigns, and said covenants shall run with the land. 5. The City Clerk shall cause this agreement to be recorded in the public records of Okeechobee County, Florida. IN WITNESS WHEREOF, the parties hereto set their hands and seals on the aforesaid Page 1 of 2 Signed, sealed and delivered in presence of: Witness Print Nam e% 7.13 41--ue 4 Address:/A-37/11/67&,&_4___" Witness Print Na e: - Mier� Address: / &37/ tilt 1 -e_ ted for the City: Donnie Robertson, Public Works Director Reviewed for Legal Sufficiency: John R. Cook, City ttorney OR BK 'J' :152 9 PG 1487 David Nunez, Own D & A Sod Lands g, Inc. Anita Nunez, Owner D & A Sod Landscaping, Inc. Page 2 of 2 JoAtice Lane amiotea ;'City Clerk A`C 'RO D V CERTIFICATE OF LIABILITY INSURANCE DATE (MM/OD/YYYY) 07/17/2014 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 poiicy(ies) must be endorsed. If SUBROGATION 15 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 Marcum Inc. P.O Box 400 Okeechobee, FL 34973 INSURED 4 Girls Enterprises, Inc. 701 NE 3rd Street Okeechobee, FL 34972 Phone:(863) 467 -0611 CONTACT William E. Marcum NAME: PHONE 863- 763 -0089 (AtC M9 ,.Ext) :. E-MAIL admin m marcurn.com ADDRESS: Y INSURER (SI AFFORDING COVERAGE INSURER A : Travelers Indemnity Company INSURER B INSURER C : INSURER D INSURER E : INSURER F FAX 863 -763 -5678 (A/C, No); NAIC 11 25658 COVERAGES CERTIFICATE NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INDICATED, NOTWITHSTANDING ANY REQUIREMENT, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. INSR. -.. SAD LTR TYPE OF INSURANCE � INSP...., Ma... V IJIViV rV Vn11OCIN INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 5UBRi [MMtDO/YY F 1 POLICY rr _.... WVD' POLICY NUMBER YY)i(MnwoolYYm � LIMITS A i GENERAL LIABILITY i XI COMMERCIAL GENERAL I - - - -- CLAIMS -MADE 1 �GEN L AGGREGATE LIMIT /\ PCtLICY PRO- JECT LIABILITY j OCCUR APPLIES PER: LOC SCHEDULED I AUTOS ,, NON -OWNED AUTOS :. 1- 660 - 70100436- IND -13 (I 12/20/2013 1 12/20/2014 ' TEACH OCCURRENCE DAMAGE TO RENTED... PREMISES/Ea occurrence) i MED EXP (Any one person) 1 PERSONAL s ADV INJURY GENERAL AGGREGATE ' IryftGDUCTS- f,OMPlOP AGG COMBINED SINGLE LIMIT {Ea accident) BOOR Y INJURY {Per person) BODILY INJURY (Per axident) PROPERTY DAMAGE { Per accident) s 006,000 $ 100,060 _ $ 5,000 $ 1,000,000 $ 2,000;000 - $ 2,000,000 $ - $ $ _ $ AUTOMOBILE 1 LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS UMBRELLA LIAR . OCCUR LESS LIAB CLAIMS -MADE ' DED j ■ RETENTION $ ` . EACH OCCURRENCE AGGREGATE $ S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE NIA! A : OFFICER/MEMBER EXCLUDED' �j '' (Mandatory in NH} i Pf yes, describe under j DESCRIPTION OF OPERATIONS t�eloty 1 i� 1 I WC STATU- I OTH- __ TORY LIMITS , ER _ E.L. EACH ACCIDENT $ - -- -- - -_ E.L DISEASE EA EMPLOYEE $ ..... -__ -- E.L. DISEASE - POLICY LIMIT 5 DESCRIPTION OF OPERATIONS 1 LOCATIONS !VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RTtFICATE HOLDER CANCELLATION City of Okeechobee 55 S.E. Third Avenue Okeechobee, FL 34974 Phone: 863 -763 -3372 Fax: 863 - 763 -1686 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 William E. Marcum ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. Ali rights reserved. The ACORD name and logo are registered marks of ACORD MRR- 21- 2013(THU) 13:39 SEMINDLE DESIGN -BUILD INC. ACtt7R;:' (FRX)8634670610 P.002/003 CERTIFICATE OF LIABILITY INSURANCE EMU (MMLI ►YYYY) 03/2112013 THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 'MIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EMEND OR ALTER THE COVERAGE