DATE I DIY 

ACORDE 5/15/2015

CERTIFICATE OF LIABILITY INSURANCE

HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS

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CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND 0R ALTER THE COVERAGE AFFORDED BY THE POLICIES

THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS), AUTHORIZED

REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policyIies) 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 certi?cate does not confer rights to the

certi?cate holder in lieu of such endorsementIs).

 

 

 

 

 

 

 

 

 

 

PRODUCER 
Bruce Hench-"Y Insurance TEENS. em: 239w 657?3614 I Mesa?557 64 as
711 Main 513359313 . com
ImOkalee I FL 34142 INSURERISI AFFORDING COVERAGE NAICII
L023031 .NSURER GRANITE STATE INSURANCE CO
INSURED VASQUEZ CITRUS HAULING INC INSURER 
PO BOX 17 6 INSURER .-
LAKE PLACID FL 33862 INSURER D:
863*465r5003 INSURERE:
INSURER I: 

 

 

 

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. 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.

 

ADDL SUBR POLI POLICY EXP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INSR CY EFF
Lre TYPE OF INSURANCE mse POLICY NUMBER LIMITS
GENERAL LIABILITY EACH OCCURRENCE 1 000 000
. UAMAGI: IO RENTED
COMMERCIAL GENERAL LIABILITY PREMISES {Ea occurrence) 8 10 000
CLAIMS-MADE I I OCCUR MED EXP (Any one pars-an; 5 000
A 05/14/2015 05/14/2015 5 1,000,000
GENERAL AGGREGATE 2 000 000
AGGREGATE LIMIT APPLIES PER: PRODUCTS COMPIOP AGG 2 000 000
I POLICY I I 538+ I I LCD 5
AUTOMOBILE LIABILITY 5 1 0 00 000
- BODILY IN RY son 3
?ri'g?gw SCHEDULED 05/14/2015 05/14/2015 JU I I
A AUTOS AUTOS BODILY INJURY (Per 
NON-OWNED PROPERTY DAMAGE 5
HIRED AUTOS AUTOS (Per accident)
PIP 5 10 00 0
UMBRELLA LIAE OCCUR EACH OCCURRENCE 5
EXCESS CLAIMS-MADE AGGREGATE 5
BED I I RETENTIONS 
WORKERS COMPENSATION WC STATU- 
AND EMPLOYERS LIABILITY we TORY LIMITS ER
ANY EL EACH ACCIDENT 
OFFICERIMEMBER I NM
(Mandatory in NH) EL. DISEASE EA EMPLOYEE 
If yes. describe under
DESCRIPTION OF OPERATIONS below EL DISEASE -POLICY LIMIT 5
4L

 

 

 

 

 

 

 

 

DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES {AIIach ACORD 101. Additions! Remarks Schedule, If more space is required}
SEE ATTACHED LIST

"As provided for in section 320.02 Florida Statues, the listed insurance policy(s)
or surety bond(s) may not be canceled on less than 30 days written notice by the insureer

to the Department of Highway Safety and Motor Vehicles, such 30 days notice to commence
from the date notice is received by the department."

 

CERTIFICATE HOLDER CANCELLATION

 

 

DEPARTMENT OF HIGHWAY SAFETY MOTOR
VEHICLES BUREAU OF MOTOR NEIL KIRKMAN

BLG RM A110 TALLAHASSEE, FL 32399

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 .
If;  its; 

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NJ 
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