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-,t4ut0- Owners Page 1 19020 ( 10 - 80 ) <br /> Issued 01 - 03 - 2006 <br /> INSURANCE COMPANY AUTOMOBILE POLICY DECLARATIONS <br /> 6101 ANACAPRI BLVD . , LANSING , MI 48917 - 3999 <br /> AGENCY FLOWERS - YATES INSURANCE INC Renewal Effective 02 - 17 - 2006 <br /> 12 - 0172 - 00 MKT TERR 051 ( 772 ) 461 - 3171 POLICY NUMBER 42 - 209 - 850 - 00 <br /> INSURED EXCHANGE CLUB CASTLE Company Use <br /> 20 - 04 - FL - 0002 <br /> ADDRESS PO BOX 12908 Company POLIC=TERM <br /> Bill 12 : 01 a . m .FORT PIERCE FL 34979 - 2908 02 - 17 - 2006 <br /> In consideration of payment of the premium shown below , this policy is renewed . Please attach this <br /> Declarations and attachments to your policy . If you have any ques{ ions , lease consult with <br /> p your agent . <br /> DESCRIPTION OF ITEM INSURED AGE SYMBDL/COST <br /> TERRITORY CLASS/PG <br /> Comprehensive Liability - . 027 <br /> SPL <br /> St Lucie County , FL <br /> COVERAGES LIMITS <br /> PREMIUM <br /> Combined Liability S 500 , 000 occurrence <br /> FOREIGN TERRORISM 5123 . 99 <br /> - <br /> CERTIFIED ACTS SEE FORM 59350 1 . 24 <br /> TOTAL $ 125 . 23 <br /> Additional Forms For This Item : 79547 ( 03 - 99 ) 79539 ( 03 - 99 ) <br /> PREMIUM BASIS : Estimated cost of hire - liability 5 If Any ( Subject to audit ) <br /> 140 <br /> 1 . 1999 FORD WINDSTAR 8 <br /> VIN : 2FMZA5147XBB03813 027 8CA <br /> St Lucie County , FL <br /> COVERAGES LIMITS <br /> PREMIUM <br /> . Combined Liability $ 500 , 000 occurrence 5943 . 00 <br /> Uninsured Motorist $ 500 , 000 person/$ 500 , 000 occurrence <br /> Medical Payments S 10 , 000 181 . 00 <br /> Personal Injury person 18 . 00 <br /> Protection 5 10 , 000 34 . 00 <br /> Comprehensive Actual Cash Value - $ 500 deductible 103 . 00 <br /> Collision Actual Cash Value - 5 500 deductible <br /> Additional Expense $ 40 /Day , $ 1200 Maximum 230 . 00 <br /> FOREIGN TERRORISM - 60 . 00 <br /> CERTIFIED ACTS SEE FORM 59350 - 15 . 69 <br /> TOTAL $ 1 , 584 . 69 <br /> Interested Parties : None <br /> Additional Forms For This Item : 79255 ( 12 - 01 ) 79308 ( 01 - 01 ) 79402 ( 07 - 94 ) <br /> 79537 ( 06 - 92 ) 79539 ( 03 - 99 ) 79939 ( 03 - 05 ) <br /> PREMIUM BASIS : Radius of operation - within a 100 mile radius . <br /> USE CLASS ( 00552 ) : NDC Not Wholesale Or Retail Delivery . <br /> 140 0020500 <br /> `-'� <br />