Blk 57 City of Okee/Trent/Alley Lots 5-7 & 15-17CC _
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10506 MiE1666
LICENSE AGREEMENT
THIS AGREEMENT, BY AND BETWEEN THE CITY OF OKEECHOBEE, FLORIDA,
a Florida Municipal corporation (hereinafter "CITY "), RON TRENT (hereinafter "OWNER(S) ",
dated this a,S- day of __TvLY , 2003.
WHEREAS, OWNER (S) hold fee simple title to the following described real property
in Okeechobee County, Florida, to wit:
Lots 15, 16, 17, Block 57, and lots 5, 6, & 7 Block 57, CITY OF
OKEECHOBEE, Public Records of Okeechobee County, Florida; and
WHEREAS, the OWNER(S) desire to make certain improvements in the form ofplacing
concrete over an alleyway between the Tots listed above, and installation of chainlink fence
with gates, located. within the right -of -way and alley as described which is an open,
unimproved right -of -way. Which right -of -way is owned by the CITY.
NOW, THEREFORE, in consideration of the mutual promises and covenants set forth
herein, the parties agree as follows:
03 JUL 25 P11 1: 23
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 the fence, 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.
O 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
Lai the portion of the alleyway as herein described, to be used by them, insures the
Cn
CITY against any liability arising out of alleged injuries or other activities which
0'j 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 the OWNER(S) agree that the covenants herein shall bind themselves,
their heirs and assigns, and said covenants shall run with the land.
4. 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
date.
Signed, sealed and delivered in presence of:
Rznald TLc�1L
cepyed for the
Donnie Robertson, Public Works Director
Revived for Leg • S
iciency:
John R. Cook, City Attorney
Page 1 of 1
C2)?`QIC
Witness
"Oak 11/1. &MVJ
Witness
Lan .Gamiotea, City Clerk
08- 13 -'14 13:10 FROM -Farm Bureau
863 - 385 -5356 T -432 P0002/0002 F -749
CERTIFICATE OF INSURANCE
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 LISTED BELOW.
The policies of insurance IiSted below have been issued to the insured named above and are in force at this time. 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 01 such policies.
CO.
LTR
COMPANIES AFFORDING COVERAGES:
FLORIDA FARM BUREAU INSURANCE COMPANIES
POLICY EFFECTIVE DATE
(MM /DDNY)
P.O. BOX 147030
Company
Letter A;
GAINESVILLE, FLORIDA 32614 -7030
9523253
04/25/2014
Florida Farm Bureau General Ins. Co.
NAME AND ADDRESS OF INSURED:
company
QUIK - STOR INC
Letter B:
& /OR RONALD TRENT
$ 300
709 NE 2ND AvE
Florida Farm Bureau Casualty Ins. Co.
OKEECHOBEE FL 34972 -2659
$ 5 0
The policies of insurance IiSted below have been issued to the insured named above and are in force at this time. 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 01 such policies.
CO.
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE DATE
(MM /DDNY)
POLICY EXPIRATION
DATE (MM /DD/YY)
ALL LIMITS IN THOUSANDS
A
General Liability:
�r
Ivl Commercial General Liability
(Occurrence FOOT))
❑ Owner's & Contractor's
Protective
❑ Farmer's Personal Liability
9523253
04/25/2014
04/25/2015
General Aggregate
$ 600
Products comoteted
operatrons aggregate
$ 600
Personal a Advertising Injury
$ 300
Each Occurrence
$ 300
Fire Damage (Any one lire)
$ 5 0
Medical Expense (Any one person)
$ 5
Automobile Liability:
❑ Any auto
0 All owned autos
❑ Scheduled autos
❑ Hired autos
❑ Non -owned autoe
?
'
� `\I ;
\ p . -C'
Al �
1',U
''
0
ft
Combined
Single unit
$
Bodily Injury
(Per Person)
$
Bodily injury )
(Per Accident
$
Property
Damage
$
Excess Liability:
❑ Umbrella Form
❑ Other than Umbrella Torm
'
'.■ 'y.
