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Client#: 5887 INDIARIV1 <br /> ACORDrM CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) <br /> 06/12103 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Palmer SO Cay of FL, LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND , EXTEND OR <br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> 1500 Mahan Drive , Suite 111 <br /> Tallahassee , FL 32308 INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED INSURER A. American Cas Co of Reading PA <br /> Indian River Memorial Hospital INSURER R National Union Fire Ins Co Pa <br /> 1000 36th Street <br /> INSURFR C . <br /> Vero Beach , FL 32960 <br /> INSURER D . <br /> INSURER E <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING <br /> ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN . THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS , EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES . AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS . <br /> TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION <br /> LTR NSR DATE MM/DD/YY DATE MM/DD/YY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED ncel $ <br /> CLAIMS MADE a OCCUR MED EXP (Any one Fw.rson) $ <br /> PERSONAL R ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GENS AGGREGAfF I IMIT APPI lES PH? PRODUCTS - COMP/OP AGG $ <br /> PRO- <br /> PO-ILICY JECT I ( W <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT $ <br /> ANY AUTO ( Fa accident ) <br /> AI. I OWNED At ITOS <br /> BODILY IN. IURY $ <br /> SCHFDIJI FD M ITO ^ ( Per person ) <br /> HIRFD AIITOS <br /> BODII Y INJURY $ <br /> NON r IWNI " 11 At H ( Y, ( Per artcldenl ) <br /> PROPERTY DAMAGE <br /> (Per acodent) <br /> GARAGE LIABILITY AUI O ONLY - !iA M ;CIDF NT <br /> ANY AttTO O1HER THAN FA ACC $ <br /> AUTO TO ONI Y AGG $ <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> OCCUR aCI. AIMS MADE AGGREGATE $ <br /> $ <br /> DEDUCTIBLE <br /> $ <br /> RF TFNTION $ $ <br /> A WORKERS COMPENSATION AND WC247857798 01 /01 /03 01 /01 /04 WRYLIMI I ( 1114 <br /> EMPLOYERS' LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXFCIITIVF - 1: I FAGII ACC: IDENF A1000yo- 00 <br /> OFF ICER/MF MHFR F X/CI . I IDFD "� <br /> 11 L 1 DISI: ASI FA F MPI rIYCF $ 1 , 000 ,000 <br /> YPs. desr'ribe under <br /> SPECIAL PROVISIOWS below 1 . 1 DL'7F ASF POI IC:Y ( IMIT $ 1 , 000 ,000 <br /> B OTHER Medical Prof CNM7055124 12/01 /02 12/01 /03 $ 1 , 0004000 <br /> $ 3 , 000, 000 Aggregate <br /> Shared Limit <br /> DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br /> ** Supplemental Name ** <br /> Indian River Memorial Hospital <br /> Indian River Hospital District <br /> Indian River Hospital Foundation , Inc . <br /> ( See Attached Descriptions ) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> Indian River Memorial DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _10_ DAYS WRITTEN <br /> Hospital , Inc NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL <br /> 1000 36th Ave IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> Vero Beach , FL 32961 REPRESENTATIVES . <br /> AUTHORIZED REPRESENTATIVE <br /> r / <br /> ACORD 25 ( 2001 /08 ) 1 of 3 # S35512 /M35510 21 KPW r> ACORD CORPORATION 1988 <br />