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diESSEX INSURANCE COMPANY <br /> MARM <br /> COMMERCIAL LIABILITY DECLARATIONS <br /> 3 CH4 314 Policy Number <br /> Renewal of Number 3 CK3 3 0 8 <br /> Item 1 . Named Insured and Mailing Address : LI1.C 4 u 32ob � P. ,: ;°`q`', e L. <br /> _ LIC � 1`-.� 2Jt2 12 -t't Ser cr,:n Bivtl, otim <br /> Cultural Council of Indian River Co . , Inc cassel`7 <br /> asseiuerry FL 32707 <br /> 2145 14th Avenue Ste : 11 <br /> Vero Beach , Fl 32960 PRODDAmSid Bannack <br /> cITY�Oro ° each , FL <br /> This insurance Is 7:7ed oursuant to the <br /> Florida Surplus Li,iea Lava. er;r;r,s insured <br /> j; . . .-r <br /> . s ..o ;:•at have <br /> Item 2 . Policy Period From : 0 3 / 10 / 2 0 0 3 To: 03 / 10 / 2004 Term • liheyrearWn of to � FIC, ida surance <br /> uarality Act to ane e,,. ; ;i of C- :y rght of <br /> 12:01 A. M . Standard Time at the address of the Named Insured as stated herein. recovery for the obligation of anv it <br /> unlicensed insurer. <br /> File # <br /> Item 3 . Retroactive Date: <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(a) Form No . and Edition Date Premium <br /> Commercial General Liability Coverage Part $ 41227 , 00 <br /> Professional Liability Coverage Part $ <br /> Policy Fee $ 35 . 00 <br /> Service Fee $ 12 . 79 <br /> Tax $ 213 . 10 <br /> $ <br /> $ <br /> $ <br /> Audit Period Annual unless otherwise stated : 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: crap Insurance Services of Florida , Inc . 1211 Semoran Blvd , Ste : 227 Casselberry , FL <br /> 32707 <br /> Agent Number: 104990 <br /> Countersigned 03/25 /2003 kp By <br /> DATE p%pp`,� ((EE�t 4 C � <br /> THIS COMMERCIAL LIABILITY DECLARATIONS AND THE SUPPLEMENTAL DECLARATION ,T1 FLAT ER�tWIITH LLiE CTIS FJL POLICY C CONDITIONS, <br /> COVERAGE FORM (S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED POLICY. <br /> 011 -1056 (9-93) INSURED 93 <br />