I • ' !.
oc ua h
$
Aggregate
$
Employers Liability:
0 Farm Employers Liability
❑ Farm Employee's Medical
°'
'' :i.i.:..:i.
;it ' ;:':
.,,.r...
si ::
$
(EacltCccurrencel
$
acnEmplorar)
Other:
.;:. .
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES:
709 NE 2ND AvE
OKEECHOBEE FL 34972
CANCELLATION: Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to
mail J 0 days written notice to the below named certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind
upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER;
COUNTY CODE
28 DATE ISSUED 08/13/14
Serviced by HIGHLANDS
County Farm Bureau
JOSEPH BULLINGTON
AUTHORIZED REPRESENTATIVE
93 -7 -692 (Rev. 5/93)
11- 12 -'13 16:08 FROM-
863 - 385 -5356
CERTIFICATE OF INSURANCE
T -640 P0002/0002 F -465
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 LISTED BELOW.
FLORIDA FARM BUREAU INSURANCE COMPANIES
COMPANIES AFFORDING COVERAGES:
P.O. BOX 147030
Company
POLICY EXPIRATION
DATE (MMIDO/YY)
Letter A:
GAINESVILLE, FLORIDA 32614 -7030
A
General Liability:
' commercial General Liability
(Occurrence Form)
❑ Owner's & Contractor's
Protective
❑ Farmer's Personal Liability
Florida Farm Bureau General Ins. Co.
NAME AND ADDRESS OF INSURED:
Company
QUIK - STOR INC
Letter B:
& /OR RONALD TRENT
$ 600
709 NE 2ND AVE
Florida Farm Bureau Casualty Ins. Co.
OKEECHOBEE FL 34972 -2659
$ 300
e po ic'es o insurance listed below have been issued to the msufed named above and are In force at this time. 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.
CO.
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE DATE
(MMIODNY)
POLICY EXPIRATION
DATE (MMIDO/YY)
ALl LIMITS IN THOUSANDS
A
General Liability:
' commercial General Liability
(Occurrence Form)
❑ Owner's & Contractor's
Protective
❑ Farmer's Personal Liability
9523253
04/25/2013
04/25/2014
General Aggregate
$ 600
Products-completed operations
oper aggregate
$ 600
Personal a Advertising Injury
$ 300
Each Occurrence
$ 300
fire Damage (A y one fire)
$ 50
Medical Expanse (Any one person)
$ g
Automobile Liability:
❑ Any auto
❑ All owned autos
❑ Scheduled autos
❑ Hired autos
❑ rvon -owned autos
Combined
Single Unit
$
Bodily Injury
(Per Person)
$
BOdily Injury
(Per Accident)
$
Property
Damage
$
Excess Liability:
❑ Umbrella Form
❑ Other than Umbrella form
Occurrence
Aggregate
Employers Liability:
❑ Farm Employer's Liability
❑ Farm Employer's Medical
$
(Earn Ocarcencs)
$
(Earl Employee'
Other:
,. ... :. .
DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES:
CANCELLATION: Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to
mail I days written notice to the below named certificate holder. but failure to mail such notice shall impose no obligation or liability of any kind
upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER:
COUNTY CODE 28
DATE ISSUED 11/12/13
Serviced by HIGHLANDS County Farm Bureau
JOSEPH BULL INGTON
AUTHORIZED REPRESENTATIVE
93-7-692 (Rev. 5/93)
03- 15 -'13 09:18 FROM- 863 - 385 -5356
CERTIFICATE OF INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
THIS CERTIFICATE DOES NOT AMEND, EXTEND CR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW.
T -673 P0002/0004 F -872
FLORIDA FARM BUREAU INSURANCE COMPANIES
P.O. BOX 147030
GAINESVILLE, FLORIDA 32614 -7030
NAME AND ADDRESS OF INSURED:
QUIK -- STOR INC
709 NE 2ND AVE
OKEECHOBEE FL 34972 -2659
COMPANIES AFFORDING COVERAGES:
Company
Letter A:
Florida Farm Bureau General Ins. Co.
