2004-229L - Laserfiche WebLink

Home Browse Search

y ACORD. CERTIFICATt OF LIABILITY INSURANCE OP ID E DATE (MMIDDIYYYY) PRODUCER INDIA - 1 11 04 ( THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Florida Hospital Ins Svc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1675 Terrell Mill Assocss HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Marietta GA 30067 Phone * 800 - 476 - 7601 Fax : 770 - 850 - 0988 INSURERS AFFORDING COVERAGE INSURED NAIC # INSURER A: Admiral Insurance Co . INSURER B: American Automobile Ins . Co . Indian River Memorial Hospital Greg Morgan INSURER C: 1000 36th Street Vero Beach FL 32960 INSURER D: COVERAGES INSURER E. 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 NSRr TYPE OF INSURANCE POLICY NUMBER DATE MMI 71M�iWD LIMITS GENERALLIABILITY EACH OCCURRENCE S $ 5r000 , 000 X X COMMERCIAL GENERAL LIABILITY CAPTIVE SIR 10 / 01 / 04 UAMAGE 10 PREMISESEREMUrloe i X CLAIMS MADE F-IOCCUR MED EXP (Any one person) j PERSONAL 6 ADV INJURY $ $ 54001000 GENERAL AGGREGATE S $ 1510001000 GEWL AGGREGATE LIMIT APPLIES PER POLICY PROFLOC PRODUCTS - COMP/OP AGG S $ 510001000 AUTOMOBILE LIABILITY X ANY AUTO COMBINED SINGLE LIMIT (Eascddent) $ $ 2 , 000 , 000 ALL OWNED AUTOS B X SCHEDULED AUTOS XZA8 0 8 3 3 3 6 7 BODILY INJURY 5 10 / 12 / 04 10 / 12 / 05 ( mon) B X HIRED AUTOS MZA80833367 10 / 12 / 04 10 / 12 / 05 B X NON-OWNEDAUTOS MZA80833367 BODILY INJURY 10 / 12 / 04 10 / 12 / 05 (Per accident) s PROPERTY DAMAGE j (Peracdderd) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT j ANY AUTO OTHER THAN EA ACC 5 AUTO ONLY: AGG i EXCESSRIMBRELLA LIABILITY EACH OCCURRENCE 1 $ 20o0001000 A OCCUR XI CLAIMSMADE CRL - FLm10013 - 1002 - 03 10 / 12 / 04 11 / 01/ 05 AGGREGATE 5 $ 20 , 0001000 Excess j DEDUCTIBLE Above SIR j RETENTION S WORKERS COMPENSATION AND $ 5M/ $ 15M j EMPLOYERS' LIABILITY T7ACCIDEN7T ANY PROPRIETOR/PARTNERIEXECUTNE E.L. EOFFICER/MEMBER EXCLUDED?Wyes, describe under E.L. Di SPECIAL PROVISIONS below OTHER E.L. DISEASE - POLICY LIMIT j DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT !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 TATWES. _ Vero Beach FL 32960 AUT W.LIJ RtPHEV"TAjPVE ACORD 25 (2001 /08) © ACORD CORPORATION 1988