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ACORQ CERTIFICATE OF LIABILITY INSURANCE OP ID $ DATE (MM+DD/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 Phones 800 - 476 - 7601 Fax : 770 - 850 - 0988 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Admiral Insurance Co . Indian River Memorial Hospital INSURER 8: American Autcmabils Ins . co . 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, Y EFF LTR INSRE TYPE OF INSURANCE POLtCYNUMBFJ2 DATE MINDD/YY DATE MWD LIMITS GENERAL LIABILITY r EACH OCCURRENCE S $ 5000010 0 0 X X COMMERCIAL GENERAL LIABILITY CAPTIVE SIR 10 / 01 / 04 10 / 01 / 05 PREMISES (Ea roccuD- S X CLAIMS MADE OCCUR MED EXP (Arty one person) E PERSONAL d ADV INJURY $ $ 510001000 GENERAL AGGREGATE E $ 151 0 0 01 0 0 0 GENIL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ $ 510000000 POLICYf"l JEG�T LOC AUTOMOBILE LIABILITY X ANY AUTO COMBINED SINGLE LIMIT (Ea accident) E $ 210001000 ALL OWNED AUTOS E $ X SCHEDULED AUTOS MZA80833367 10 / 12 / 04 10 / 12 / 05 (BODILLYSINJURY B X HIRED AUTOS MZA80833367 10 / 12 / 04 10 / 12 / 05 BODILY INJURY B X I NON-OWNED AUTOS MZA80833367 10 / 12 / 04 10 / 12 / 05 (Per accident) E PROPERTYDAMAGEF1 E (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT E ANY AUTO OTHER THAN EA ACC E AUTO ONLY: �AGG i — EXCESSIUMBRELLA LWBILRY EACH OCCURRENCE E $ 2 010 0 010 0 0 A occuR KICLAIMSMADE CRL - FL - 10013 - 1002 - 03 10 / 12 / 04 11 / 01/ 05 AGGREGATE $ $ 20 / 0001000 Excess E DEDUCTIBLE Above SIR E RETENTION E $ 5M/ $ 15M E WORKERS COMPENSATION ANDSTATUO EMPLOYERS' LIABILITY TORYLIMITS I ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT E OFFICERIMEMBER EXCLUDED? Ns, describe under E.L. DISEASE • EA EMPLOY S SPECIAL PROVISIONS below OTHER E.L. DISEASE - POLICY LIMIT t 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 TATBMS. _ Vero Beach FL 32960 AUT IZEDREPRE TA VE ACORD 25 (2001 /08) I © ACORD CORPORATION 1988