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Florida Retail Federales <br /> .0 BOAM Of 7r02k4tw% <br /> ♦ W, "l3rlt " Kurrdral. Jr. , l'hmrman. inn Ory l 'tR1rr <br /> Admiaislrmd ►4 SrMM4 silks 1979 Gourp Samdukr. Vru¢ Chairm+n. P.+laka <br /> ehind <br /> P.0 . Box 488 • Lakeluid, 17. 3 3802m0988 • mitw.scuumaho(di, � s torn v _ Ki.r.l . trkeland <br /> } !�� 'Cla.arur 5. l'ui�v� tY. l�krlanu! <br /> �f Tcleph4me iX63 ) t6i - 00) rlr 1 .800-282 - 643 • F3x ( 863 ) 66& 1958 ChAirlra X. Wrniz. .W. Avnniltr <br /> Certificate of Insurance <br /> RE : 0520 - 25864 <br /> ISSUED TO : Indian River County Board of County Commissioners <br /> 1840 25th St <br /> Vero Beach , FL 32960 - 3365 <br /> This is to certify that Boys & Girls Club of Indian River County , Inc P . O . Box 3068 Vero Beach . FL 32964 <br />, <br /> being subject to the provisions of the Florida Workers ' Compensation Law , has secured the payment of any <br /> workers ' compensation benefits due by insuring their risk with the Florida Retail Federation Self Insurers Fund . <br /> POLICY NUMBER : 0520 - 25864 Statutory Limits - - State of Florida <br /> Employers Liability <br /> EFFECTIVE DATE : September 13 , 2003 $ 500 , 000 ( Each Accident) <br /> $ 500 , 000 ( Disease - - Each Employee ) <br /> EXPIRATION DATE : September 13, 2004 $ 500 , 000 ( Disease - - Policy Limit) <br /> This certificate is not a policy and of itself does not afford any insurance . Nothing contained in this <br /> certificate shall be construed as extending coverage not afforded by the policy shown above or affording <br /> insurance to any insured not named above . <br /> The policy of insurance listed above has been issued to the named insured for the policy period indicated . <br /> Notwithstanding any requirement, term or condition of any contract or other document to which this certificate <br /> may pertain , the insurance made available by the described policy in this certificate is subject to only the <br /> terms , exclusions and conditions of such policy . Paid claims may have reduced the shown limits . <br /> If the policy described above is cancelled before the expiration date indicated , the issuing company will <br /> attempt to mail 30 days ' written notice to the certificate holder named above . However, the issuing company , <br /> its agents or representatives accept no obligation or liability of any kind for failure to mail such notice . <br /> Date 09/ 24/ 2003 <br /> summit consulting , : nc . , Administrator <br /> 71orida Retail Federation Self Insurers Fund <br /> �01�33 , 12�57 <br /> 61 <br /> 4tzrS� co <br /> N � ` <br />