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<br />ALLIED SPECIAL_ TY INSURANCE, INC.
<br />10451 Gulf BOil I.I;;'vanJ Tr'~:HIf:;Ur'f,~ J> 1;:lnd, FI.IP- id:! ;'>'::'.i70(-
<br />To ll. Fr't.H? :l.-"n()()":.:~:J7""~!.:Y~i'.:i iI.OJ( j 0 lid I.
<br />l'800-2B2-~'176 FJoridd
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<br />r.~ '.': (' !" I f j c :.j f. ,:':, fllJ/fIt) f:~ r' ~ 90
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<br />'J his C;fH- t If' c a IE' Tl t.) I t h (,i')' .0) f f , r' ill..;! t I \JI'.~ I.";, n () r' rl(.;~g.J'! I v f~' I. y 0,; ill '::: n \1;:;. ':::'.l<. t I';~ nd!~ 0 r' .:J I. t I';')-!;;
<br />Ihe C:OV~l-ag~ <3ffurtl(?!.l b}' t,,~? pol.it:V(;/.H;) d(','~~r'l"ib/".\d "r""/:"/In ,',>n'-' i,,: p;'".I.I.(~'d .3!; <:l
<br />iIl.:dtel- of inful'mati(11l ,~J1;J o:::nrll"('~r<;; fin ;.:j(.Jlll",ij::;ojj"fhFo l'IOi.cfc-;'I, '.
<br />
<br />The pollcy(If?S) Idf.~ntlfl!?(J I:)~:~I.IH:.I by.:l Po I. I C'l'" nr.!"":....".. ,,; Inforcf:.\ on tlH? date of
<br />cert Iflc:at",? Issl1c;'''c,,'', IlI!:HII";lh/:P Is; ,',lffo)"C/('!!d ollty hllth 1"(;~';;r:H.:(::t III thl/!l;e C:OVf:W-"
<br />',:ll]eS fO'- which i:l SF'I:;>r.:i1"lc !.Imil.' of 1.','1bl I,lty h:I",. 1:'PC'n I;.'n(r'::'icd "Inti i:;;. i:P...bjf?C!' tt,
<br />..:dl 1"el"fIlS of th~ pili. if;:)' tHiVinq r~::'f('."(:!llj:(,~ HH:'>r'o:,~'I:o. t'"thinq IjI.:~n:~jn c()nt..~illed
<br />(:;hall modify <~ny F',"ovlsl 011 (If t:..:1 id pol Ic)', .
<br />
<br />1" the f.~ ve fI t () f c: i:\ m:: e. l I. <,It j (~fl (),. I J I \' t' (j I. ! c y . -r- "J '" ("" i'll"' ,:i i1 ~" I:'.; I! I n ~~ !': ;.) I d PilI. I I: y
<br />will mal'le dl.l.n:?,'l!H'llabl.f.? f)/fprl ~~, !'H?Tl'III/dlc/;~ u"f" C<:lIlCt~'.L.I!i~ln to I In;;' cel..ti...
<br />flcate holdel. at the <'lddn?s;:;; ;':"I'I\1.ln hf'i"/,.jl,<. 1111! (h.;'~ c ()Inp.-, I", d,::.<:;II,,,(;),:: no r'(?r:;p"H!:;I-
<br />b i lit If?!,'; f Ill- ..~ fly' III 1!1i t ,;} 1.( e Il I' f i:I j I Ii I' \'. t 0 ~.J j \0 i:.' (:; './.': 'I (, (; t 1<:; f;).
<br />
<br />CERTIFICATE OF INSURANCE
<br />
<br />Any Insurance m;Hlc~ a pr:\\"t or 'ltH" pot I!::; Incl.l\Ill~'.':::, .J~:: "I PP)';:;')" In;:"\.Irc(~ with
<br />r,~sPect to i.~fl O('~CUI'j'I:;'ilf:'!:~ takin9 P'.dC:f~...t d '::.i':I::':(I..~ th(.~ {,-.ji,..