AFFORDED BY THE POUCMES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CQN67YTUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CER71FICATE HOLDER. IMPORTANT: 11 the certificate holder NI an ADDITIONAL INSURED, the policy(les) must be endorsed. M SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, oath n policies may requlrs an endorsement A statement on this certificate does not confer sights to the certificate holder In Ileu of such erldersemonUs). PRODUCER - - Marcum Inc. P.o. Box 400 Okeechcpbee, FL 34973 INSURED 4 Girls Enterprises, Inc. 610 N. Parrott Ave. Okeechobee, FL 34972 T Sursha A.HOYENs tM. Nat, 88. 47 -1283 SURM(8J4rraaala 0 COYERAes IN$UAER A : Travetars insurance Comm INOSIRER a: INMURIAC: IN8URaR D : INSURER! INSURER F: NM • COVERAGES CERTIFICATE NUMBER: • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 70 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, `. TYPE Or INSURANCE ICIDCWITIT OMR HARI PDAdcY NUme®r ImAED (AVOW LIWTS A L1eN8RALUASIUTY • I- I- 860- TC100436- T1A -12 12120/2012 12/02/2013 !AAOIOCCURRENCE $ 1,000,000 X COmCLAIM8L GENERAL LIABILITY 7 CLAiMI/ -MADE n OCCUR PREMISE8Ike Qf�10•[IC8) 8 100,000 MED EXP (Ana onapenion1 0 6.1100 .3 1,000,000 $ 2,000,00 PERSONAL AAOVINJURY GENERAL AGGREGATE _GG 1N1. AGGREGATE UNIT APPLIES PER I POLICY I LIg f Lac PRODUCTS - COMP/OP AGG tom_ e AUTOMOSIL8 LIABILITY r OM !6$II�P LIMIT $ — -. -__ ANY AUTO _ _ BODILY INJURY (Per person) 1 ALLOY ED HIRED AUTOS SCHEDULED AUTOS D AUTOS BODILY INJURY (Par accident 1 _ $ UMBRELLA LIAO !)LOESS UM .r_.. moot CLAIMS -MACE I r i _ EACH OCCURRENCE 8 AGGREGATE $ DEO 1 RETENTION$ S WORKERS COMPENSATION AND EMPLOYERS' UABIUTY Y/ M ANY PROPRIETORIPARTNER/EXECUTIVE OFFICEAAEMSER!XCLUO D? E (Mandatory In MI under rIIFFnMCRl�MN rwnPFRATIONX bean NIA WCSTATU• 1 IOfN TORY LINT A l 1 A ! L L EACH ACCIDENT E.L. OIS ASE - EA EMPLOYEE 0 !.L DISEASE • POLICY LIMIT B �MI �-'`'' DESCRIPTION OP OPERATIONS / LOCATIONS / VEHICLES (Mean ACORD 101, Addnbnal Nanarlq Oonssue, N mare apace a rasulra0l CERTIFICATE HOLDER CANCELLATION City of Okeechobee 55 SE Third Ave. Okeechobee, FL 34974 SHOULD ANY OF THE ABOVE D6aCRIBBD POLICIES OE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITHIN!! POLICY PROVISIONS. AUTHORIZED RMPRESPNTATN! William E. Marcum 101938 -2010 ACORD COR )RATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD !l! MRR- 21- 2013(THU) 13:39 SEMINOLE DESIGN -BUILD INC. .............mn=1.11.0sismo eau' . irlir Nuilitoincultatiigunug imo TRAVELERS? (FRX)8634670610 P. 003/003 One Tower Square, Hartford, Connecticut 06183 COMMERCIAL GENERAL LIABILITY POLICY NO.: I-660-7C100436-TI A-12 COVERAGE PART DECLARATIONS ISSUE DATE; 12 -26 -12 INSURING COMPANY: THE TRAVELERS INDEMNITY COMPANY OF AMERICA DECLARATIONS PERIOD: From 12-20-12 to 12 -20 -13 12:01 A.M. Standard address shown In the Common Policy Declarations. The Commercial General Liabflhy Coverage Part consists of these Declarations and below, 1. COVERAGE AND LIMITS OF INSURANCE: COMMERCIAL GENERAL LIABILITY COVERAGE FORM General Aggregate Limit (Other than Products - Completed Operations) Products-Completed Operations Aggregate Limit Personal & Advertising Injury Limit Each Occurrence Limit Damage To Premises Ranted To You Limit (any one premises) Medical Expense Limit (any one person) 2. AUDIT PERIOD: NONE 3. FORM OF BUSINESS: CORPORATION Time at your malting the Coverage Form shown LIMITS OF INSURANCE $ 2,000,000 $ 2.000,000 $ 1.000,000 $ 1.000,000 $ 100,000 $ 5.000 4. NUMBERS OF FORMS, SCHEDULES AND ENDORSEMENTS