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•_ may • ai ' _ . . . . . <br /> Surplus Linea Agwt's Name: r M Fo la r <br /> aom a !`dminn Redl t'A11 <br /> qq S Lino Agent's Address: Py � us r <br /> � ,...., a .e..., FL ¢4413 C.a t . -va .. <br /> Surplus Imes Agem's Licence• t e er o . iy w .. . ._ <br /> Producing Agent's Name: k o -i.,=r--;c. <br /> producing Agent's Address: <br /> JeJIPr + . 690 2p <br /> POLICY NUMBER: SS000011 TotalFreminm: I ;- 0 CG DS 01 10 01 <br /> Service Fee: <br /> Agents toiai®rarw=/ <br /> COMMERCIAL GENERAL & PROFESSIONAL LIABILITY <br /> DECLARATIONS <br /> ASPEN SPECIALTY INSURANCE COMPANY CRC Insurance Services , Inc. <br /> 99 HIGH STREET 30 Jericho Executive Plaza, Suite 200C <br /> BOSTON , MASSACHUSETTS 02110-2320 Jericho, NY 11753 <br /> NAMED INSURED : United for Families, Inc. <br /> MAILING ADDRESS : 10570 S. Federal Hwy., Suite. 201 <br /> Port St. Lucie, FL 34952 <br /> POLICY PERIOD: FROM 03/1512005 TO 03/15/2006 AT 12 : 01 A.M. TIME AT <br /> YOUR MAILING ADDRESS SHOWN ABOVE <br /> IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS <br /> POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. <br /> LIMITS OF INSURANCE <br /> GENERAL LIABILITY <br /> i <br /> EACH OCCURRENCE LIMIT $ 190000000 <br /> DAMAGE TO PREMISES <br /> RENTED TO YOU LIMIT $ 100,000 Any one premises <br /> MEDICAL EXPENSE LIMIT $ 55000 Any one person <br /> PERSONAL & ADVERTISING INJURY LIMIT $ 11000,000 Any one person or organization <br /> GENERAL AGGREGATE LIMIT $ 3, 0001000 <br /> PRODUCTS/COMPLETED OPERATIONS AGGREGATE LIMIT $ 190009000 <br /> Surplus Lines Tax: — .1t 690 • Lo <br /> PROFESSIONAL LIABILITY FSLSO Tax: <br /> Each Medical Incident Policy Fee: $ 1 ,000, 000 <br /> Aggregate Insp. Fee: <br /> Company Fee: $ 3,0001000 <br /> Retroactive date (If Applicable) FL EMPATF: N/A <br /> Deductible NONE <br /> Each Medical Incident or Claim (Including ALAE <br /> A-oy38o � i � 95 $2 . <br /> DESCRIPTION OF BUSINESS <br /> FORM OF BUSINESS : <br /> ❑ INDIVIDUAL ❑ PARTNERSHIP () JOINT VENTURE ❑ TRUST <br /> ❑ LIMITED LIABILITY COMPANY X ORGANIZATION, INCLUDING A CORPORATION (BUT NOT <br /> i INCLUDING A PARTNERSHIP, JOINT VENTURE OR LIMITED LIABILITY <br /> COMPANY) <br /> CG DS 01 10 01 © ISO Properties , Inc. , 2000 Page 1 of 2 ❑ <br />