Company
Letter B:
Florida Farm Bureau Casualty Ins. Co.
The policies of-Insurance listed below have been issued to the insured named above and are in force at this time. 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 he policies described herein is subject to all the terms, exclusions and
conditions of such policies,
CO.
LTR
A
TYPE OF INSURANCE
General Liability:
WCommerciai General Liability
(Occurrence Form)
U Owner's & Contractor's
Protective
❑ Farmer's Personal liability
POLICY NUMBER
9523253
POLICY EFFECTIVE DATE
(MM/DONY)
POLICY EXPIRATION
DATE (MM/DDNY)
ALL LIMITS IN THOUSANDS
04/25/2012
04/25/2013
General Aggregate
$ 600
Products - completed
operations aggregate
$ 600
Personal & Advertising Injury
$ 300
Each Occurrence
$ 300
Fire Damage (My ono tire)
$
50
Medical Expense (Any one person) $
Automobile Liability:
❑ Any auto
❑ All owned autos
❑ Scheduled autos
❑ Hired autos
❑ Non•owned autos
•
Excess Liability:
❑ Umbrella Form
❑ Other than Umbrella form
Employers Liability:
❑ Farm Employer's Liability
❑ Farm Employee's Medical
Other:
Combined
Single Unit
$
Bodily Injury
(Per Person)
Bodily Injury
(Per Accident)
Property $
Damage • O '� (I€ ` }" u• Ooc ence
$
5
Aggregate
(Each Occurrence)
f (Eadr Employes)
1
;:_ I !`h�,+, jig.; 4 ,pi.:,
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES:
CANCELLATION: Should any of the above described policies be cancelled before the expiration date thereof. the issuing company will endeavor to
mail 1 O days written notice to the below named certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind
upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER:
COUNTY CODE 28 DATE ISSUED 03/12/13
Serviced by HIGHLANDS County Farm Bureau
JOSEPH BULLINGTON
AUTHORIZED REPRESENTATIVE
93 -7 -1592 (Rev. 5/93)
03- 15 -'13 09:18 FROM-
COMMERCIAL PROPERTY
COVERAGE PART
SUPPLEMENTAL SCHEDULE
Policy Number: CPP 9523253 02
Membership Number: 914693
863 -385 -5356 T -673 P0003/0004 F -872
FLORIDA FARM BUREAU GENERAL INSURANCE CO.
5700 S.W. 34th Street
P.O. Box 147030
Gainesville, Florida 32614 -7030
County# 35 -1
Agent# 2 17 3 5
DESCRIPTION OF PREMISES:
Prem. Bldg.
No. No. Location, Construction /Fire Protection and Ocoupanoy
1 1 709 NE 2ND AVE OKEECHOBEE, FL 34972 -2659
WAREHOUSE -MINI WAREHOUSE , MT: BIG LAKE NAT'L BANK
NON - COMBUSTIBLE
1 2 709 NE 2ND AVE OKEECHOBEE, FL 34972 -2659
WAREHOUSE -MINI WAREHOUSE - MT: BIG LAKE NAT'L BANK
NON - COMBUSTIBLE
COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of
is shown or for which an entry is made.
Limit of
Insurance
53,539
53,539
Prem.
No
1
1
Bldg.
No.
1 BUILDING
2 BUILDING
Coverage
Causes of (2)
Loss Form
SPECIAL 901
SPECIAL 90�
Coinsurance (1)
(1) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol.
insurance
Premium
218
218
OPTIONAL COVERAGES:
Prem,
No.
1
1
Bldg.
No,
1
2
BUILDING
BUILDING
Coverage
Agreed Value Replacement
Amount Expiration Date Cost
(X)
(X)
Incl.
Stock
Inflation
Guard
4 I
4�
OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY
Bldg. Agreed Value Agreed Value Monthly Limit of
No. Date Amount Indemnity (Fraction)
Prem,
No.