FORMING PART OF THIS COVERAGE PART ARE ATTACHED AS A SEPARATE LISTING. COMMERCIAL GENERAL LIABILITY COVERAGE IS SUBJECT TO A GENERAL AGGREGATE LIMIT CO TO 01 11 03 PP0bUCER: STANDARD LINES BROKERAGE VG678 OFFICE: TAMPA FL Page 1 of 1 247 AFRO CERTIFICATE OF LIABILITY INSURANCE OP ID: J2 DATE (MM /DDNYYY) 07/01111 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 Pritchards & Associates, Inc. 1802 S Parrott Ave Okeechobee, FL 34974 -6179 Lowell H Pritchard 863 - 763 -7711 863 - 763 -5629 CONTACT NAME PHONE (A /C, No Ext): E-MAIL ADDRESS. PRODUCER CUSTOMER ID FAX (A /C, No): 4G1 RL -1 INSURER(S) AFFORDING COVERAGE NAIC # INSURED 4 Girls Enterprises, Inc. 701 NE 3rd Street Okeechobee, FL 34972 INSURER A : Nautilus Insurance Company INSURERB -Omega US Insurance, Inc 12961 INSURER C 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. INSR LTR TYPE OF INSURANCE A GENERAL LIABILITY LIT . AIM _- r.a -.oE X C -ELI L AFPL.ES PET PPE - P� L ADDL _INSR SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP (MMlDDNYYY) (MMIDDlYYYY) LIMITS N N 065280 10127/10 10/27/11 La_HLCLuPPENCE S TAMA-ETO DENTE "GEM DES 1Ea; ur n e 1,000,000 100,000 DIED E ,nri $ 5,000 ^EF1EL HA,L L AI Le' 1,1J- 1 �''r' I- E1LEP P _D.MFN_,FG1.. $ i ^E181NEC 1,000,000 2,000,000 Included AUTOMOBILE LIABILITY GNI AL -- `i 1='EJAU SING ,LE. LIMIT :ES TLcEient) =LSD L'% Ir,JU =Y 1,F�- person! $, -i iL. I6..0 , .Ee-Ar rri-nl -'F +LFI L• °:P,4 A..._ UMBRELLA LIAB , EXCESS LAB CEDED T ELT F'ETEL,TITT _ -_H RPEL?E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ar EF PPITT P LP''I P`ExESI_ TfL.E DEFI ER. MEM EF E.o =U IEE N 1 A (Mandatory in NH) It - te=rek - .,n i1P, DE _F'1 =L114 PE' TINS 'Sel,Sw TLLT LIMIT E L E?�IH = IDE'I- -- E I:LEA.,E E.L. EMEL._, EE $ $ 1 TH I EP _L CASE `.E -R LIB_ i LIM B Property Section OUS032000734 12/14/10 12114/11 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule. if more space is required) City of Okeechobee is listed as additioanl insured in respects to the General Liability policy. CERTIFICATE HOLDER OKEEC -4 City of Okeechobee 55 SE 3rd Ave. 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 "p L g ACORD 25 (2009/09) (D 1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD VCR 1 Ir1%.,m I C jr LIHa1L1 I T IIVJVRHIVk►C I 11/10/10 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 Pritchards & Associates, Inc. 1802 S Parrott Ave Okeechobee, FL 34974 -6179 Lowell H Pritchard 863 - 763 -7711 863 - 763 -5629 CONTACT NAME: PHONE (A/C, No, Ext): E -MAIL ADDRESS: FAX (A /C, No): PRODUCER 4GIRL -1 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED 4 Girls Enterprises, Inc. 701 NE 3rd Street Okeechobee, FL 34972 INSURER A : First Community Ins Company 13990 INSURER B : INSURER C : 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF IMMIDDIYYYY) POLICY EXP (MM /DDIYYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR 090004974813801 10115110 10115/11 EACH OCCURRENCE $ PREMI E TO REN rED PREMISES (Ea occurrence) $ 50,00( CLAIMS -MADE MED EXP (Any one person) $ 5,00( X _ Business Owners PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ POLICY PF —� LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N / A WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ - below E.L. DISEASE - POLICY LIMIT $ BUILDING 602,30' DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION OKEEC -4 City of Okeechobee 55 SE 3rd Ave. 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 c5� -r' © 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD From:Janet LaCroix FaxID: Page 1 of 2 Date:1/20/2009 02:04 PM Page:1 of 2 OP ID JL ACORD_ CERTIFICATE OF LIABILITY INSURANCE 4GIRL-1 DATE (MWOD/YY Y) 01/20/09 PRODUCER Pritchards & Associates , Inc . 