|
lli �12i 'Lt11S4 bb : 4b !Dbl 2yy: 640 bu'YS GIFLS i:LUb iRC PAGE 02
<br /> WED 05 ; ? 4 PM M AY , INC , FAX Na. 772 546 5772 r, U6
<br /> ei
<br /> loridaMUM ftderad=
<br /> ftmd
<br /> . ,. Gurm
<br /> 1 . . ll'. " fr . lt ' KutHt ai . l r , t 'I ,,Nt nun, S ,lr t'rtc <', N ' r
<br /> i. , CimsrF : 5 .r►d, b4 �'nvliun , rw,. ( din, {. r
<br /> •, • ^ :iLllrtHidf!<frT� kil 4�0Mrlrll fillet, 1979 Xn Njitwl, WrIlW4
<br /> 0- , t 'J ` � i . lk 111 1, I 'l. 3,ir•gi •u �� a 1s'K'7Y..SI+ +VUrt )if iiru121. f17R1 71r>;na, $_ Rh . �, Ltlrinv,
<br />'
<br /> top 1 .( l li{>c tw + C n r { bal s K• Wtely . Jln ,l +r�ntlfr
<br /> H> iCl `lu11617` ( 961 ) ax5awr>~ or Ivm[ 0•?.A2.7E�49 Rix ( XV) 66ev1 (6`i. . �. . �— . . . ...
<br /> ,
<br /> c :: s:• c: r �*rr� ?.trancc
<br /> RE : 0520- 25854
<br /> 155LIeD TO : Indian River county Board of county commissioner3
<br /> 1640 25th St
<br /> Vero Beach, FL 32960 . 3365 ;
<br /> L 329 -
<br /> Is to ccrtify that Spys . Gir15 Cstl� t?L��!d11 . Rlver_C u��;Y. lt1�R• � - � Pu 505$.1lC�o. I . _ K
<br /> Subjars t;� the provisions of the Florida Workers ' Compansatlon l,aw, has secured the payment of any
<br /> 4~: cri; ers ` compensation benefits due by insuring their risk with the Florida Retail Federation Self InSufers Fund
<br /> �,O JCy NUMBER 05z O." z5L Statutory Limits- - stab! of Florida
<br /> Employers LlabilitY
<br /> sTVt; DATE : SptGmUer 13 , .2004 $ 500 , 00G . ( Each Accident)
<br /> $ 5001000 ( Disease- - 59ch Employee)
<br /> '_X ' lit/ai1GN DATB : $ s00, 000 ( DI Seale - - Policy Limit)
<br /> T ' w crtiflcate Is not a policy and of itself does not afford any insurance . Nothing container) In this
<br /> i be construed as amending , extending, or altering coverage not afforded by the policy shown
<br /> r "^ -dirg insurance to any insured not named above ,
<br /> :> ; cIicy of insurance listed above hag been issued to the named insured for the policy period indicated .
<br /> ny contract or atNer document to Which this cerNf! cate
<br /> any requirement, term or condition of a
<br /> described policy in this
<br /> - '� Berta n , the insurance made available by the bertificate Is subject to Only the
<br /> .C; _ -• s, mxclus!ons and conditions of such policy. Paid claims may have redLced the shown limits ,
<br /> I ` r?,. ., eolicy described above Is cancelled before tho expiration date indicated , the issuing company will
<br /> .T i ' 34 days' written notice to the cert holder named above , although if cancailauon is for
<br /> w -: :nt of premium , then the isxulfig Company will attempt to mail 1?0 days' written notice #o the
<br /> ^rr , 'icate holdor . In any event, the issuing company, its agents, and rep ► esentatives accept no obligation or
<br /> ry of any kind for failure to mail such notica,
<br /> 0 � t . -
<br /> Date 11./ 03/ 2004
<br /> Ire . . r`, 11LplaCzdtCx
<br /> A'uno
<br /> xctail Tederarion Gelt ,tnkt, Xars
<br />
|