Laserfiche WebLink
To : 561562902C Fram : State Fara Fax : State Farm LTOPCALL at : OCT-02-2003-08: 11 Doc : 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 certif es that: 0 STATE FARM MLIT LIA'L AUTOMOBILE INSURANCE COMPANY of Bloomington , Illinois , or <br /> ❑ STATE FARM FIRE AND CASUALTYCONPANYof Bloomington. Illinois <br /> has coverage in force for the fodoMng Named insured as shown below : <br /> Named Insureci St Peter's Misslopiary Baptist Chl. rch Inc <br /> Address of Named Insured 4250 38 ' Ave <br /> Vero Beach , FL 32967 <br /> POLICY NUMBER 3402832DO959F <br /> EFFECTIVE UA.'E OF j 04108103. 10f09103 - - -- - -- - - -- - - - - -�- - - ----- - -- - - - ---- ----- -- --. <br /> POLICY <br /> 1994 DODGE 6350 VAN <br /> DESCRIPT: ONOF I <br /> VEHICLE j <br /> LIABILITY CO wES ❑NO YES <br /> LIMITS OF LABILITY ❑N-O— -- � []YES_ _ ❑NO ❑ YES ❑ NO <br /> -t---. <br /> a . Bocily Injury -Each Person <br /> a. Bodily Irpry ----- - - ----- - ----- - ---Each Accident <br /> b. Property Damage f— — ------ t - -- — — - ---- + --- -- <br /> c . Bodi ly Injuryi — -r -- ----- - --- - --- ---- - ----- - — - --- - <br /> Property Damage $ 1 ,000,C00 .00 <br /> Single Jmit Each <br /> Accident <br /> ❑ <br /> PHYSICAL DAMAGE -t--- -- - --+ -- 1 - --- L - -- - _YES ❑ NO ❑ YES --- ---❑ NO -- I -- >ayEc <br /> COVERAGES � NO ❑YES [ NO <br /> 5250 OC Deductible Deductible Deductibie <br /> a_ Comprehens,ve Deductible <br /> b . Collison $ OAO Deduc�Cbie Deductible O '� ❑ NO ❑YES ��NO <br /> Deductible Deductible <br /> EMPLOYER'S <br /> NON-OVVNERSHIP <br /> wE5 OND ❑YES ❑ NO ❑YES ❑ NC OYES 0 N <br /> HIRED CAR COVERAGE - --- - EYES [,INC <br /> EYES [INC) <br /> --- --- -- - - ONO I ----�------�Y-ES ❑ NG <br /> i <br /> Agent 2733 10/02/03 <br /> Signature cf Authcnzed Representative Title Agent' s Code Number Date <br /> Name and Add •ess of Certificate Holder Name and Address of Agent <br /> Indian P, iverCounty David E Hedges, State Farm Insurance Agency <br /> 1990 25`' Street 2601 2UStreet Suite B <br /> Vero Beach , FL 32960 Verc Beach FL 32960 <br /> i <br /> -- ---- -- ------ -- - <br /> eck if a permanent Certificate of Insurance for lability coverages needed ❑ <br /> Check if the Cer6f bate Holder should be added as an Additonal Insured : ❑ <br /> Remarks: ---- ----- --- — -- -- - - <br /> 1584302 Rco. 9-94 Ffin:eC in J .SA. - -- -- ---- -------- - <br />