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40 <br />CER71FICAIE OF INSURANCE <br />This certifies that STATE FARM FIRE AND CASUALTY COWAW,131mmmingtoo. Igirtois <br />STATE FARM GENERAL IIISURATICF eOM("AFIY, Bloominylon, Illinois <br />ares the tolloWng polleyholder for the coverages Indicated below. <br />Name orpolleyholder WILLIAM CLOVER, IIJC . <br />Address or policyholder <br />Location or operations <br />286 N BA13COCK <br />MELBOURNE, FL 32935-6'717 <br />Description of operations <br />a policies listed below have been Issued to the policyholder For the policy periods shown. The insurance described in these policiss is <br />r„hinnl In e}I IF.. 1a nanlncI— find rnndirinnc nr ILnen nniiri— Trio limile of iinhiliiv chmmi innv have hnvn rorrimrd by Anv paid Cin me <br />113 srd of C©lanky Commissiorierfa <br />rias,. •rxl Addrhr of Coidi city Hordoe <br />'I'"]IAN RIVER COUNTY <br />P tN POWELL PLIRCIIASING DIRK11OR <br />2b25 19Th Avg <br />XPRO BRACH F1, 32960 <br />la ,+.rwM+.r�s+sA <br />IF any or Irr@ UUMOK'ru PVIPUJes ail lianccrw UBrcrrt nS <br />expliatlon date, State Form will try to mall a written notice to <br />Ilia certificate holder 30 days before cancellation 11, <br />however, we fail to mall such notice, no obligation or liability <br />Wtl be imposed on Slate Farm or Its agents or <br />represenlatiyex <br />'l+pn�ruM� rr ®•rlr4n 4 Rry+r#rrer^` Y•• <br />; act) <br />1trl+. <br />' • _ --F�OLICY F�EfiIfJD� -- <br />-- - � LICAI'1 a UF� LliAi31LITY . <br />POLICY NUMBER <br />TYPE OF INSURANCE <br />Effective Date Ex Iratian tate <br />_ (at beglnn6rig aI olle t�perlod} <br />Comprehensive <br />BODILY INJURY AND <br />98 -CF -2507-4 <br />Business Liability <br />05/17/00 <br />05/17/01 <br />PROPERTY DAMAGE <br />I Insurance lndudes: Products -Completed Operations <br />B Contractual Llabilily <br />❑ Underground Hazard Coverage <br />Each Occurrence $ l w fl . [Kill <br />❑ Personal Injury <br />Advertising Injury <br />General Aggregate $ 2., fl4Cl� {]f4f1 <br />❑ Explosion Hazard Coverage <br />Products - Completed <br />® Collapse Hazard Coverage <br />Operations Aggregate S 2, nf]O - 000 <br />General Aggregate Limit appiles to each project <br />POLICY PERIOD <br />BODILY INJURY AND PROPERTY DAMAGE <br />EXCESS LIABILITY <br />Effective Date Expiration Date <br />(Combined Single Limit) <br />❑ Umbrella <br />Each Occunence $ <br />❑ Other <br />_ <br />A2gregaie $ <br />_ <br />Part t STATUTORY <br />Part BODILY INJURY <br />Workers' Compensation <br />and Employers Liability <br />Each Accident $ <br />Disease Each Employee $ <br />Disease - Folie Ly Irnit� $_ <br />POLICY PERIOD <br />LIMITS OF LIABILITY <br />s000YNUMBER <br />TYPE OF INSURANCE <br />Effective Date Ex ballon Date <br />(at 1�eq1nnInj1 of poticLrperiort) <br />113 srd of C©lanky Commissiorierfa <br />rias,. •rxl Addrhr of Coidi city Hordoe <br />'I'"]IAN RIVER COUNTY <br />P tN POWELL PLIRCIIASING DIRK11OR <br />2b25 19Th Avg <br />XPRO BRACH F1, 32960 <br />la ,+.rwM+.r�s+sA <br />IF any or Irr@ UUMOK'ru PVIPUJes ail lianccrw UBrcrrt nS <br />expliatlon date, State Form will try to mall a written notice to <br />Ilia certificate holder 30 days before cancellation 11, <br />however, we fail to mall such notice, no obligation or liability <br />Wtl be imposed on Slate Farm or Its agents or <br />represenlatiyex <br />'l+pn�ruM� rr ®•rlr4n 4 Rry+r#rrer^` Y•• <br />; act) <br />1trl+. <br />