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This certificate is executed by Liberty Mutual Insurance Group as respects such insurance as is afforded by those companies. BM0068 <br /> Certificate of Insurance <br /> This certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This certificate is not an insurance <br /> policy and does not amend, extend, or alter the coverage <br /> afforded b the licies listed below. <br /> This Is to certify that (Name and address of Insured) <br /> CHILDREN'S HOME SOCIETY OF FLORIDA • <br /> 1485 S. SEMORAN BLVD. '` Liberty <br /> SUITE 1448 MUtUMTM <br /> WINTER PARK, FL 32792 <br /> is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) <br /> is subject to all their terns, exclusions and conditions <br /> and is not altered by any requirement, term or condition of any contract or other document with respect to which this certificate may be issued. <br /> Expiration Type Expiration Dates Policy Numbers Limits of Liability <br /> Continuous ' 07/01 /2004 WA6- 15D-280851 -013 Coverage afforded under WC law of Employers Liability <br /> Extended the following states : Bodily Injury By Accident <br /> X Policy Term FL $ 500,000 Each Accident <br /> Bodily Injury By Disease <br /> $ 500,000 Policy Limit <br /> Workers Compensation Bodily Injury By Disease <br /> $ 500,000 Each Person <br /> General Aggregate-Other than Prod/Completed Operations <br /> General Liability <br /> Products/Completed Operations Aggregate <br /> Claims Made <br /> Occurrence Bodily Injury and Property Damage Liability Per <br /> Occurrence <br /> Retro Date Personal and Advertising Injury Per Person / <br /> Organization <br /> Other Liability Other Liability <br /> Each Accident - Single Limit - B . 1 . and P. D . Combined <br /> Automobile Liability <br /> Each Person <br /> Owned <br /> Non-Owned Each Accident or Occurrence <br /> Hired <br /> Each Accident or Occurrence <br /> C <br /> O <br /> M <br /> M <br /> E <br /> N <br /> T <br /> S <br /> *If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration <br /> date. However, you will not be notified annually <br /> of the continuation of coverage. <br /> Special Notice - Ohio: Any person who, with intent to deGaud or knowing that he / she is facilitating a fraud against an insurer, submits an application <br /> or files a claim containing a false or <br /> deceptive statement is guilty of insurance fraud. <br /> Important information to Florida policyholders and certificate holders: in the event you have any questions or need information about this certificate <br /> for any reason, please contact your local sales <br /> producer, whose name and telephone number appears in the lower left comer of this certificate. The appropriate local sales office mailing address may <br /> also be obtained by calling this number. <br /> Notice of cancellation: (not applicable unless a number of days is entered below) . Before the stated expiration date the company will not cancel or <br /> reduce the insurance afforded under the above <br /> policies until at least 30 days notice of such cancellation has been mailed to: <br /> Office : JACKSONVILLE, FL Phone: 904-363 -0099 <br /> Certificate Holder: Scott Carnes <br /> DAN HOOD Authorized Representative <br /> CHILDREN ' S HOME SOCIETY <br /> TREASURE COAST DIVISION <br /> 415 AVENUE A <br /> SUITE 101 <br /> FT . PIERCE , FL 34950 Date Issued: 07/02/2003 Prepared By: TH <br />