Laserfiche WebLink
To : 561562842C Frei: State Farm Fax : State Farm LTOPCALL at : OCT-02-2003-08: 11 0oc : 767 Fage: 002 <br /> CERTIFICATE OF INSURANCE <br /> SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER WILL NOT BE CANCELED OR OTHERWIS <br /> TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED BELOW, BUT IN Nr <br /> EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM THE DATE WRITTEN . THIS CERTIFICATE OF INSURANCi <br /> DOES NOT CHANGE THE CCVERAGE PROVIDED BY ANY POLICY DESCRIBED BELOW. <br /> This cetif! es that: El STATE FARM MUT JA A.U70MOBILE INSURANCE COMPANY of Bloomington , Illinois , or <br /> ❑ STATE FARM FIRE AND CASUALTY COMPANY of Bloomington. Illinois <br /> has coverage in force for the foilowing Named insured as shown belowr : <br /> Named Insured St Peter's MissionaR, Baptist Ch ,. rch Inc <br /> Address cf Aained Insured 42;,0 ^084 ', Awe <br /> Vero Beach . FL 32967 <br /> I <br /> POLICY NUMBER 8402332DO959F <br /> –_—`— <br /> POLICY <br /> ! 1994 DODGE B350 VAN <br /> DESCRIPTION OF <br /> VEHICLE j <br /> LIABI _ITY COVERAGE_--� _ ❑YES ❑ NO ❑YES ❑ NO ❑YES ❑ NO ❑ YES [] NC <br /> LIMITS CF LIABILITY - -- -- -- � - - - <br /> a . Bocily Injury <br /> Each Person --- ---- - - -- - - ! --� <br /> a . Bodily Irjury -- -Each Accident <br /> b. Property Damage { - - - -- - -- -- -- -- -------- -- <br /> c . Bodily Injury & — -� -- ---- - --- - --- - --- - --- ------ ---- <br /> PropertyDamage $ 19000,C00 .00 <br /> Single Limit Each <br /> Accident _ <br /> PHYSICAL DAMAGE -t - --- - --- _— - <br /> ❑ YES � NO � ❑ YES � NC ❑ YES � NO � ❑YES � N� G <br /> COVERAGES 5250 OC DedLctible Deductible DeductibieDeductible <br /> a . Comprehensve -- <br /> — —❑ YES 21\10 - - YES - - - --� - <br /> b collision $ 0 -0p Deductible Deductible ❑ NO YES No <br /> Deducuble Deductible <br /> EMPLOYER'S <br /> NON-0WNERSHiP ❑YES [:INC) DYES 0` NO ❑YES Dc ❑ YES ❑ NO <br /> COVERAGE <br /> HIRED CAR COVEW E _ AYES ❑ MO OYES ONO <br /> LYES UJNC ❑ Y'ES LINO <br /> Agent 2733 10/02/03 <br /> Signature cf Authorized Representative Title Agent' s Code Number Date <br /> Name and Address of Certificate Holder Name and Address of Agent <br /> Indian River County David E Hedges, State Farm Insurance Agency <br /> 1990 25" Street 2601 2C' Street Suite B <br /> Vero Beach , FL 32960 Vero Beach FL 32960 <br /> i <br /> Check if a permanent Certificate of Insurance for Liability coverage ; s needed ❑ <br /> heck if the Certif Cate Holder should be added as an Additional Insured : ❑ <br /> Remarks. <br /> 158.4430.2 Rw. 9-54 Fr:n:ed in J . SA. <br />