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04 <br /> - %�-2003 THU 12 ' 15 PH WH DAY FAX N0. 5615465772 P , <br /> Florift Retafl er. <br /> Self curers n.Mir � rorfe <br /> � <br /> Al <br /> lY. "l3rti� lieu<Irar. lc, l'h urnttn, ,�Irrr [ '11r < 'fgf.•r <br /> Ad�nialalrrrYl iy layi r, ii since 1979 (l .;,r�t 4:utlefir, �'ic: ch.1h min. Pwlaf4a <br /> Nn Nrzsrii . JAeland <br /> r <br /> 1'.U. li � R >B� • [ .alcrltu�d, 1 [. z3.`�J ? -018 � sr<r x• sr+ nuuah4Gl;,rRt. iour Thorn" S_ Y. k,011. 1 <rd .l� <br /> $ Icigilu�rlc <br /> (AM )i 663 m600 nr l -8Mw242*7644 � RiX (941) 66C1• 195� (� .alrs 1L PJui ��, .►w Ilarmt+1(r <br /> �. �- - <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 ofIndian River Counky, Jns P .O . Box 3068Verb a FL X2964, <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 /> =CL Cv NUMBER : 9_520-25864 Statutory Limits - -State of Florida <br /> Employers Liability <br /> EFFECTIVE DATE : SepterpbeL 1 2002 $ 500 , 000 ( Each Accident ) <br /> $ 500 , 000 ( Disease - - Each Employee ) <br /> EXPIRATION DATE : aggLembqrX3 , 2QQ2 $ 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 issding 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 05/ 22/ 2003 <br /> ..... , tt corroulefrp , :nc . . Adrnintatzatar <br /> Florida Retail Federattor, sair Insurers Fund <br /> r + <br />