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t <br /> gig ESSEX INSURANCE COMPANY <br /> J. <br /> COMMERCIAL LIABILITY DECLARATIONS <br /> 3 CH4 314 Policy Number <br /> Renewal of Number <br /> 3CK3308 <br /> Item 1 . Named Insured and Mailing Address <br /> $IJc! [iLI�JI-rgr �C`n : <br /> Lh r 1' 03 kic:2 1211 SFTji r ui�U iOtS'il <br /> Cultural Council of Indian River Co . , Inc suix227 <br /> 2145 14th Avenue Ste : 11 Casselberry FL 32707 <br /> Vero Beach , Fl 32960 PRODAGTSid Bannack _ <br /> OIn,Voeroo- each , FL <br /> This insurance is, <br /> � r apt <br /> FloriC4 Surplus Lir - < ; ,; cured to the <br /> Item 2. Policy Period From : 0 3 10 2 0 0 3 <br /> TO: 03Z10 / 2004 Term : 1fheYearn of ine rlo : <br /> 12 :01 A. M . Standard Time at the address of the Named Insured as stated herein. y oaf on e; of <br /> 12 :01 <br /> recover for the CD!i ^ Y <br /> unlicensed insurer. <br /> Item 3. Retroactive Date : File # <br /> Item 4. Business Description : Promotes the arts & cultural activities & programs <br /> Item 5 . In return for the payment of the premium , and subject to all the terms of this policy, we agree with you to provide <br /> the Insurance as stated in this policy. <br /> This policy consists of the following coverage parts for which a premium is Indicated . Where no premium is shown , there Is <br /> no coverage . This premium may be subject to adjustment. <br /> Coverage Part (s) Form No . and Edition Date <br /> Premium <br /> Commercial General Liability Coverage Part $ 41227 , 00 <br /> Professional Liability Coverage Part <br /> Policy Fee $ 35 . 00 <br /> Service Fee <br /> Tax $ 12 . 79 <br /> $ 213 . 10 <br /> $ <br /> $ <br /> $ <br /> Audit Period Annual unless otherwise stated : <br /> Total $ 41487 , 89 <br /> Item 6. Forms and endorsements applicable to all Coverage Parts : 011 - 1054 ( 04 - 00 ) , 011 - 1061 ( 08 - 02 ) <br /> SHOW NUMBERS <br /> Agent Name and Address : Crump Insurance Services of Florida , Inc . 1211 Semoran Blvd . Ste : 227 Casselberry , <br /> FL 32707 <br /> Agent Number: 104990 <br /> Countersigned 03 /25 /2003 kp B Zoe <br /> � <br /> Y <br /> DATE <br /> THIS COMMERCIAL LIABILITY DECLARATIONS AND THE SUPPLEMENTAL DECLARATION ,TOG�T� ER` WITH THE COMMONttPOLICY CONDITIONS , <br /> COVERAGE FORM (S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED POLICY. <br /> 011 - 1056 (9-93) INSURED <br />