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ACORD„ CERTIFICATIt OF LIABILITY INSURANCE OPID E DATE (MWDDNYYY) 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 * 770w850 - 0988 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Admiral Insurance Co . INSURER O: American Autnnobils 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 CONTRACTOR 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 INSRE TYPE OF INSURANCE POLICYPOLICYNUMBER DATE 62 DATE IMIND LIMITS GENERAL LIABILITY f EACH OCCURRENCE $ $ 5 F 0 0 0 1 0 0 0 X X COMMERCIAL GENERAL LIABILITY CAPTIVE SIR 10 / 01 / 04 10 / 01 / 05 PREMISEBKhfrence i X CLAIMS MADE OCCUR MED EXP (Any one person) s PERSONAL d AoV INJURY $ $ 5 , 0 0 0 , 0 0 0 GENERAL AGGREGATE $ $ 1510001000 GENIL AGGREGATED 1 APPLIES PER PRODUCTS - COMP/OP AGG S $ 5 f 0 0 0 0 0 O 0 POLICY JECT LOC AVYOMOsILE LIABILITY X ANY AUTO COMBINED SINGLE LIMIT (Ea accident) s $ 2 , 000 , 000 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-OWNEDAUTOS MZA80833367 10 / 12 / 04 10 / 12 / 05 (Per accident) s PROPERTY DAMAGE s (Per accident) GARAGE LIABILITY AUTO ONLY . EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S E(CESSIUMBRELLA LIABILITY EACH OCCURRENCE $ $ 2 0 , 0 0 0 , 0 0 0 A OCCUR KICLAIMSMADE CRL - FLm10013 - 1002 - 03 10 / 12 / 04 11 / 01/ 05 AGGREGATE $ $ 20 , 000 , 000 Excess s DEDUCTIBLE Above SIR s RETENTION s $ 5M/ $ 15M $ WORKERS COMPENSATION AND EMPLOYER34 LIABILITY TORY LIMITS 1 ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT S OFFICERN GL48ER EXCLUDED? K yes, describe under E.L. DISEASE - EA EMPLOYE S SPECIAL PROVISIONS below OTHER E.L. DISEASE - POLICY LIMIT i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / 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 TATInS. _ Vero Beach FL 32960 AUT IZEDREPRE TA VE ACORD 25 (2001 /08) © ACORD CORPORATION 1988