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_ out' <br />SEP 1-198Z': <br />qft <br />r t Ca u + <br />I <br />CERTIFICATE OF INSURANCE <br />BLOOMINGTON, ILLINOIS , <br />This is to certify that the Company indicated above has the following insurance in force: <br />POLICY ORTGAGEE <br />POLICY EXPIRATION LOAN NUMBER <br />NUMBER 79-0394907-0 DATE 8/2/$3 (IF APPLICABLE) <br />NAME AND ADDRESS OF PARTY TO WHOM NAME AND ADDRESS OF <br />CERTIFICATE.IS ISSUED OTHER INTERESTED PARTY <br />r- _1 r -I <br />Board of County Commissioners ADDITIONAL INSURED: <br />of Indian River County Indian River County <br />1840 25th Street 1840 25th Street <br />Vero Beach, F1 32960 Vero Beach, F'1 32960 <br />L J L J <br />OLD <br />viii§— LOCATION OF UNIT (IF DIFFERENT THAN SHOWN ABOVE) <br />NAME OF <br />INSURED William B. & Minerva Herrick <br />(ASSOCIATION) <br />ADDRESS P.O. Box 6501 , Vero Beach, F1 32960 <br />LOCATION OF PREMISES: (IF DIFFERENT THAN SHOWN ABOVE) <br />No.1 3620 1st Street, S.W., Vero Beach, F1 <br />32960 <br />No. 2 <br />No. 3 <br />No. 4 <br />Premises described above and with respect to those coverages and <br />kinds of property for which a specific limit of <br />liability is shown below are <br />subject to all of the terms of the original policy available at the Office of the Association or Named Insured including <br />forms and endorsements <br />made a part thereof: <br />LIMIT OF LIABILITY <br />COVERAGE <br />PERCENTAGE <br />Loa No. BIGg. No. <br />Loa No. Bldg. No. Lot. No. Bldg. No. <br />Loc. No. Bldg. No. <br />APPLICABLE <br />A. Building(s) <br />$100,000 <br />$ $ <br />$ <br />SECTION <br />B. Personal Property <br />$ 70,000 <br />$ $ <br />$ <br />I <br />Addl. Cov. (Specify by Name) <br />PROPERTY <br />$ <br />$ $ <br />$ <br />COVERAGE <br />$ <br />Is is <br />is - <br />$ <br />Is Is <br />Is <br />$ <br />Is Is <br />Is <br />SECTION <br />COVERAGE <br />LIMIT OF LIABILITY <br />II <br />C. Bodily and Personal Injury and Property Damage Liability <br />$300,000 <br />each occurrence $�00 <br />aggregate <br />LIABILITY <br />D. Premises Medical Payments <br />$ <br />. each person $ <br />2-5,000 <br />each accident <br />COVERAGE <br />gTA/g sAR16 <br />THIS CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE A 1! Y NOR <br />NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE AFFORDED BY THE POIR #1 IRIm <br />Li <br />Bob Grfce Insurance Agency, Inc. <br />2175 - 20th St., Suite A, Oak Plaza <br />Vero Beach, Florida 32960 <br />Phone: Off. 305 567-1106 <br />Agent - State Farm 8/20/82 <br />F .2Signature of Authorized -presentative Title Date <br />on. <br />r <br />