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.4Cr .W CERTIFICATE OF LIABILITY INSURANCE OP ID C DATE (MM/DDmvr) <br /> HIBIS-2 10 / 05 / 06 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> R . V . Johnson { GSM } HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 2041 E Ocean Blvd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Stuart FL 34996 <br /> Phone : 772 -287 - 3366 Fax : 772 - 287 - 4255 INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED INSURER A: National Indemnity Co . <br /> INSURER B: Markel International <br /> Hibiscus Childress Center Inc . INsuREPC: Brid e£ield Employers Ins . <br /> 6Hibiscus Childress Foundation 4 <br /> P O Box 305 INSURER D: <br /> Jensen Beach FL 34958 <br /> INSURER E: <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br /> ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> LTR INSR TYPE OF INSURANCE POLICYNUMBER POLI Y IVE PTI N <br /> GATE MM/OD/VY DATDAT I E MMlT! LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1 , 000 , 000 <br /> B X COMMERCIALGENERALLIABILITY 3602SS255610 - 3 07 / 12 / 06 07 / 12 / 07 1 PREMISES (Eaomurence) $ 200 , 000 <br /> CLAIMS MADE [X ] OCCUR I MED EXP one person) g 155000 <br /> PERSONAL B ADV INJURY $ 1 , 000 , 000 <br /> X ABUSE /MOLES $ 1M/ $ GENERAL AGGREGATE $ 3 , 000 , 000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMPIOP AGG $ 3 , 0001000 <br /> X POLICY � PRO- <br /> JEcr Loc E Ben . $ 1M/ $ 3M <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT $ 11 0001, 000 <br /> A X ANY AUTO BINDER #43766 07 / 12 / 06 07 / 12 / 07 (Ea accident) <br /> ALL OWNED AUTOS <br /> BODILY INJURY $ <br /> SCHEDULED AUTOS (Per person) <br /> X HIREDAUTOS <br /> BODILY INJURY $ <br /> X NON-OWNED AUTOS (Per accident) <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY ACCIDENT $ <br /> ANY AUTO <br /> OTHER THAN EA ACC $ <br /> AUTO ONLY. AGG $ <br /> OEXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 2 , OOO 1 OOO <br /> B X OCCUR CLAIMS MADE 4602SS255623 -2 07 / 12 / 06 07 / 12 / 07 ls2 , OOO , OOO <br /> 3 <br /> DEDUCTIBLE �$ <br /> X RETENTION $ 10000 $ <br /> WORKERS COMPENSATION AND TORY LIMITS X I H <br /> C EMPLOYERIETOWPAR 0830 -28580 - 02 22 <br /> ER <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE / / O6 02 /22 / 07 E.L. EACH ACCIDENT $ 500000 <br /> OFFICERIMEMBER EXCLUDED? <br /> If yes, describe under E.L. DISEASE - EA EMPLOYEE $ 500000 <br /> SPECIAL PROVISIONS belay E.L. DISEASE - POLICY LIMIT II $ 500000 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS I LOCATIONS ! VEHICLES ! EXCLUSIONS ADDED BY ENDORSEMENT ! SPECIAL PROVISIONS <br /> 30 days notice of cancellation for workers compensation coverage . <br /> Companies have the option to cancel 10 days for non-payment . Certificate <br /> holder is added as additional insured . <br /> CERTIFICATE HOLDER CANCELLATION <br /> INDIA02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 • DAYS WRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> Indian River County IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> 1840 25th Street REPRESENTATIVES. <br /> Vero Beach FL 32960 AUTHO D PRESENTpJIVE <br /> 10 <br /> ACORD 25 (2001108) C� © ACORD CORPORATION 1988 <br />