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_ CERTIFICATE OF LIABILITY INSURANCE DATE O(�M/20D1/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS �r CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the w certificate holder in lieu of such endorsement(s). PRODUCER CONTACT a Aon Risk Services Northeast, Inc. PHONE - New York NY Office A/C.No.Ext): (866) 2837122 IF No.): (800) 363-0105 `y a 199 water Street E-MAIL o New York NY 10038-3551 USA ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Lloyds Syndicate No. 623 AA1126623 Falck Southeast II Corp. INSURER B: Liberty Mutual Fire Ins Co 23035 dba American Ambulance Service 4227 St Lucie Blvd INSURER C: American Guarantee & Liability Ins Co 26247 Fort Pierce FL 34946 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570051471012 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested ILTR NSR TYPE OF INSURANCE ADD SUBR POLICY NUMBER POLICY EFF POLICY ERCP MD LIMITS A GENERAL LIABILITY W143B713 1 1 1 01Q/'3200123 10/01/2014 EACH OCCURRENCE $5,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $100,000 P EMISES a occurte ce CLAIMS-MADE X❑OCCUR MED EXP(Any one person) $25,000 PERSONAL B ADV INJURY Included GENERAL AGGREGATE $5,000,000 r GEN'L AGGREGATE LIMIT APPLIESPRO- PER: PRODUCTS-COMP/OP AGG $5,000,000 LO X POLICY LOC Professional Liability 55,000,000 0 rar B AUTOMOBILE LIABILITY AS2-631-510005-023 10/01/201310/01/2014 COMBINED SINGLE LIMIT $5,000,000 r_ ddr X ANY AUTO BODILY INJURY(Per person) O ALL OWNED SCHEDULED BODILY INJURY(Per accident) Z AUTOS AUTOS .� HIRED AUTOS 14ON-OWNED PROPERTY DAMAGE v AUTOS Per accident C C X UMBRELLA LIAB X OCCUR UMB541577000 10/01/2013 10/01/2014 EACHOCCURRENCE $10,000,000 U EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED RETENTION WORKERS COMPENSATION AND WCSTATU- OTH- EMPLOYER S'LIABILITY Y/N TORY LIMITS ANY PROPRIETOR I PARTNER/EXECUTIVE OFFICER/ME ABER EXCLUDED? ❑ N/A E.L EACH ACCIDENT (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIL L DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) M CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Indian River County Fire Rescue AUTHORIZED REPRESENTATIVE Attn: Brian Burkeen 4225 43rd Avenue I r � � Vero Beach FL 32967 USA cCJ_.!� c/,I("/ _ ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ----- --- ------------------- - - ------ -- -110