Maximum Period of
Indemnity
Extended Period of
Indemnity (Days)
DEDUCTIBLE: $ 1000
Deductible Exceptions. 5% Wind Or Hai1
(2) EQ (if shown) = Earthquake
FFB CP 001 (Ed. 03/93)
W15
03- 15 -'13 09:18 FROM-
COMMERCIAL PROPERTY
COVERAGE PART
SUPPLEMENTAL SCHEDULE
Policy Number: CPP 9523253 02
Membership Number: 914 6 93
863 - 385 -5356 T -673 P0004/0004 F -872
FLORIDA FARM BUREAU GENERAL INSURANCE CO.
5700 S.W. 34th Street
P.O. Box 147030
Gainesville, Florida 32614 -7030
County# 35 -1 Agent# 21735
DESCRIPTION OF PREMISES:
Prem. Bldg,
No. No. Location, Construction /Fire Protection and Ocoupancy
1 3 709 NE 2ND AVE OKEECHOBEE, FL 34972 -2659
WAREHOUSE -MINI WAREHOUSE - MT: BIG LAKE NAT'L BANK
NON - COMBUSTIBLE
COVERAGES PROVIDED: Insurance at the
is shown or for which an entry is made.
Limit of
Insurance
53,539
Prem. Bldg.
No. No.
1 3 BUILDING
described premises applies only for coverages for which a limit of insurance
Coverage
Causes of (2) Coinsurance (1) Premium
Loss Form
SPECIAL 90% 218
(1) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol.
OPTIONAL COVERAGES:
Prem. Bldg.
No. No.
1 3 BUILDING
Coverage
Agreed Value Replacement Incl.
Amount Expiration Date Cost Stock
( X )
Inflation
Guard
4.%
OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY
Prem.
No
Bldg, Agreed Value Agreed Value
No. Date Amount
Monthly limit of
Maximum Period of Extended Period of
Indemnity (Fraction) indemnity Indemnity (Days)
DEDUCTIBLE: 91000
Deductible Exceptions. 5% Wind or Hail
(2) EQ (if shown) c Earthquake
FFB CP 001 (Ed. 03/93)
W15
05/27/2011 10:43 4072933423
FARM BUREAU
CERTIFICATE OF INSURANCE
PAGE 02/02
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 LISTED BELOW.
The policies of insurance ((sled below have been Issued to the Insured named above and are in force at thle time. Notwithstanding any requirement, term or condition of any contract or
other document with respect to which this certificate may be issued or may perta n, the Insurance afforded by the policies described herein is subject to all the terms, exclusions and
Conditions of such policie9.
CO.
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE DATE
(MMlpo(YY)
POLICY EXPIRATION
DATE (MWDD/YY)
ALL LIMITS IN TI{OUSANDS
A
General Liability:
G/7Commercial General Mobility
(Occurrence Form)
❑ Owner's a Contractor's
Protective
n Farmer's Pomona! Liablllty
Automobile Liability:
❑ Any auto
❑ AN owned autos
0 scheduled autos
0 Hired :Moe
Non•owned autos'
CPP 9523253
04/25/17.
04/25/12
General Ag9ri to $ 800
Produces - completed
operations steeple
600
Feraonnl d Advertising Injury
$ 300
Each Occurrence
$ 300
Firs wnega (Any One Orel
$
50
Mt dloal Eepanso Any ono parson) $
Combined
Single Limit
Bodily Injury
(Per Perron)
Bodily Injury
(Per Accident)
Property
Damage
Excess Liability:
Umbrolfa Form
n Other then Umbrella form
Employers Liability:
❑ Farm 6mploynr's Llebllxy
Farm Employee's Medial
Other:
Aggregate
(Felt Oectsrenco)
(Earn Employee)
DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES:
CTTY
CANCELLATION: Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to
mail 10 days written notice to the below named certiflcate holder, but failure to mail such notice shall impose no obligation or (lability of any kind
upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER:
THE CITY OF OKEECHOP);E
55 SE 3RD AVE
OKF,ECHOBEE, FL 34974
COUNTY CODE 4a DATE ISSUED 05/27/3,1
Serviced by ORANGE County Farm Bureau
STANLEY D BROCK, PA, LUTCF
AUTHOR1ZE0 REPRESENTATIVE
93 -7.992 (Rev, 5193)
COMPANIES AFFORDING COVERAGES:
FLORIDA FARM BUREAU INSURANCE COMPANIES
P.O. BOX 147030
Company
Letter A:
GAINESVILLE, FLORIDA 32614 -7030
Florida Farm Bureau General Ins. Co.
