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<br /> RE : 0520- 25554
<br /> iSSOED TO : Indian River County Board of county Commissioners
<br /> 1840 25th St
<br /> Vero Beach, FL 32960 . 3365
<br /> c i . tc ccr:ify that Bpy, , Fx � IrJs Gsl,t1ft . R►ver_CO3U Y,1ar,�P - 9•-il3px 305$.1fCto. P�! �5�. irk 329.yg ,
<br /> ub;j �4i to the provisions of the Florida Workers' Compansatlon i.aw, has securad the payment of eny
<br /> s: Cr 'kers ' compensation benefits due by Insuring their risk with the Florida Retail Federation Sclf Insurers Fund
<br /> '• Oi- C NUMBER ; 0$ r ? Statutory Limits- • 5tatb of Florida
<br /> Employers LiabilitY
<br /> :VE DATE : pl.emlier , l3 , .Z004 $ 500, 000 , ( Each Accident)
<br /> 1500, 000 ; ( Disease- - Each Employee)
<br /> -_ X `" ' RA ION DATA ; Se(�ZCILIt?�'r'_1 �200 $ 500 ,000 ' ( Dlseaae -- Policy Limit )
<br /> certificate Is not a policy and of itself does not afford any insurancle . Nothing c0rltaine6 in this
<br /> be construed as amending , extending , or altering coverage not afforded by the poliey Shawn
<br /> rte; ^ ; i � g insurance to any insured not named above .
<br /> -
<br /> ^ %y of insurance listed above has been issued to Che named lnswred for the policy period ind ?cated.
<br /> any requirement, term or condition of any contract or other doatment to which this cartif! cato
<br /> available by the described policy in this r; ertain , tile insurance made s certificate Is subject
<br />to only the
<br /> cr - s, exclusbns and conditions of st0 policy , Paid claims may have redtrced the shown limits ,
<br /> eolicy described dbovo is cancelled before the expiration date indicated , the issuing company will
<br /> r oc 34 days' wrlttcn notice to the certificrata holder named ebbve, although if cancall4L is for
<br /> of premium , than the isxuing company will attempt to mail ib days' written notice to the
<br /> r,.Fr `icate noldor , In any event, the issuing company, its agents, and repl'esentatives accept no obligation or
<br /> ; rs5i ; iry of any kind for failure to mail such notice. ,
<br /> Date 11 / 0312004
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<br /> Ret # 0 'Federation tell InAetiXert A'urd
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