<br />01" exhlbitloll ',!':;;!:;ocl,JtiI.H1t ~~,r:/"":;/n jl'9 lJi.l;Jdlllz....lliOT] OJ C:1)1f)'flllh"l.~ (2) (IH:'> owno:?r
<br />(ll. l r~t:;!'if:~ e th er t~ () f (;J.\ .;l IIi tl H j f:: i P ,'1 r. i ./. >. <.P",~ n I' I WI ! f! e t.l ::, rlH:.'d 1 n';; u ," /':JI P ".::r- ill I H!5 j () Ii to
<br />opel-ate a(n) t bu.t unl.Y "'~;:. I"I:;:';".PF:C"!::; hodi f.}o' i Ii.i""; I))' pr11pt?i'!-')<' .
<br />dama9f~ c:aused by 0" cOI,tribl!Ii.'H/ tp !:ii" the. W.':..r/.;<:,I:,.,iI"'" /iflhi:' t.',,"It.;-.,d Inf.Hlrf:1(f 'io!hil.e
<br />,'let I nq In 'lhe r.:{1l"-~(.? ,,,no::! ~::.t::()Pr,:; (l.r .ftl(:.oi, f':fIlpl r';'-il"':.:[,I':
<br />
<br />NAME & ADDRESS OF INSURED: Ar'r'ITIONAL INSURED:
<br />,",1. I. all C. Hi I. I. E Ill: f.,)I...t :" i TiIlH:.' ni: G () i P ,
<br />VBA GI'('?i:lt '~illi~I"il:"JTl Cil"CI.l~;
<br />:~!4"77 B"l ic:kney Poi fit J:~o:;)(j
<br />Gu i 'h::':; 30'lH t.~ J U D
<br />Sard5nta, FL 34231
<br />NAME ~ ADDRESS OF CERTIFICATE HUL[lER:
<br />
<br />DATES: ........f ;:i"
<br />
<br />F: fa MA. RY ....C Ov. Eli AU E
<br />
<br />EXCESS. COVERAGE
<br />
<br />Comp any:
<br />
<br />1.I-I.E. In~u)"a"cE
<br />C I) 'liP a n ,~.,
<br />'" ~.,:L_IU a;'HU... ... '" ..... ....
<br />~-- !l>.J. .I.() QQ J.!i QQ ..,.... __!! ......_
<br />.... --~(l.Ic..L u(;l~jJ ........... ........ .......
<br />
<br />..", ..... ............ .......-..---.. .... ......"
<br />
<br />Po 11 cy Numbel-:
<br />LIABILITY LIMITS
<br />Bod' 1y InJury:
<br />PI-OP erty Damage:
<br />
<br />2/' ~~\~ /'9 :~~
<br />=;!/ 26 /'~' 3
<br />
<br />-Sidl'I~-JII~~~'-~
<br />PI-opel-ty damage
<br />
<br />-..... ........ !t", ....._ _..... . ....... ........ .~:
<br />E~ :< r. 1::)1;; S II f
<br />
<br />.... ....._ t... ....... ...... ....... . ...... .,!~
<br /><I;
<br />'''' ~...... ........ --'-." ....." .- .... . .... .......... ... ..
<br />
<br />,...._,.~~J~r.~.~ iid~~~~'~""
<br />j: *
<br />.... F'x'i:J:;;';:; .id!"-.............. ...
<br />
<br />:! ...-.. .-............ ...-.,-- ......~~......
<br />'II
<br />
<br />Food Products:
<br />Policy Period:
<br />From:
<br />To:
<br />
<br />--_!I!l lie .L.uded......_
<br />
<br />0/00/';/0
<br />0/00/':;'0
<br />
<br />...._. ""_00. .........._......_..... .........
<br />
<br />0/00/00
<br />O/OO/f)O
<br />
<br />COve'"a9f.? sllu,,,,,,, herfJill app'.i""5 unlv .to -(-hose 11"',r',':;{"IIC~dlJlc',i on or 1'~lld/))"'$ed !Il
<br />the policy. This cel-tificate is not valid unless an original signatul"e appears
<br />below. (Copies Not V~L1d.)
<br />
<br />~. ... CI:)tiHJNEl.I G !.ifGI...E LItHT
<br />
<br />.)1 I" ~)") 1"':)''''
<br />"'f.---~-Jn~~~~~_ Z~~______
<br />D'I f;? 0'" Ctn-t, flea If.-) ,',":;~;u<'ilTlC(?
<br />
<br />....._.~~~_..........
<br />I~II tll 0)' i :<: ,;'d Hi fJ il,;; t t! H?
<br />
<br />A ALLIED SPECIALTY INSURANCE, INC..
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