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=4ct - - ACORD CERTIFICATE OF LIABILITY INSURANCEGP I<a DATE (MMIDOIYYYV) ST�ETEA 09 / 23 / 03 �Toouc6R THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAn ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hatcher Insurance , Lnc . HOLDER, THIS CERTIFICATE DOES NOT AMEND , EXTEND OR P . O . Box 540659 ALTER THE COVERAGE AFFORDED 6Y THE POLICIES BELOW Orlando FL 32854 - 0689 Phone : 407 - 841 -2Eg6 Fax : 407 - 841 -2688 I INSURERS AFFORDING COVERAGE NAIC # _ _— — 14FURED — - I .".USURER A' Qhi ladelphla Indemn.:.ty In ' C o miSURERe: American International Group St . Peters Academy Charter Sch _ — - -- –_. - Ste Peters Human Services , Inc :15UptRC: - • • ___ . . ._ 4250 38th Avenue rMSURERO _ Vera Beach FL 32967 - 1711 isees - - - ---- - "JRER E: COVERAGES THE POLICIES OF MURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO_ICY PERIOD INDICATED. NOTWITHSTAIVUING ANY REOUIREMEr, T TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHILI-i THIS CERTIF.CAT = NIAY BE ISSUED OR MAY PERTAIN , THE JNSUPANCE AFFORDED BY THE POLICIES CESCRIBEC HEREIN IS SUBJECT TO ALL THE TERNS , EXCLU9=NS AND CONDITIONS OF SUCH POLICIES , AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED CY PAID CLAIW , LIC�EFFE'7T17E ' POL�YFXr�TRATION LtM .TS - --- - -- - STU y ! PUMOV NUMBER DATE Rr�MIODIYYI I DATE ( MM!OO/YY Lrq INSR❑ T PE OF INSURANCE 3ENERALL4BIL;TY r I FACHCCCURkEN.E ` 51000000 p I X ; COMrALR•JIALGENERA`_ L1A81Lm' PEPK060275 , 09 / 17 / 03 ; 09 / 17 / 04 rRErns=s (E3 u:dance) s 100000 _— I r l I I MED EX= :Any cne per:Dn`, — is 5000 . .� CLAIMS JAC'c I $ OCCUR I i ! I '-- - - .. .. .- �- PERSCNAL & AM INJURY 131000000 i I - GENSRAe. AGGREGA -E 5 2000000 Ij ?GULP . :ROCIOIS CGNPr,c A. y 5 �.000OOO* F%P- AGGREGA' LNIT APPLI ;. � _ . PRO- ' WC -_ IECI ! AUTOh!OBILELIABIUTY I CCM15!NECJ SINGLE U .Mil c I r ANYF.'JTO ` I (E9 occl^.err,: ,--. . I -- ALL OWNED AJTOS 60IXLY IN.CJ ! S I (Pcr pers )n) j I CrCIaFCU�ED AUTCG hIftEQ AUTOS I i� i ECCILY Ik,iURV I S NON-CWNEC AJTO$ 1 (Ppr accitl2ntf .. .._ ---• i ? R ^P E.R7Y DAMAGE S GARAGE UABILITV i I kJTG 7NLY • EP ACGIGENT -rS --- . .. _.N ANY A.1"O 1 I 1 I OTHER THAN GA AC'C S P I AUTO ONLY. i`C; _ $ _....... . .__ I EXCE8S ,1641SRELLA UAEI_ITY I EACs: CCCURRENCE I t 1000000 p, FX OCCUR I J C: A.AMSrtAUE RENEWAL Oe 2HUB0122!1909117 / 03 ! 09 / 17 / 04 I AGsAEGATE S1000000 I r—Iwo ; F- DEDUCTILILE I 1 0 00.2 S I WORKERS COMPENSATIOM AND I X i -CRYukrik IsRE ' — _ _ ,• — B I!( EMPLOYERS' LIABILITY I ` k=. L . �ACH ACr�DEL:T . . . _ IS3. 00000 WC7829377 09 / 1703 09 / 17 / 04 AM' PRGPPIEOZrPARTi=RF�iECTNE L CISEA5E • cA E .IP�C_E7 f SOOOOO �^FPCCR .?AIME=r EXCLUGE07 _.- . If yd6. lfAscrA:e urCBr SzECIAL PROVISONS he!cr. ( j t+. L. GSEASE . ?OLY_'y LIMIT S 500000 ! OTHER I I i DESCRIPTION OF OPERATIONS ( LOCATIONS I V15HIC .ES I EXCLUSIONS ADDED BY ENDORSE111 NT I SPEOIAr PROVISIONS Certificate holder is included as additional insured applicable General Liability Coverage . *Except as required by Florida Statute . t CERTIFICATE HOLDER CANCELLATION SCHODI3 SHOVLO ANY OF THC ABOVE DESCRIBED POLICIES be CANCE• .LED SEFCRE TILE EXPIRATION School District of Indian DATETHEREOf The ISSUING INSURER WILL ENDEAVOR TO MAIL 30 * DAYSWRTTTEN River Co / Judy Bartlett NOTICE TO THE CERTIFICATE HOLDER NMAED TO THE LEFT, BUT FAI _URF TODD 50 5HALL } INPO� NC OBLIGATIO "ILITY OF ANY KIND VPON THE INSURER, ITS fi4ENTS OR 1990 25th Street REPRESENTATIVES _ Ve :o Beach FL 32960 AUTHORIZED REPRE s oe A RD 25 (2001103 } A=ORDCORPORATION 1 TOTAL P , C11