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<br />NAME AND ADDRESS OF AGENCY
<br />B y, Inc.
<br />P.O. Box 220
<br />Vero Beach, Fl. 32960
<br />AND ADDRESS OF INSURED
<br />CCI~iARaA1d8ES AFft3ftD1
<br />I'�
<br />COMPANY U.S. Fia*- lty & ____
<br />LETTER V n�.e• rrnn�
<br />'
<br />COMPANY "`'"
<br />LETTER 24`
<br />'•` lq� t C t m
<br />r
<br />i-"• W .L
<br />COMPANY + 0
<br />LETTER
<br />1
<br />P.O. B= 1D3
<br />i �FRSONAL INJURY
<br />S
<br />COMPANY
<br />} BODILY INJURY
<br />Vero Beach, Fl. 32960
<br />LE rTER
<br />y., t/++
<br />At m: Geo Childers
<br />CO
<br />LET ERNY
<br />This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. Notwlthstandin
<br />of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies I
<br />terms, exclusions and conditions of such policies.
<br />❑_ OWNED
<br />COMPANY
<br />TYPE OF INSURANCE POLICY NUMBER
<br />oLI r
<br />F.�MRATION DATE
<br />-
<br />LimitsofLia
<br />i U HIRED
<br />GENERAL LIABILITY
<br />S i t
<br />I , ❑ NON -OWNED I
<br />; ODIL/ 1N 1j
<br />I RY AP,D
<br />s
<br />OMPREHENSIVE FORM
<br />10 /'t/8A
<br />BODILY INJURY
<br />1M 012235124
<br />•L / i 't
<br />-
<br />I
<br />U PREMISES—OPERATIONS
<br />SGD'Lt I !:TRV ANO
<br />{
<br />l
<br />UMBRELLA FORM
<br />,—,
<br />rkOPE�+i Y DAMAGE
<br />-
<br />_) 'Tt,EP THAN UVHREL La
<br />PROPERTY DAMAGE
<br />❑ EXPLOSION AND COLLAPSE
<br />i
<br />HAZARD
<br />❑
<br />UNDERGROUND HAZARD
<br />❑ PRODUCTS;COMPLETED
<br />}
<br />HAZARD
<br />{
<br />BODILY IN;URY AND
<br />❑OFERATIONS
<br />UONTRACTUAL !NSUP.ANCE
<br />t
<br />PROPERTY DAMAGE
<br />❑ BROAD FORM PROPERrY
<br />+
<br />}
<br />I
<br />COMBINED
<br />DAMAGE
<br />❑
<br />1
<br />INDEPENDENT CONTRACTORS`
<br />❑ PERSONAL INJURY
<br />1
<br />�z
<br />requirement, term or condition :
<br />bed herein is subject to all the
<br />y in Thousands (0 a)
<br />`ACH AGGREGATE
<br />OCCURRENCE,
<br />i
<br />$1, 000 !f S1,000
<br />=
<br />I t
<br />V1'ORKenS'5:W0PEP4SATf Gfq1 h --
<br />a n a,
<br />EMPLOYERS' LIABILITY I
<br />OTHER � -----
<br />I
<br />DESCRIPTION OF OPERA QNS'LQ:
<br />Additicnal Insured: IncU II River Cot mty
<br />.__ �__. - � �,o•.y,��^. '-now aro
<br />F id ?v Vow
<br />i
<br />n
<br />Cancellation: Shouid ..r"✓GogCari/� nc-e i8' 0"_ ',h9 CC i!_iTion date
<br />;-,3nv i ? n!' .-:]'i -10—?—d 4$(i;�".. it' ,±G1d2T. ;J jt t
<br />1'nai ..Lit- I .. ;c ,l, r r. , .; re
<br />' 7:1 P tr :i.'f. :.3i HJT 1
<br />*Indim Tt�,� ^R�Z.�%� L.tiJfr{ii '..i; F •. fit �'..:-: B�1JQ1[ -� ler Agency, Im.