NAME AND ADDRESS OF INSURED;
OUIK - STOR INC
709 NE 2ND AVE
Letter B;
OKEECHOBEE FL 034972
Florida Farm Bureau Casualty ins. Co.
The policies of insurance ((sled below have been Issued to the Insured named above and are in force at thle time. Notwithstanding any requirement, term or condition of any contract or
other document with respect to which this certificate may be issued or may perta n, the Insurance afforded by the policies described herein is subject to all the terms, exclusions and
Conditions of such policie9.
CO.
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE DATE
(MMlpo(YY)
POLICY EXPIRATION
DATE (MWDD/YY)
ALL LIMITS IN TI{OUSANDS
A
General Liability:
G/7Commercial General Mobility
(Occurrence Form)
❑ Owner's a Contractor's
Protective
n Farmer's Pomona! Liablllty
Automobile Liability:
❑ Any auto
❑ AN owned autos
0 scheduled autos
0 Hired :Moe
Non•owned autos'
CPP 9523253
04/25/17.
04/25/12
General Ag9ri to $ 800
Produces - completed
operations steeple
600
Feraonnl d Advertising Injury
$ 300
Each Occurrence
$ 300
Firs wnega (Any One Orel
$
50
Mt dloal Eepanso Any ono parson) $
Combined
Single Limit
Bodily Injury
(Per Perron)
Bodily Injury
(Per Accident)
Property
Damage
Excess Liability:
Umbrolfa Form
n Other then Umbrella form
Employers Liability:
❑ Farm 6mploynr's Llebllxy
Farm Employee's Medial
Other:
Aggregate
(Felt Oectsrenco)
(Earn Employee)
DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES:
CTTY
CANCELLATION: Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to
mail 10 days written notice to the below named certiflcate holder, but failure to mail such notice shall impose no obligation or (lability of any kind
upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER:
THE CITY OF OKEECHOP);E
55 SE 3RD AVE
OKF,ECHOBEE, FL 34974
COUNTY CODE 4a DATE ISSUED 05/27/3,1
Serviced by ORANGE County Farm Bureau
STANLEY D BROCK, PA, LUTCF
AUTHOR1ZE0 REPRESENTATIVE
93 -7.992 (Rev, 5193)
APR -22 -2010 02:40P FROM:QUIK- CHANGE OIL & LU 863 - 467 -6178
TO:7631686
P.1
CER'T'IFICATE OF INSURANCE
THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO. RIGHTS UPON THE CERTIFICATE HOLDER.
THIS CERI1FICA'FE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED 8ELOW.
FLORIDA FARM BUREAU INSURANCE COMPANIES
P.O. SOX 147030
GAINESVILLE, FLORIDA 33814 -7030
NAME AND ADDRESS OF INSURED:
QUIK - WOE /NC
709 NE 2ND AVE
OKEECHOBEE FL 034972
COMPANIES AFFORDING COVERAGES:
Company
Letter A:
Florida Farm Bureau General Ina. Co.
Company
Letter B:
Florida Farm Bureau Casually Ins. Co.
The . ' T nlurande """ - OW e v e 'F S** t o die sense • • are n . , r ! Om. ��,+ T , n g any r e s 4 r o n e tremor IAl1Owal of s y contract or
other d cument Mich impact to whklt m Co ea* (nay be issued or mty Pertain, the harm ellorded by the peas described herein Is subject to M die tee, exclusions and
condtpone of ma policies.
