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luto- Owners Page 1 19020 ( 10 - 80 ) <br /> 17" 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 20 - 04 - FL - 0002 <br /> Company POLICY TERM <br /> ADDgEss PD BOX 12908 Bill 12 : 01 a . m . 12 : 01 a . m . <br /> FORT PIERCE FL 34979 - 2908 to <br /> 02 - 17 - 2006 02 - 17 - 2007 <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 questions , please consult with your agent . <br /> DESCRIPTION OF ITEM INSURED AGE SYMBOL/COST TERRITORY CLASS/PG <br /> Comprehensive Liability - 027 SPL <br /> St Lucie County , FL <br /> COVERAGES LIMITS <br /> PREMIUM <br /> Combined Liability $ 500 , 000 occurrence $ 123 . 99 <br /> FOREIGN TERRORISM - <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 $ If Any ( Subject to audit ) <br /> 140 <br /> 1 . 1999 FORD WINDSTAR 8 027 8CA <br /> VIN : 2FMZA5147XBB03813 St Lucie County , FL <br /> COVERAGES LIMITS PREMIUM <br /> Combined Liability $ 500 , 000 occurrence $ 943 . 00 <br /> Uninsured Motorist $ 500 , 000 person/$ 500 , 000 occurrence 181 . 00 <br /> Medical Payments $ 10 , 000 person 18 . 00 <br /> Personal Injury <br /> Protection $ 10 , 000 34 . 00 <br /> Comprehensive Actual Cash Value - $ 500 deductible 103 . 00 <br /> Collision Actual Cash Value - $ 500 deductible 230 . 00 <br /> Additional Expense $ 40 /Day , $ 1200 Maximum 60 . 00 <br /> FOREIGN TERRORISM - <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 - OS ) <br /> PREMIUM BASIS : Radius of operation - within a 100 mile radius . <br /> USE CLASS ( 00552 ) : NOC Not Wholesale Or Retail Delivery . <br /> 140 0020500 <br /> LN-e <br />