<br />Ui litres Dept.. ---
<br />1840 - 25th St. c
<br />Vero Beach, Fl. 32960 E
<br />-- Attn: Joyce Hmdltm
<br />?. rr+^«s• re5'�n+q'°9;q�"��y'-as . F a'��•'� -4 Br. .- - f rr<s---v s -v ,- .¢ .- ^-� �.r ��.. �'i� " .r^
<br />�.i'�r��-a..:� n.,a..v..., ��...r �"�f_:m:,`+.s:-,ci:=���,...��.'i�-=> ac,�:8'^�`___. _x•ima E_nc+s.:..�=..,ss�s� �- < v. .a.�.�-�.4' ,eu�,..i.a-,�*.....,��� _,... i�c�,7 ,a4.�s'�.s'�;...-_. _,-. >.... __.m_,�. _ ...-s: ..-v?
<br />79
<br />DEC 7 1983 55 W15 78 @Q{tK
<br />1
<br />i �FRSONAL INJURY
<br />S
<br />AUTOMOBILE LIABILITY
<br />} BODILY INJURY
<br />EACH PEPS01
<br />❑ COMPREHENSIVE FORD -
<br />i BODILY INJURY
<br />$ *4
<br />01
<br />❑_ OWNED
<br />} I -EACH ACCIDENT)
<br />�T s
<br />i U HIRED
<br />I } FZ•71'F?r D :DIAD=
<br />S i t
<br />I , ❑ NON -OWNED I
<br />; ODIL/ 1N 1j
<br />I RY AP,D
<br />s
<br />EXCESS LIABILITY
<br />-
<br />I
<br />171
<br />SGD'Lt I !:TRV ANO
<br />{
<br />l
<br />UMBRELLA FORM
<br />,—,
<br />rkOPE�+i Y DAMAGE
<br />-
<br />_) 'Tt,EP THAN UVHREL La
<br />i
<br />V1'ORKenS'5:W0PEP4SATf Gfq1 h --
<br />a n a,
<br />EMPLOYERS' LIABILITY I
<br />OTHER � -----
<br />I
<br />DESCRIPTION OF OPERA QNS'LQ:
<br />Additicnal Insured: IncU II River Cot mty
<br />.__ �__. - � �,o•.y,��^. '-now aro
<br />F id ?v Vow
<br />i
<br />n
<br />Cancellation: Shouid ..r"✓GogCari/� nc-e i8' 0"_ ',h9 CC i!_iTion date
<br />;-,3nv i ? n!' .-:]'i -10—?—d 4$(i;�".. it' ,±G1d2T. ;J jt t
<br />1'nai ..Lit- I .. ;c ,l, r r. , .; re
<br />' 7:1 P tr :i.'f. :.3i HJT 1
<br />*Indim Tt�,� ^R�Z.�%� L.tiJfr{ii '..i; F •. fit �'..:-: B�1JQ1[ -� ler Agency, Im.
<br />Ui litres Dept.. ---
<br />1840 - 25th St. c
<br />Vero Beach, Fl. 32960 E
<br />-- Attn: Joyce Hmdltm
<br />?. rr+^«s• re5'�n+q'°9;q�"��y'-as . F a'��•'� -4 Br. .- - f rr<s---v s -v ,- .¢ .- ^-� �.r ��.. �'i� " .r^
<br />�.i'�r��-a..:� n.,a..v..., ��...r �"�f_:m:,`+.s:-,ci:=���,...��.'i�-=> ac,�:8'^�`___. _x•ima E_nc+s.:..�=..,ss�s� �- < v. .a.�.�-�.4' ,eu�,..i.a-,�*.....,��� _,... i�c�,7 ,a4.�s'�.s'�;...-_. _,-. >.... __.m_,�. _ ...-s: ..-v?
<br />79
<br />DEC 7 1983 55 W15 78 @Q{tK
<br />
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