1802 S Parrott Ave Okeechobee FL 34974 -6179 Phone: 863- 763 -7711 Fax: 863- 763 -5629 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 4 Girls Enterprises, Inc. 610 N. Parrott Avenue Okeechobee FL 34972 INSURER A. rirst community rim company 13990 INSURER B: GENERAL INSURERC 090004974813800 INSURER D: 10/15/09 INSURER E: $ 2, 000 , 0 0 0 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. 1NsR LTR tNJD'L NSRD TYPE OF INSURANCE POLICY NUMBER DATE (M�MIDDm POLICY EXPIRATION—. LIMBS A /PREESSSEENNpT/ATTIVES. AUTH`/, P�. GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY 090004974813800 10/15/08 10/15/09 EACH OCCURRENCE $ 2, 000 , 0 0 0 PREM ISES (Ea occuence) $ 50000 CLAIMS MADE X OCCUR MED EXP (My one person) $ 5000 X Business Owners PERSONAL & ADV INJURY $ Included GENERAL AGGREGATE $ 4,000,000 GENL AGGREGATE LIMIT APPLIES PER: POLICY PEa LOC PRODUCTS - COMP /OP AGG $ 2,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY IOCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes. describe under SPECIAL PROVISIONS below WC S TS 01H- TORY LI MMI ITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER BUILDING 556868 PROPERTY 10000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES I EXCLUSIONS ADDEO BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION OKEEC -4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of Okeechobee 55 SE 3rd Ave. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Okeechobee FL 34974 RE /PREESSSEENNpT/ATTIVES. AUTH`/, P�. 001108) ®ACORD CORPORATION 1988 From:Jessika Siefker FaxID: Page 1 of 1 Date:10/27/2011 09:09 AM Page:1 of 1 OP ID: J2 .4WRO" CERTIFICATE OF LIABILITY INSURANCE DATE 10 /27DNWV) 10/27111 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 - 763 -7711 Pritchards & Associates, Inc. 1802 S Parrott Ave 863 - 763 -5629 Okeechobee, FL 34974-6179 Lowell H Pritchard NAME: Rachel Williams PHONE FAX (Alc, No. Ext): 863- 763 -7711 (MC, No): 863- 763 -5629 ADDRESS: rwilliams @pritchardsinc.com PRODUCER 4GIRL -1 CUSTOMER ID*: INSURER(S) AFFORDING COVERAGE NAIC t INSURED 4 Girls Enterprises, Inc. 701 NE 3rd Street Okeechobee, FL 34972 INSURER A: Nautilus Insurance Company LIABILITY X INSURER B : Om eg a US Insurance, Inc 12961 INSURER C : TBD INSURER D : 10/27/12 INSURER E : $ INSURER F : DAMAGE TO RENTED PREMISES (Ea occurrence) 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 SUER WVD POLICY NUMBER POLICY EFF (MMIDD/YYYV) POLICY EXP (MMIDD/VYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X OCCUR X TBD 10/27/11 10/27/12 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100 000 CLAIMS -MADE MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER 7 POLICY PRO JECT LOC PRODUCTS - COMP /OP AGG $ Included $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETORIPARTNERJEXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS below N / A WC STATU- OTH- TORY LIMITS ER E L EACH ACCIDENT $ E . DISEASE - EA EMPLOYEE $ E L DISEASE - POLICY LIMIT $ B Property Section OUS032000734 12/14/10 12/14/11 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHCLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Okeechobee is listed as additioanl insured in respects to the General Liability policy. CERTIFICATE HOLDER CANCELLATION OKEEC-4 City of Okeechobee 55 SE 3rd Ave. 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 RE ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD