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Certificate of Insurance <br /> The Company indicated below certifies that ,the insurance afforded by the policy or policies numbered and described <br /> below is in force as of the effective date ' of this certificate. This Certificate of Insurarce does not amend , <br /> extend , or <br /> otherwise atter the Terms and Conditions of Insurance coverage contained in any policy or policies numbered and <br /> described below. <br /> Certificate Holder's Name and Address: Insured 's Name and Address ,• <br /> INDIAN RIVEN COUNTY MIDSTATE MECHANICAL OF VERO BEACH, INC , <br /> 1840 25TH STREET 3825 712` STREET <br /> VERO BEACH , FL 32960 VERO BEACH, FL 32967 <br /> POLICY POLICY <br /> TYPE OF INSURANCE POLICY NUMBER ANE) EFFEUM EVIRATION LIMITS OF LIABILITY <br /> ISSUING COMPANY GATE DATE ("Limits At Inception) <br /> GENERAL LIABILITY NATIONWIDE <br /> ® Promises-Operations Ilvsul�ANCE <br /> 7TAC550611 -3001 7!31 /03 7/31 /04 General Aggregate` S 1 , 000,000 <br /> * Products-Completed Operations Pr. Comp. Op. Agg . " S 5000000 <br /> Each OceurrQnce S 500 , 000 <br /> , <br /> ® Personal & Advertising Injury <br /> 9 Medical Expense Any One Person/Org. $ 500, 000 <br /> 0 Fire Damage Legal Any One Person $ 51000 <br /> ❑ Other Liability Any One Fire $ 50 , 000 <br /> Each Accident <br /> El GARAGE LIABILITY-PREMISES Aggregate' <br /> AUTOMOBILE LIABILITY # 7713A55d6l1 -0003 7/31 /03 7131104 <br /> ® BUSINESS AUTO Bodily Injury <br /> ❑ GARAGE (Each Person) <br /> 0 Owned <br /> ® Hired (Each Accident) <br /> ® Nen-Owned Property Damage <br /> (Each Accident) <br /> Combined Single <br /> # <br /> Fill In Either Combined Limit S 5009000 <br /> Single Limits cr Split Limits <br /> EXCESS LIABILITY 77MU650611 -0005 7/31 /03 7/31104 <br /> ® Umbrella Form Each Occurrence S 4, 000, 000 <br /> Aggregate* 5 41000,000 <br /> Workers Compensation STATUTORY LIMITS <br /> 77WC550611 -0005 7131 /03 7/31 /04 <br /> Bodily Injury Each Accident <br /> and (DRUB FREE WORK PLACE) by accident 100,000 <br /> Employers' Liability Bodily Injury Each Employee <br /> by Disease 100,000 <br /> Bodily Injury Policy Limit <br /> by Disease 500 ,000 <br /> Insurance in force only for hazards indicated by X. <br /> Descrijortion ftecial s : <br /> Authorized Representative: <br /> Countersigned at: Pat O'oonneil insurance P . O . Box 650339 Vero Beach , Florida 32965 Date Issued : 10/26103 <br /> I <br />