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10/ 10/2003 15 : 16 HCIR. 4 17725634564 N0 . 143 1?02 <br /> ACO1�P_ - INSURANCE BINDER OPIo DATE <br /> 10 / z0 / n3 <br /> YHIS BINDER 15 A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM. <br /> TI <br /> PRODUCER I_Ag No E 800 - 729 - 4149 COMPANY af1+DFRz 80411 <br /> 704 - 365 - 7124 Fireman ' s Fund Ins . Cos . <br /> DATE TIME EXPIRATION <br /> T@IRATI TIME <br /> E4cNeasy Healthcare - FL " I-�------� -- <br /> 6525 Morrison Blvd . , suite 200 AM Is:o, Alrf <br /> Charlott® NC 28211 10 / 12 / 03 PM 12 / 11 / 03 it NOON <br /> Florida_ Hospital Aasoai-aHE <br /> tion THIS BINDER 16 ISSUED TO EXTEND COVERAGE IN TAFtOVENAMEDCOMPANY <br /> �.� SUB CODE, PEREXPIRINGPOLICYO: MZG80819831 <br /> CODE; I <br /> AGENCY• DESCRIPTION OF OPERATIONWEHICLESIPROPERTY (InduMnp Location)CUSTOMER M : INC) ZA` 1 <br /> INSURED <br /> Indian River Memorial Hospital <br /> Greg Morgan <br /> 1000 36th Street <br /> Vero Beach FL 32960 <br /> COVERAGES [ IMl I <br /> type OF INSURANCE COVERAGEJFORMS DEDUCTIBLE COINS U AMOUNT <br /> PROPERTY CAUSES OF LOSS <br /> l BASIC _ BROAD SPEC <br /> GENERAL LIABILITY I EACH OCCURRENCE S <br /> COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) S <br /> I I CLAIMS MAD[ I i OCCUR MED EXP (Any 9m parson) $ <br /> I PERSONAL a AOV INJURY S <br /> —� GENERAL AGGREGATE_ $ <br /> +� RETRO DATE FOR CLAIMS MADE: PRODUCTS • COMP/OP AGG $ <br /> AUTOMOBILE LIABIUTY COMBINED SINGLE lIM(T S 2 , OOO � OOO <br /> �( <br /> ANY AUTO ROPILY INJURY (Pot pm6oAI -- 1 S <br /> ALL OWNED AUTOS BODILY INJURY (Pe, aceidea) <br /> SCHEDULED AUTOS PROPERTY DAMAGE s <br /> " - <br /> HIRED AUTOS MEDICAL PAYMENTS I L 5 , 000 <br /> .� .�. <br /> __ • NON-OWNED AUTOS PERSONAL WJURY PROT S <br /> � UNINSUREDMbTORIST s1 , 000 , 000 <br /> I i <br /> AUTO PHYSICAL DAMAGE DEDUCTIBLE X j ALL VEHICLES SCHEDULED VEHICLESX ACTUAL CASH VALUE <br /> Xy COLLISION- 500 STATED AMOUNT $ <br /> X I OTHER THAN COL' 2.5 0 _ OTHER <br /> GARAGE LIABILITY I AUTO ONLY . EA ACCIDENT S <br /> ANY AUTO OTHER THAN AUTO ONLY <br /> EACH ACCIDENT f <br /> ••' - � - -- AGGREGATE S <br /> EXCESS LIABILITY EACH OCCURRENCE S <br /> UMORELLA FORM AGGREGATE S <br /> OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE : SELF •INSURED RETENTION 3 <br /> WC STATUTORY LIMITS <br /> WORXER66 COMPENSATION E.L EACH ACCIDENT j ;AND <br /> ^ <br /> EMPLOYER'S LIABILITY E.L. DISEASE - EA EMPLOYEE S <br /> E.L, DISEASE • POLICY LIMIT 5 <br /> SPECIAL rHY6ICAT. DAMGE ( COti' ' T ) : ALmbulanoaa G Heavy Units : $ 500 Dad _ Comp 6 $ 1000 FEES S <br /> CONDITIONS! ped C011iSiOn Ambulance Equipment : $ 102 , 470 scheduled Equipment / 01 , 000 TAXES S <br /> OTHER ped except $ 5 , 000 as re eCta wind/hail and flood / " Broad Form " <br /> COVERAGES <br /> ESTIMATED TOTAL PREMIUM 5 <br /> NAME 8 ADDRESS <br /> MORTGAGEE ADDRIONALINSUREO <br /> LOSS PAYEE —..._ . . . , .. . --LOANS <br /> AUT D EPRETA• <br /> Fl ida HospitaI Vociation <br /> ACORO 75-S ( 1198 ) NOTE : IMPORTANT STATE INF ORMA ION ON REVERSE SIDE @ACORO CORPORATION 1993 <br />