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AUVIW <br /> M Lt: K i it- IGA ! t Utw LIA8iLI l YftNbIUMNCE 03/19/2004 <br /> I PROD (410) 3 56-4020 FAX 7'10356 -461-7 THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION <br /> Insurance Designers of Maryland , Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 300 Redland Court HOLDER. <br /> OERISCEGEAFFRpS NOT AMEND, <br /> ESENDO <br /> Suites 105 - 107 THE RAPO <br /> Owings Mills , NO 21117 INSURERS AFFORDING COVERAGE MAIC <br /> INsuRED Boys and Girls Clubs o Indian River County INSURMA, Capitol SPecial , Ltd , <br /> P . O . Box 3068 CJSURER6: <br /> Vero Beach , FL 32964 INSURER C; <br /> WBURER D: <br /> rauRER E <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED: NOTWITHSTANDINI <br /> ANY REQUIREMENT, TERM OR CONDITION OP ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR <br /> MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITK)NS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> IN€RDD' <br /> Imt TYPEOFINSURANfS POLICYNUMBER <br /> tJM1T5 <br /> dEhIPJWLI.taBILIrY 3001809 04/02/2004 04/04/2004 EACH OCCURRENCE S 11000 , 00 <br /> X 01 <br /> COMMERCIAL GENERAL LIABILITY DAnRgGb TO RENTED a 50 , 00 <br /> CLAIMS MwF Q OCCUR - MED EXP (A,ry one parson) S <br /> A <br /> PER90NAL A ADV INJURY S LOW 00 <br /> GENERAL AGOR4QATfi S 29000 , 00 <br /> OENL AGGREGATE UMITAPPLIB6 PER: PRODUCTS - COMP,OP AGG s 1 000 00 <br /> F] POUCY17 JPEFT LOC <br /> ALTONIOBLLE LIABILITY <br /> ANY AUTO COMBINED SINGLE LIMIT <br /> (Ea 600dent) S <br /> ALL CWNED AUTOS <br /> ' <br /> SCHEDULED AUT08 BODILY INJURY <br /> (Per Percen) <br /> HIRSO AUTOS <br /> NON-OWN6ODILYINJURY S <br /> mAUTO5 (Pw aedaent) <br /> PROPERTY DAMAGE i <br /> (Per aoatmnt) <br /> GARAGE LIABILITY <br /> AUTO ONLY . EA ACCIDENT 6 <br /> ANYAUTO <br /> OTHER THAN EAACCi <br /> AUTO ONLY. AOG S <br /> EXCESSNMBRELLA LIABILITY 30019191 04/02/2004 04/04/2004 TACH OCCURRENCE S 2OCCUR 117 CLAMS MADE 00 <br />0 00 <br /> A AGGREGATE _ $ 21000 , 00 <br /> DEDUCTIBLE <br /> $ <br /> X RETENTION 5 10 , 00 s <br /> WORKeRBCONIPENSATIDNAND WGSTATU- 0TH. <br /> EMPLOYERS' L ABUTY <br /> ANY PROPRIETO"ARTNERUEXECUTIvE E.L EACH ACCIDENT S <br /> OFFICE"EMBRR 1XCLUDED7 <br /> It pea, dOWAbe widar E.L, DISEASE - EA EMFLOI'E 3 <br /> SPEC14 PROVISIONS below <br /> e.L. DISEAGE - POLICY LUT s <br /> A Liquor Liability 3001810 04/02/2o04 04/04/2004 110007000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br /> /3 /D4 Vince Gill Concert <br /> The certificate holder is added as additional insured solely with respect to claims arising <br /> from the negligetnt operations of the named insured , <br /> TIFICATE HOLDER ANCELLATI N <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> EXTIRAMON DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br /> 30 DAYS WmTTEN NOTICE TO THE CERTIPICAT! HOLDER NAMM TO rNE LEFT. <br /> Indian River County BUT FAILURE TO NAILSUCH NOTICE SHALL IMPOSE NO OBL13ATION OR LN8IWTY <br /> 1840 25th Street OF ANY KIND UPON THE INSURER, ITS AGENTS OR RI3+RESENTATUES, <br /> VQr0 Beach , FL 32960 — AUTMOR4CDREPRiSENTArnE <br /> 3effre Cohen ETHAN ss✓ <br /> ACORD 26 (2001108) OACORD CORPORATION 1985 <br />