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t • <br /> y <br /> ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID $ DATE (MM/DD/YYYY) <br /> PRODUCER INDIA - 1 11 04 04 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Florida Hospital Assoc Ins Svc HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 1675 Terrell Mill Rd . ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Marietta GA 30067 <br /> Phonee 800 - 476 - 7601 Faxe770 - 850 - 0988 INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED <br /> INSURER A: Admiral Insurance CO . <br /> Indian River Memorial Hospital INSURER 8: American Automobile xna . Co . <br /> Greg Morgan INSURER C: <br /> 1000 36th Street <br /> Vero Beach FL 32960 INSURER D: <br /> INSURER E: <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br /> ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> LTR JNSRI TYPE OF INSURANCE POLICYNUMBER DATE (MM?DDI ATE MWD LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ $ 510001000 <br /> i <br /> X X COMMERCIALGENERALLIASILITY CAPTIVE SIR 10 / 01 / 04 10 / 01 / 05 III I U ICU <br /> PREMISES Eaoccvrer>ce i <br /> X CLAIMS MADE OCCUR MED EXP (Any one Person) S <br /> PERSONAL d ADV INJURY 2 $ 5 , 0 0 0 , 0 0 0 <br /> GENERAL AGGREGATE 5 $ 1510001000 <br /> GEN'L AGGREGATELIMITAPPLIES PER PRODUCTS - COMPI AGG $ $ 510000000 <br /> POLICY El JPECT 0 LOC <br /> AUTOMOBILE LIABILITY <br /> X ANY AUTO COMBINED SINGLE LIMIT <br /> (Es accident) S $ 2 , 000 , 000 <br /> ALL OWNED AUTOS <br /> B X SCHEDULED AUTOSMZA808333b7 10 / 12 / 04 10 / 1BODILY INJURY s <br /> (Per Person) <br /> B X HIRED AUTOS MZA80833367 10 / 12 / 04 10 / 12 / 05 BODILY INJURY <br /> B X NON-0WNEDAUTOS MZA80833367 10 / 12 / 04 10 / 12 / 05 (Peracddent) $ <br /> PROPERTY DAMAGE : <br /> GARAGE LIABILITY (Per acddeM) <br /> AUTO ONLY - EA ACCIDENT S <br /> ANY AUTO <br /> OTHER THAN EA ACC 5 <br /> AUTO ONLY: AGG S <br /> IXCESSIUMBRELLA UABIITTY EACH <br /> GA <br /> A OCCUR aCLAIMSMADE CRL - FL - 10013 - 1002 - 03 10 / 12/ 04 11 / 01/ 05 AGGREGATTE� S $ 20 , 000 , 000 <br /> Excess $ <br /> DEDUCTIBLE Above SIR S <br /> RETENTION s $ 534/ $ 1514 <br /> $ <br /> WORKERS COMPENSATION AND <br /> EMPLOYERS' LIABILITY I TORY LIMITS I JWR <br /> ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT s <br /> OFFICERNEMBER EXCLUDED? <br /> Vyes, describe under E.L. DISEASE - EA EMPLOYEE S <br /> SPECIAL PROVISIONS below <br /> OTHER <br /> E.L. DISEASE - POLICY LIMIT S <br /> DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br /> Certificate Holder is added as Additional Insured with respect to their <br /> interest in contract with the Named Insured . <br /> CERTIFICATE HOLDER CANCELLATION <br /> INDIANC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> Indian River County IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> 1840 25th Street REPRE TATBIES. <br /> Vero Beach FL 32960 AUT ITEDRtPRE TA VE <br /> ACORD 25 (2001108) I © ACORD CORPORATION 1968 <br />