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A4CORpM CERTIFICATE OF LIABILITY INSURANCEDATE (MM/DD/YYYY) <br /> 07/25/2003 <br /> PRODUCER ( 863 ) 688 - 5495 FAX ( 863 ) 688 - 4344 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Herndon & Associates Insurance , LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 91 Lake Morton Dr . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, <br /> P 0 Box 3608 <br /> Lakeland , FL 33802 INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED Tri - Sure Corporation INSURER A: Southern Owners Insurance Co <br /> P 0 Box 653 INSURERS: Auto Owners Ins Co <br /> Auburndale , FL 33823 INSURER C : Ohio Casualty <br /> INSURER D: Bridgefield Employers Ins Co <br /> INSURER E: Great American Inland Marine <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINI <br /> ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS , EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES . AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS . <br /> iLT R , rRAL <br /> E OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE IMM DATE imminghm LIMITS <br /> BILITY 20607135 46 10/01/2002 10/01/2003 EACH OCCURRENCE $ 1 , 000 , 00 <br /> CIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50 , 00 <br /> IMS MADE OCCUR MED EXP (Any one person) $ 5100 <br /> A PERSONAL & ADV INJURY $ 10000200 <br /> GENERAL AGGREGATE $ 2 , OOO , OO <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 210000000 <br /> POLICY PRO- <br /> JECT LOC <br /> AUTOMOBILE LIABILITY 43042761 00 10/01/2002 10/01/2003 COMBINED SINGLE LIMIT <br /> X ANY AUTO (Ea accident) $ <br /> 1 , 000 , 00 <br /> ALL OWNED AUTOS <br /> BODILY INJURY $ <br /> B SCHEDULED AUTOS (Per person) <br /> X HIRED AUTOS <br /> BODILY INJURY X $NON-OWNED AUTOS <br /> (Per accident) <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO <br /> OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESS/UMBRELLA LIABILITY BX052883 5 54 10/01/2002 10/01/2003 EACH OCCURRENCE $ 20000 , 000 <br /> X OCCUR F1 CLAIMS MADE AGGREGATE $ 290009000 <br /> C $ <br /> DEDUCTIBLE <br /> RETENTION $ $ <br /> ::'c ;:e:^.0 cc?r.?E sAT10!: At ;� 83027986 10/25 /2002 10/25/2003 WCSTATU- OTH- <br /> T VII } C <br /> EMPLOYERS' LIABILITY _. <br /> D ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ SOO , OO <br /> Oyes, describe <br /> and EXCLUDED? E.L. DISEASE - EA EMPLOYE $ 5009000 <br /> If yes, describe under <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 5000000 <br /> ented/ Leased IMP1764624 10/01/2002 10/01/2003 $ 2009000 <br /> E Equipment $ 2500 Deductible <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br /> E : Whippoorwill Estates Water Assesment Project IRC Bid # 5072 <br /> ° 10 Days notice given for cancellation for nonpayment of premium <br /> Indian River County is named as additional insured with regards to the General Liability and Automobile <br /> Liability <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br /> 30 " DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br /> Indian River County BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br /> 2625 19th Avenue OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br /> Vero Beach , FL 32960 AUTHORIZED=REPRTATIVE <br /> ACORD 25 (2001 /08 ) ©ACORD CORPORATION 1988 <br />