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Client#: 5887 INDIARIV1 <br /> ACORD , .r CERTIFICATE OF LIABILITY INSURANCE DATE (MMIODIYYYY) <br /> 06/12/03 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Palmer 8r 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 <br /> INSURED <br /> INSURER <br /> # <br /> SURER A. American Cas Co of Reading PA <br /> Indian River Memorial Hospital <br /> 1000 36th Street INSI IRFR R National Union Fire Ins Co Pa <br /> Vero Beach , FL 32960 IN SURFR ( , <br /> INSLIRLR U <br /> INSURER F <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 /> I <br /> LTR rNWSREI TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION <br /> GENERAL LIABILITY DATE MM/DD/YY DATE MM/DD/YY LIMITS <br /> EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ <br /> CLAIMS MADE OCCUR MED EXP (Any one person) $ <br /> PERSONAL A ADV INJURY <br /> GENERAL AGGREGATE $ <br /> GEN'1. AGGRFGA IF I )MIT APPLIES PFR . <br /> POI PRO_ PRODUCTS - COMP/OP AGG $ <br /> JECT I I IOC <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGt F LIMIT <br /> ANY At ) l O ( Fa accident ) $ <br /> Att OWNFDAIITOS <br /> RODILY INJURY 4 <br /> SCHFI ) f)I FI ) AIITO (Per person) <br /> HIRFFI AUTOS <br /> NON OWNFO Al llrls FIODII Y INJURY 4 <br /> ( PPf IiC(:IdP.nI) <br /> PROM RTY DAMAGE' <br /> ( Per acudenU $ <br /> GARAGE LIABILITY <br /> AUTO ONL Y IFA AY;CIDF NT <br /> ANY Al I TO <br /> * <br /> OIIiER 1HAN FA ACC <br /> - <br /> AUTO ONI . Y AGG <br /> EXCESSIUMBRELLA LIABILITY <br /> EACH OCCURRENCE $ <br /> OCCI IR ❑ CLAIMS MADE AGGREGATE $ <br /> DEDUCTIBLE <br /> RF_ FF NTION $ <br /> $ <br /> A WORKERS COMPENSATION AND WC247857798 01 /01 /0301 /01 /04 W( . i TARI UTH <br /> EMPLOYERS' LIABILITY LIM <br /> ANY PROPRIETOR/PARTNER/FXFCtITIVF I: . L . EACHACCIDI- NF S1 000000 <br /> OFFICER/MF Milt R F XCI I IDFD"? <br /> If yes, rfes( ow under E . I DISL- ASI LA f MPI. r)YEE $ 1 ,000 ,000 <br /> SPECIAL PROVISIONS below L . L. DI:F ASF Pf IL ICY LIMIT $ 1 , 000 ,000 <br /> B OTHER Medical Prof CNM7055124 12/01 /02 12/01 /03 $ 1 , 000 ,000 <br /> $ 3 , 000 , 000 Aggregate <br /> DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Shared Limit <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 /> rTIIORl7ED REPRESENTATIVE <br /> At wACORD 25 2001 /08 .... 1' �✓,x..�t ( _. . t ;.N,'l'`� %l�..fl•�A/�Lr <br /> A.. <br /> ) 1 of 3 # S35512/M35510 21KPW w ACORD CORPORATION 1988 <br />