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This certificate is executed by Liberty Mutual Insurance Group as respects such insurance as is afforded by thou companies. <br /> BMnt0 <br /> Certificate of Insurance <br /> This certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This certificate is not an insurance <br /> policy and d(ws nix amend. extend, or alter the coverage <br /> Fafforded by the policies listed below. <br /> This is to certify that (Name and address of Insured ) <br /> CHILDREN'S HOME SOCIETY OF FLORIDA <br /> 1485 S . SEMORAN BLVD. wbEarty <br /> SUITE 1448 <br /> WINTER PARK, FL 32792 ' . . <br /> is, at the issue date of this certificate. insured by the Company under the policy( ics ) listed below . The insurance afforded by the listed policytits <br />t is subJect to all their terms . exclusions and conditions and <br /> is no: altered by anv requirement, term or condition of anv contras or other document with respect to which this certificate may be issued. <br /> Expiration T Ex iration Date(s ) Policy Number(s)' Limits of Liability <br /> Continuous * 07/01 /2005 WA6- 15D-280851 -014 Coverage afforded under WC law of Employers Liability <br /> Extended the following states: Bodily Injury By Accident <br /> X Policy Term FL $500.000 Each Accident <br /> Bodily Injury By Disease <br /> 5500.000 Policy Limit <br /> Workers Compensation Bodily Injury By Disease <br /> $500.000 Each Person <br /> General Liability General Aggregate-Other than Prod/ICompleted Operations <br /> Products/Completed Operations Aggregate <br /> Claims Made <br /> Occurrence Bodily Injury and Property Damage Liability Per <br /> Occurrence <br /> Retro Date� Personal and 4dNertising Injur} Per Person / <br /> l <br /> Organization <br /> Other Liability Other Liability . <br /> Each Accident - Single Limit - B. 1 . and P. D . Combined <br /> Automobile Liability <br /> Each Person <br /> Owned <br /> Non-0wnedEach Accident or Occurrence <br /> Hired <br /> 00� Each Accident or Occurrence <br /> . . . . . <br /> C <br /> O _ <br /> M <br /> M <br /> E <br /> N <br /> T <br /> S <br /> *If the oettificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate <br />expiration date. However, you will not be notified annually of <br /> the continuation of coverage . <br /> Special Notice - Ohio: Any person who, with intent to defraud or knowing that he / she is facilitating a fraud against an insurer, submits an application <br /> or files a claim containing a false or <br /> deceptive statement is guilty of insurance fraud. <br /> Important information to Florida policyholders and certificate holders: in the event you have any questions or need information about this certificate for <br />any reason. please contact your local sales producer, <br /> whose name and telephone number appears in the lower left corner of this certificate. The appropriate local sales office mailing address may also be <br /> obtained by calling this number. <br /> Notice of cancellation: (not applicable unless a number of days is entered below ) . Before the stated expiration date the company will not canal <br /> or reduce the insurance afforded under the above <br /> policies until at least 30 days notice of such cancellation has been mailed to: <br /> Office : Orlando. FL Phone: 407-829-7951 <br /> Certificate Holder, Tereasa Myers <br /> DAN HOOD Authorized Representative <br /> CHILDREN ' S HOME SOCIETY <br /> TREASURE COAST DIVISION <br /> 415 AVENUE A <br /> SUITE 101 <br /> FT . PIERCE , FL 34950 Date Issued: 07/06/2004 Prepared By : TH <br />