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CERTIFICATE OF INSURANCE <br /> SUCKJOURAME AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER WILL NOT BE CANCELED OR OTHERMSE <br /> WITHOUT GIVING 10 DAYS PRIOR WRITTIMN NOTICE TO THE CERTIFICATE HOLDER KAMM SIBLUiRs gVT IN No <br /> THIS CERTIFICATE BE VAUD <br /> THAN 30 DAYS FROM THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE <br /> 1 C • J PROVIDEDBy ANY POLICYDESCRIBED _ <br /> INWAM <br /> STATE FARM MUTUAL AUTOMOBILE INSURANCIE COMPANY of 111cominWri, tilinak, or <br /> STATE FARM I'M AND CASUALTY COMPANY of 810MM2W. Illinois <br /> has omersm- on the following Named Irmired asahown below : <br /> Address of Nomad kNRmW 42W 3e Ave. <br /> 32957 <br /> POLICYNUMDOW -t <br /> EFFECTIVE NNW' loompi <br /> POLICY <br /> �r <br /> DESCRIPTION OF 11111114DIODGE1111100VM Im WE an HIM FORD INUMAVISTMM <br /> VEMCLE EISO VAN Nis <br /> Lmfb Lir <br /> m nr <br /> " Pawn <br /> PKIRRIF own"3"k Limit Each <br /> AS <br /> ® <br /> PKYSICIALnTr - <br /> COVERAGES Y.. 1 I $250.00 . , $260.00 Deductible Y 1 W I _ <br /> 11 11 Deductible NI 11•I Deductible '. 1,1 11 Deductible :111 Q1 Deductlible <br /> EMPLOYIEWS <br /> NON-OWNPR" C3YES ONO OYES ONO DYES 11NO Om ONO <br /> l 199wAgent zrj3 10/13106 <br /> ! YES MWES <br /> Name and Ad i a am of Certificate Holder Nam and Address orAgam <br /> Indian Rivw County David E. Hedgalk , .. <br /> 1StreeM11 2f <br /> Vero SmIliv FL 1 Vero Eleach, FL :, <br /> Check if a permenant Cerwaste of Insurer= for liability coverage is needed:Check if the Certificate Holder should be added as an Additional Insured: ■ <br /> 0 <br />