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To : 5615628920 From : State Fare Fax : State Farm LTOFCALL at . CCT-02-2003-08: 11 Bac : 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 Nt <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 MUTUALAUTOMOBILE INSURANCE COMPANYof Bloomington , Ilinois, or <br /> ❑ S7ATE FARM FIREANDCASU.ALTYCOMPANYof Bloomington. Illinois <br /> has coverage in force for the fo ioMng Named !nsured as shown belovr : <br /> Named Insured St Peter's Missionarti;Ba ist Ch :, rch Inc <br /> Address of Named Insured 4zn0 3t3" Ave. <br /> Voro Beach , FL 32967 <br /> POLICY NUMBER 6402632D0959F <br /> EFFECTIVE UP.-E OF 04109103• 10109103 <br /> POLICY <br /> ! 1994 DODGE 8350 VAN <br /> DESCRiPTIONOF <br /> VEHICLE j <br /> LIABILITY COVERAGE ❑ ES ❑ NO �- ❑YES ❑ NO []YES [] NO ❑ YES El NO <br /> LIMITS OF UAB ! LITY -- -- � - - - - <br /> a. Bocily Injury <br /> _ Each Person - -- --� I -- - - - <br /> a. Bodily Irjury - -- --- --- — <br /> Each Accident — � <br /> b. Property Damage �— - - ------ - t- --- — ---- - - -t -- -- ---- - - <br /> — <br /> c . Bodily injury & -- -� - - --- - --- -t ---- — - -- ---- + <br /> Property Damage $ 1 ,000 ,c00 .00 <br /> Single Limit Each <br /> Accident — <br /> PHYSiCAL DAMAGENO - -- yES <br /> � NO ❑ YES ❑ - - -- - INO YES <br /> COVERAGESI 5253 OC Deductible i DeductibleCNJ <br /> a . Comprehensive Deductible Deductible <br /> � ' - -- S - - - ❑ NO YES ❑ NO ❑YES NO <br /> b . collision 550000 Deductue I Deductible <br /> Deductible Deductible <br /> EMPLOYERS <br /> NON-0NNERSHiP j ❑ VES ❑ NO ❑YES ❑' NO :]YES ❑ NC DYES ❑ %IC <br /> OVERAGE _ _ <br /> HIREQCARCOVERAGE ❑'VES ❑ NO ❑Yc5 ❑ NO ❑YES ❑ NC <br /> - - ❑SES [] NO <br /> i <br /> Agent 2733 10/02/03 <br /> Signature cf Authcnzed Representative Title Agent' s Code Number Date <br /> Nagle and Add -ess cf Certificate Holder Name and Address of Agent <br /> Indian River County David E Hedges, State Farm Insurance Agency <br /> 1990 215` Street 2601 2UStreet Suite B <br /> Vero Beach , FL 32960 Vero Beach FL 32960 <br /> i <br /> Check if a permanent Certificate of Insurance for iiability coverage s needed ❑ <br /> CDeck if the Certificate Holder should be added as an Additional Insured : ❑ <br /> Remarks. <br /> 156-4430.2 Rev. 9-94 Princcd in J .SA. <br />