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r "y ACORD� CERTIFICATE OF LIABILITY INSURANCE OP ID E DATE (MMIDD/YYYY) INDIA - 1 11 / 04 / 04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Florida Hospital Assoc Ins Svc HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1675 Terrell Mill Rd . ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Marietta GA 30067 Phone : 800 - 476 - 7601 Fax : 770 - 850 - 0988 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Admiral Insurance Co . INSURER B: American autrmobllu Ins . Co , Indian River Memorial Hospital Greg Morgan INSURER C: 1000 36tH Street INSURER D: Vero Beach FL 32960 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR INSR TYPE OF INSURANCE POLICYNUMJBER DATE MMI DATE IMMID LIMITS GENERAL LIABILITY EACH OCCURRENCE S $ 5 , 0 0 0 , 0 0 0 X X COMMERCIAL GENERALLIABILrrY CAPTIVE SIR 10 / 01 / 04 10 / 01 / 05 PREMISES Eaoccurenoe S X CLAIMS MADE OCCUR MED EXP (Any one person) S PERSONAL & ADV INJURY $ $ 5 , 0 0 0 , O O O GENERAL AGGREGATE $ $ 15F0001000 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S $ 510001000 POLICY JPPCT El LOC AUTOMOBILE LIABILITY COMBINED SINGLE X ANYAUTO ( cdM $ $ 2 , 000 , OOO ALL OWNED AUTOS BODILY INJURY B X SCHEDULED AUTOS MZA80833367 10 / 12 / 04 10 / 12 / 05 (Per person) $ B X HIRED AUTOS MZA80833367 10 / 12 / 04 10 / 12 / 05 BODILY INJURY B X NON-OWNED AUTOS MZA80833367 10 / 12 / 04 10 / 12 / 05 (Peraclderd) $ PROPERTYDAMAGE $ (Per sodden!) TANYAUTO LIAZLITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESSRIMBRELLA LIABILITY EACH OCCURRENCE x $ 2 0 , 0 0 0 , 0 0 0 A IOCCUR K CLAIMSMADE CRL - FLm10013 - 1002 - 0 10/ 12 / 04 11 / 01/ 05 AGGREGATE S $ 2049000 , 000 Excess s DEDUCTIBLE Above SIR $ RETENTION S $ 5M/ $ 15M $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABIIJTY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? H Yes, describe under E.L. DISEASE - EA EMPLOYEE S SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT s OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate Holder is added as Additional Insured with respect to their interest in contract with the Named Insured . CERTIFICATE HOLDER CANCELLATION INDIANC, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Indian River County IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1840 25th Street REPRE TATIXES. _ Vero Beach FL 32960 AUT DED REPRE TA VE ACORD 25 (2001108) © ACORD CORPORATION 1988