- Contract Date
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BIG LAKE LEASING RENTAL AGREEMENT
305 C.R. 17 W Avon Park, Florida 33825 877-513-8182 |
BIG LAKE LEASING RENTAL AGREEMENT 1006 State Road 80 P.O. Drawer 760 Belle Glade, Florida 33430(561) 996-3095 |
BIG LAKE LEASING RENTAL AGREEMENT
981 New Harvest Road Immokalee, Florida 34142 1-800-222-3093 |
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Glade & Grove Supply Co., Inc.
of
P.O. Drawer 760,
983 New Harvest Road, Immokalee, FL
33934 «» (239) 657-8258
% (239) 657-5381 Fax
REQUEST FOR CERTIFICATE OF INSURANCE
PLEASE FAX THIS FORM TO YOUR INSURANCE AGENT IF YOU ARE OBTAINING COVERAGE FROM YOUR INSURANCE AGENT. IF YOU WISH TO PURCHASE INSURANCE FROM GLADE AND GROVE SUPPLY SIMPLY MARK THE BOX BELOW AND WE WILL FORWARD TO OUR INSURANCE DEPARTMENT FOR PROCESSING.
DATE:
- Check this box if you want to purchase insurance from Glade and Grove Supply Co.
- Check this box if you are providing insurance coverage. The requirements are:
Equipment being
rented/demo:
Model Year _____ S/N Value $
Model Year _____ S/N Value $
Model Year _____ S/N Value $
Model Year _____ S/N Value $
Certificate of
Insurance Details:
1. Glade and Grove Supply Co., Inc. will be named the lessor as ADDITIONAL INSURED and LOSS PAYEE.
2. Lessee shall carry BODILY INJURY and PROPERTY DAMAGE insurance covering the equipment in the combined amounts of not less than $500,000 for each occurrence.
3. Certificate of Insurance will state that it will give Lessor THIRTY (30) DAYS written notice before the policy in question shall be altered or cancelled and that any proceeds shall be paid jointly to the Lessor and Lessee as their interest may appear.
The Certificate of Insurance can be faxed to the appropriate dealership shown on the top of this page and to the
ATTENTION OF: Sales person or
AUTHORIZATION FOR INSURANCE AGENT TO PRODUCE THIS REQUEST.
BY: ________________________________ SIGNED: ________________________
Lessee Printed Name
EXEMPTION
CERTIFICATE
CERTAIN POWER
FARM EQUIPMENT
This is to certify that the power farm equipment indentified below, purchased on or after ___________ (date) from _______________________________ (Selling Dealer’s Business Name) is purchased, leased, licensed, or rented for the following purpose:
( ) Power farm equipment for exclusive use in the agricultural production of crops or products, as produced by those agricultural industries included in s. 570.02(1), F.S
( ) Power farm equipment for exclusive use in fire prevention and suppression work for such crops or products, as produced b those agricultural industries included in s. 570.02(1), F.S
POWER FARM EQUIPMENT:
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
I understand that if I use the equipment for any purpose other than the one stated, then I must pay tax on the purchase or lease price of the taxable item directly to the Department of Revenue. I understand that if I fraudulently issue this certificate to evade the payment of sales tax I will be liable for payment of the sales tax plus a penalty of 200% of the tax and may be subject to conviction of a third degree felony.
The exemption specified by the purchaser may be verified by calling 1-800-352-3671.
Purchaser’s Name: _________________________________________________________________
Purchaser’s Address: _______________________________________________________________
Name and Title of Purchaser’s Authorized Representative: _________________________________
_________________________________________________________________________________
By: _____________________________________________________________________________
(Signature of Purchaser or Authorized Representative)
Title: ____________________________________________________________________________
(Title- only if purchased by an authorized representative of a business entity)
Date __________________