CAIVCEI.LAT(Qtk $IlouW qtly d Ute Itbove desorlbed• Donis pm or u,'eNad below the elfpkaNOrt dale thereof, the ieeuMe3 company w1$ andeev r b
mall , .10 • days vsrhlen nodes to the below named conincaae holder, but ?allure to mail such netioe eha htlposa no obNgetion or rebillty of any Idnd
upon the canpeny,
NAME AND ADDRESS OF CEA`r'IF CA'rE HOLDER:
QUM- STORE, INC
709 NE 21! AVE
OKEECHOSEE, FL 34972
COUNTY CODE 49 _ DATE ISAt1ED 04/22/10
&entoed by O c1B Codnty Farm Bureau
DAVID DAVIS, JR
AUTHORIZED REPNW3ENTATIVE
eo-7 r (Pay. OM)
TYPE OF INSURANCE
. �.
NUMBER
DATE
POLICY
ALL Limns IN mom
A
General t l AbNRy:
C(Ca ender unolty
(c +r ram)
0 rac«a+eter�
0 Fermata Pomona' uaesty
CPP 9523253
04 /25/10
04/25/3.1
Omura A9r
$ 600
$ 600
moose• iti. •_
s 300
_ _
a 300
1ks DewIMrenr nnc
$ 50
*dad Evelio (Mean per n)
$ 5
0000_,
Combined
Single Lin*
$
.-----1
Soddy mn
(Per Person)
godly Injury
(Per Accident)
Property
Malaga
$
._-_.
bat*
0 Umbrella Form
0 Oust Men Umbrella tam
EMtpIo urs Wildly:
n r tir n employers WONKY
O Pam Employees Medical
•
b
$
$
Ilrn Genera j
Irian ice)
Other.
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES:
» INZ SToRAfcf E RENTAL SPACES
709 Ns 2ND AVE
OKEECHOB E, FL 34972
CAIVCEI.LAT(Qtk $IlouW qtly d Ute Itbove desorlbed• Donis pm or u,'eNad below the elfpkaNOrt dale thereof, the ieeuMe3 company w1$ andeev r b
mall , .10 • days vsrhlen nodes to the below named conincaae holder, but ?allure to mail such netioe eha htlposa no obNgetion or rebillty of any Idnd
upon the canpeny,
NAME AND ADDRESS OF CEA`r'IF CA'rE HOLDER:
QUM- STORE, INC
709 NE 21! AVE
OKEECHOSEE, FL 34972
COUNTY CODE 49 _ DATE ISAt1ED 04/22/10
&entoed by O c1B Codnty Farm Bureau
DAVID DAVIS, JR
AUTHORIZED REPNW3ENTATIVE
eo-7 r (Pay. OM)
UN. 23. 2009 11:48AM
BRUCE HOMER INSURANCE AGENCY O. 8)8 P 1
Pi le
CERTIFICATE OF INSURANCE
The company indicated below certifies that the insurance afforded by the policy or policies numbered and
described below is in force as of the effective date of this certificate. This Certificate of Insurance
does not amend, extend, or otherwise alter the Terms and Conditions of Insurance coverage contained in any
policy numbered and described below.
CERTIFICATE HOLDER: INSURED:
CITY OF OKEECHOBEE QUIK -STOR INC
55 SE 3R0 AVENUE 709 NE 2ND AVE
OKEECHOBEE, FL 34974 OKEECHOBEE, FL 34972 -2659
TYPE OF INSURANCE
LIABILITY
[X] Liability and
Medical Expense
EX] Personal and
Advertising Injury
[X] Medical Expenses
[X] Fire Legal
Liability
[ ] Other Liability
AUTOMOBILE LIABILITY
[ ] BUSINESS AUTO
[ ] Owned
[ ] Hired
[ ] Non -Owned
EXCESS LIABILITY
[ ] Umbrella Form
POLICY NUMBER
& ISSUING CO.
77 -PR- 481862 -3001
NATIONWIDE
MUTUAL FIRE
INSURANCE CO.
