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VEHICLE OGJIPM1�J`�'EQ�'IF-f OF INSURANCE 06/1812021 (MMfDD7VYYY) a6/ia!2a21 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS BELOWCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, 'EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES REPRESENTATIVE CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE OR PRODUCER, ANO THE CERTIFICATE HOLDER. IS INSURER(S), AUTHORIZED This form is used to report coverages provided to a single specific vehicle or equipment. Do not use this form to report liability coverage Provicled to multiple vehicles under a sfttgle policy. Use ACORD 25 for that purpose. PRODUCER - CONTACT NAE1F: PICK Mathews Rich Mathews State Farm Agency PHONE _ INC. No. Ext)• 239 992-8896 lti/c -992-2957 9510 Corkscrew Palms Circle, Suited E4Yall Hol 239 33925 Estero, ADDRESS: - FI D I rn en INSURED Ag Scope Services Inc 865 11111 Ct SW Vero Beach, FL 32962 DESCRIPTION OF VEHICLE OR YEAR FAAKE I MANUFACTURER _1998 Gmc DESCRIPTION Farm Mutual Automobile Insurance Company 25178 9: IN1WHER E; PMENT MODEL BODYTYPE 2500 FlVEHICLE IDENTIFiGATION NUMBER Flat Bed 1GDJ6H1J6TJ501185 VEHICLFJEQUIPMENT VALUE I SERIAL NUMBER COVERAGES S CERTIFICATE NUMBER-. TNlS IS TO CERTIFY THAT THE POLICY(IES) OF INSURANCE LISTED BELOW HAS!HAVEBEEN TO THIEVISION NU E WSABOVE FOR THE POLICY PERIOD(S)D(S) INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERiA OR CONDITION OF AtVIISSUED '.CON7RACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE NIAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED 6Y THE POLICYNES) DESCRIBED HEREIN IS/At2E SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICY(IES). NSR nn"•L - _7R ItdSRe TYPE OF INSURANCE POLICY NUtde ER POLICY EFFECTIVE POLICY EXPIRATION DATE (hIMIDDfYYri) DATE (MM7DD/YYV Y) LIMITS X VEHICLE LIABILIry 989 1241 -F15 -59A GENERAL LIABILITY OCCURRENCE CLNrAS MADE tyPE OF INSURANCE POLICY NUMBER }.j VEH COI.LiRiON LOSS i 989 1241 -F15 -59A Y, IVEH COMP ! I VEH DTC 1 989 1241 -F15 -59A EQUIPMENT BASIC @ROAD SPECIAL Personal Injury Protect. 989 1241 -F -15-59A Ob -15-2021 1 12-15-2021 i OS DEDUCTIBLE REMARKS (INCLUDING SPECIAL CONDITIONS r pTHER COVERAGES) (Attach ACORD 101, AJditlanal Remarks Scnotlula, it more Space 15 required) _ADDITIONAL INTEREST Select elle of the following: X The add)liunal Interest described below has been added to the policy(ieS) listed neral, by policy number(s). A request has berm Sabrmfled to add the additional interest descnb0J belart to the policy(les) rcln_9 herein [, ^,lie neniUartal. VEHICLE I EQUIPMENT INTEREST: LEASED FINANCED NAtAE At1D AUDRESS OF ADDITIONAL INTEREST INDIAN RIVER COUNTY PURCHASING DIVISION 1800 271h SLreot BuildinU " {3 Vero Beach; FL 32960 10,000 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. DESCRIPTION OF THE ADDITIONAL INTEREST ADDITIONAL INSURED LOSS PAYEE LENDER'S LOSS PAYEE 15 Named Insured LOAN / LEASE N_1_11 AUTHORIZED ACORD 23 (2016!03'2015 ORD AC ' j 99 O 17.GO `M The ACORD name and logo are registered marks. Of ACORD TION. All rights reserved. 1004361 142967:3 01-262016 COMBINED SINGLE LIMIT S 1,000,000 06-15-2021 12-15-2021 BOUILYINJURY(Perperon) S — eODILYINJURY(Per aeciden-) S -- __ PROPERTY DAMAGC g EACH OC.11ENCE VENERALAGGREGATE $ POLICYEFFECT(VE DATE (Mhl/DD/YYYY). POLICY EXPIRATION DATE S ttAM/DD)YYYYj LIMITS /DEDUCTIBLE U6-15-2021 12-15-2021 n ACV ❑ AGRF.EDAtAT S LIMIT _ ❑ ❑ STATEDAMT S 1,000 OED OG -15-2021 12-15-2021 ACV ❑ AGREE 0AMT i b LIMIT ---- ❑ 0 STATED AMT 5 1,000 DED (� ACV ❑ AGREED AMT ----�---- ❑ RC ❑STATED Atrr S LIMIT __ ❑ S DED Ob -15-2021 1 12-15-2021 i OS DEDUCTIBLE REMARKS (INCLUDING SPECIAL CONDITIONS r pTHER COVERAGES) (Attach ACORD 101, AJditlanal Remarks Scnotlula, it more Space 15 required) _ADDITIONAL INTEREST Select elle of the following: X The add)liunal Interest described below has been added to the policy(ieS) listed neral, by policy number(s). A request has berm Sabrmfled to add the additional interest descnb0J belart to the policy(les) rcln_9 herein [, ^,lie neniUartal. VEHICLE I EQUIPMENT INTEREST: LEASED FINANCED NAtAE At1D AUDRESS OF ADDITIONAL INTEREST INDIAN RIVER COUNTY PURCHASING DIVISION 1800 271h SLreot BuildinU " {3 Vero Beach; FL 32960 10,000 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. DESCRIPTION OF THE ADDITIONAL INTEREST ADDITIONAL INSURED LOSS PAYEE LENDER'S LOSS PAYEE 15 Named Insured LOAN / LEASE N_1_11 AUTHORIZED ACORD 23 (2016!03'2015 ORD AC ' j 99 O 17.GO `M The ACORD name and logo are registered marks. Of ACORD TION. All rights reserved. 1004361 142967:3 01-262016