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4 C, - - <br /> ACORD. CERTIFICATE OF LIABILITY INSURANCE GR ICI DATE- (MMIOCIYYYY) <br /> STPETEA 091233 / 03 <br /> 'RODUG@R THIS CERTII' ICATE IS ISSUED AS A MATTER OF INFORMATIO <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Hatcher Insurance , Tnc . HOLDER, THIS CERTIFICATE DOES NOT AMEND , EXTEND OR <br /> P . O . Box 540659 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW <br /> Orlando FL 32654 - 0684 <br /> Phone : 407 - 841 -2686 Fax : 407 - 841 -2688 ; INSURERS AFFORDING COVERAGE NAIL # <br /> l.N$URED N'SUFCRA: Philadelphia Indemn:.j. Ins . ! Co <br /> hi5URER s: American International Group <br /> St . Peters Academy Charter 3C'.1 - -- —" - <br /> St . Peters Human ServLces , Inc NSURGIRC: <br /> 4250 38th Avenue rMSURERO <br /> Vero Beach FL 32967 - 1711 - - -------- - -- <br /> INbJRER E: <br /> COVERAGES <br /> THE POUC(ES OF ASURANCE LISTED BELDVV HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO —ICY PERIOD INDICATED, NOTWI THSTPJIUING <br /> ANY REQUIF.EMEN T TERM OR CONDITICN OF ANY C014TFZACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIF.CATE MAY BE ISSUED OR <br /> MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES CESCRIHEC HEREIN IS SUBJECT TO ALL THE TERIVS , EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES , AGGREGATE LIN44ITS SHOWN MAY HAVE BEEN REDUCED OY PAID CLAIM , <br /> T?GIICPEFFE:7TfJE • POLI r AT)ON .� <br /> LTR INSRD TYPE Or: INSURANCE POL !CYNVMGER DATEImMJODlYY1 I DATE ( MM!CC/YY) I L(M .TS <br /> 3ENE11ALLIA51UTY i i EACHcccmRErvGE 3 1000130 <br /> 0 <br /> Af IX IccMr�cR IA: GENERh'_ LIA21LfT1 i PHPX060275 09 / 17 / 03 i 09 / 17 / 04 rRcrns=_s ;e3u:u ;on«) s 100000 <br /> _ -- <br /> I CLAIMSN<Cc I X C CUR i =G6Y-- ;AnYere per 5 5000 _. .._ <br /> I <br /> PEHSCI•JAL d AGV INJURY 15 10010 () 00 <br /> CENEs2000000 <br /> (JA _ AGC �RECA 'E __ ... .._. <br /> Coc JL AG �$cuA' . LIVIT APPUE:= F=R RO"'UC:TS CGtIP+ov- A:)G s � OCQOQO <br /> JEC <br /> ! AUTOb1OBILE LIAHIUTV <br /> _ CCM3:rv „ G SINGLE L' MI & S <br /> I rV (EA ncmge.M; <br /> r... .I ANY A1UTG I <br /> I <br /> ALL OWNED A_rM5 i - <br /> I Fcor, .Y INJU? v S <br /> j BCFJ=C U..ED AUTOG (Per pereon) <br /> F— <br /> hIREDAUTL'S I . PCCILY INJURY I S <br /> ! I NON-C.WNED AUTOS I i (Pcr accilldn: I <br /> ? R ^PER'Y DAMAGE S <br /> {?C: aGGItlW :) I <br /> GARAGE L!ABILITV AUTC DN.Y . ,EP. ACCIDENT - ', S <br /> ANYAJ'O 0T <br /> i I` u'ERTHAN <br /> BAA =C . � <br /> AQT0 ONLY. AGG I $ -... . .. -- <br /> j I EXCE45AI618RFLLA UAeLITY I EACH CCCURR'cNCE ! S 1000000 <br /> A X - I OCCUR I C: Aatilv � ADE RENEWAL OP PHUB012211909 / 17 / 03 ! 09 / 17 / 04 AGGREGATE Y IS1000000 <br /> Is <br /> T ' <br /> j DEDUCTIUL E — <br /> X RETEN1' 014 £ 10000 i UTH5 <br /> I WORKERS COOFFNSATION AND .Ya iTORY 'Ik� ' 1'S I _ VI <br /> $ IEMPLOYERS' LIABILITI i WC782937 09 / 17 / 03 09 / 17 / 04 f " — 100000 <br /> ANY PROPP,ISTCM'PARTN=.RF�iEM, TN'E ' R. L . rA CH AC:tZENT .. ._ _._. <br /> = <br /> CPPICCWtAEM8:: . EXCLUDE]. L . CISEASE - EA SbIP�C_F..q S 100000 _ . <br /> Ill Wa, flpxcr,ta urpgr , f - .— <br /> S3EC; 4LPRD%ISO.NShE!Gr. j I _ F� LCISEASE POLICYL!MiT 1 S 500000 <br /> OTHER <br /> ' ( I <br /> I i I k <br /> I _ <br /> DESCRiPTiON OF OPERATIONS I LOCATIONS 1 VEHIC ES I EXCLUSIONS ADDED B'/ ENDORSEMENT 18PEGIA� PROVISIONS <br /> Certificate holder is included as additional insured applicable General <br /> Liability Coveragc 0 *zxcept as required by Florida Statute . <br /> CERTIFICATE HOLDER CANCELLATION <br /> SCH0IrI3 SHOULD ANY OF THC ABOVE OESCRiSED PDLICIES 5E CANCE..LEO BEFORE 'HE EXPIRATION <br /> School District Of Indian DATE THEREOF ThEISSUINO INSURER WILL ENDEAVOR TO MAIL 30 * 'DAYS WRITTEN <br /> River Co / Judy Bartlett NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT . BUT FAI _URG TO GO SO SHALL <br /> :'Y, 772 - 569 - 4139 IMPOSE NC D13LIGATID R LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> 1990 25th Street <br /> Ve .O Beach FL $ 2960 REPRESENTATIVES <br /> AUTHORIZE O REP YE <br /> ?Iwo Ole <br /> A OC RD 25 (2001 /03 ) JWACORD CORPORATION 1 <br /> TCITA_ P . 01 <br />