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ACC>R& CERTIFICATE OF LIABILITY INSURANCE DADDIYYYY) <br /> 5 / 22 / 20/ 2011 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED , the policy( ies) must be endorsed . If SUBROGATION IS WAIVED, <br /> subject to <br /> the terms and conditions of the policy , certain policies may require an endorsement. A statement on this certificate does not confer <br /> rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME : Penny Garrett <br /> Lassiter - Ware Insurance PHONE 352 . 787 . 3441 X105 FAX 888 . 883 . 8680 <br /> AIC <br /> 1317 Citizens Blvd . MAIL <br /> -- - - -- . ( NJ - — <br /> ADDRESS : <br /> - - - - -- - <br /> PRODUCER 0042350 <br /> CUSTOMER ID 010 <br /> Leesbui� FL 34748 INSURER(S) AFFORDING COVERAGE_ _ NAIC # <br /> INSURED INSURERAMOunt Vernon Fire Insurance Co 26522 <br /> Indian River County Healthy Start Coalition INSURERS : <br /> 1615 10th Avenue INSURERC : <br /> Vero Beach , FL 32960 - 6231 - - — <br /> INSURER D <br /> INSURERE : <br /> INSURER F : <br /> COVERAGES CERTIFICATE NUMBER : 11 / 12 GL REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY <br /> PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL <br /> THE TERMS , <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS . <br /> INSR - --- ADDL SUBR _ _ POLICY EFF POLICY EXP - - - _ <br /> LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER IMMIDDIYYYYI I (MMIDDIYYYYILIMITS <br /> GENERAL LIABILITY P2103140C 05 / 01 / 201105 / 01 / 2012 ' <br /> — EACH OCCURRENCE $ 1 , 000 , 000 <br /> DAMAGE TO RENTED -- -- <br /> X _COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence $ 100 , 000 <br /> A J CLAIMS-MADE [ X ] OCCUR X j MED EXP (Any one person 5 000 <br /> PERSONAL & ADV INJURY $ Excluded <br /> GDIN ERALAGGREGATE _ $ 21000 , 000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ Excluded <br /> POLICY F PER& LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> ( Ea accident) $ <br /> ANY AUTO ---- --- — -__._ - _. <br /> ALL OWNED AUTOS <br /> BODILY INJURY (Per person) $ <br /> - -- --- - - - -- <br /> BODILY INJURY (Per accident) $ <br /> SCHEDULED AUTOS ---- ----- ------ <br /> PROPERTY DAMAGE <br /> HIRED AUTOS (Per accident) $- <br /> NON-OWNED AUTOS <br /> --- _. — �._$ — <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> - - EXCESS LIAB I -CLAIMS-MADE- <br /> AGGREGATE <br /> t DEDUCTIBLE - '�I — $ - - — <br /> RETENTION $ - $ <br /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS' LIABILITY Y / N TQR IMIT R <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> OFFICER/MEMBER EXCLUDED? ❑ NIA E . L. EACH ACCIDENT $ <br /> (Mandatory in NH) <br /> If as , describe under E . L . _DISEASE - EA EMPLOYE _$ _ __ _ <br /> y . <br /> DESCRIPTION OF OPERATIONS below ' E . LDISEASE . POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101 , Additional Remarks Schedule, if more space is required) <br /> Certificate holder is also additional insured with regards to General Liability per policy forma . <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF , NOTICE WILL BE DELIVERED IN <br /> Indian River County ACCORDANCE WITH THE POLICY PROVISIONS . <br /> Board of County Commissioners <br /> 1801 27th Street AUTHORIZED REPRESENTATIVE <br /> Vero Beach , FL 329603365 <br /> Penny Garrett / PENNYG � 7YL <br /> ACORD 25 ( 2009/09) © 1988-2009 ACORD CORPORATION . All rights reserved . <br /> INS025 (200909) The ACORD name and logo are registered marks of ACORD <br />