POLICY
EFF. DATE
04-25.09
POLICY
EXP. DATE
04 -25 -10
LIMITS OF LIABILITY
( *LIMITS AT INCEPTION)
Arty One Occurrence $ 300,000
Any One Person /org $ 300,000
ANY ONE PERSON $ 5,000
Any One Fire or Explosion $ 100,000
General Aggregate* $ 300,000
Prod /Comp Ops Aggregate* $
Bodily Injury
(Each Person) $
(Each Accident) $
Property Damage
(Each Accident) .. $
Combined Single Limit .... $
Each Occurrence $
Prod /Comp Ops /Disease
Aggregate* $
[ ] Workers'
Compensation
and
[ ] Employers'
Liability
STATUTORY LIMITS
BODILY INJURY /ACCIDENT $
Bodily Injury by Disease
EACH EMPLOYEE $
Bodily Injury by Disease
POLICY LIMIT . $
Effective Date of Certificate: 04 -25 -2009
Date Certificate Issued: 06-23-2009
DESCRIPTION OF OPERATIONS /LOCATIONS
VEHICLES /RESTRICTIONS /SPECIAL ITEMS
SAME AND TEMPORARY WORK SITES
ELSEWHERE INT EH STATE OF
FL
Authorized Representative: Bruce A�,
Countersigned at: 900 South Parrott Avenue
Okeechobee, Fl 34974
JUL -25 -03 01:02 PM BRUCEHOMERINSURANCE 18637636010
P.01
CERTIFICATE OF INSURANCE
The company indicated below certifies that the insurance afforded by the policy or policies numbered and
described below is in force as of the effective date of this certificate. This Certificate of Lnsurance
does not amend. extend, or otherwise alter the Terms and Conditions of Insurance coverage contained in any
policy numbered and described below.
CERTIFICATE HOLDER:
CITY OF OKEECHOBEE FLORIDA
55 SE 3R0 AVENUE
OKEECHOBEE, FL 34974
INSURED: I
OUIK -$TOR INC
709 NE 2N0 AVE
OKEECHOBEE, FL 34972
TYPE OF INSURANCE
LIABILITY
[X] Liability and
Medical Expense
[X] Personal and
Advertising Injury
[x] Medical Expenses
[X] Fire Legal
Liability
[ ] Other Liability
AUTOMOBILE LIABILITY
t ] BUSINESS AUTO
[ ] Owned
[ ] Hired
C ] Non -Owned
EXCESS LIABILITY
[ ] Umbrella Form
POLICY NUMBER
& ISSUING CO.
77- PR- 481662 -3001
NATIONWIDE
MUTUAL FIRE
INSURANCE CO.
POLICY
EFF, DATE
04-25-03
POLICY
EXP. DATE
04.26.04
LIMITS OF LIABILITY
( *LIMITS AT INCEPTION)
Any One Occurrence
Any One Pe ^son /0rg
ANY ONE PERSON
Any One Fire or Explosion
General Aggregate*
Prod /Comp Ops Aggregate*
300,000
300,000
5.000
100,000
300,000
Bodily Injury
(Each Person)
(Each Accident)
Property Damage
(Each Accident)
Combined Single Limit .,
[ ] Workers'
Compensation
and
C ] Employers'
_iability
Each Occurrence
Prod /Comp Ops /Disease
Aggregate*
STATUTORY LIMTS
BODILY INJURY /ACCIDENT .,,
Bodily Injury by Disease
EACH EMPLOYEE
Bodily Injury by Disease
POLICY LIMIT
Should any of the above described policies oe cancelled before the
expiration date. the insurance company will endeavor to mail
written notice to the above named certificate holder. but failure to
mall such notice shall impose no obligation or liability upon the
company. its agents, or representatives,
I �
DESCRIPTION OF OPERATONS /LOCATI0N5
VEHICLES /RESTRICTIONS /SPE T 5
PREMIS LOCATED' 709 NE D
STRE OKEECHO
Effective Date of Certificate; 04-25-2003 Authorized Representativ
Date Certificate Issued: 07.25.2003 Countersigned at
uce A. Ha en
900 South Parrott Avenue
Okeechobee, F1' 34974