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10 14 / 2003 09 : 42 FAX 772 4656011 EXCHANGE CLUB CASTLE 2003 <br /> DCT-1.3-2003 11 : 12 HARBIR INSURFNCE AGENCY 7'72 460 2315 P102/03 <br /> F <br /> r'aRD� CERTIFICATE OF LIABILITY INSURANCE pp � °"TOimporr" <br /> HRM? 1 1d 13 03 <br /> THIS CERTM TE I5189UEC AS A MATTER OF INFORiEA14 oN <br /> R =S'OZti1I+TC8 A0ZWy ONLYAND CONFERS NO WHTS UPON THE CERTIFICA"1'E <br /> pIOLDER. THIS CERTIFICATEDOES NOT AMEND, ELTENo OR <br /> ealeia� al head , quite 100 ALTER TKECOVERAGE AFFORDED 13YTHE P'f1mESMMLO1N. <br /> Fort Pierce n 34959 - 5309 <br /> >'hosce : 779 - 463 - 6090 711ir772 - 460 - 2315 INSURERS APPORb1NGMVIiRAtaE NAIC9 <br /> INSURED <br /> TheE�CCh�go L,1 Ce ta>: M18URERA Phil&"! Ius xndeij #, U -- <br /> fChi d 1:48 <br /> or t revent an 09 IN8uR6R ®I Twin Fire Insurance Co <br /> a DX 1 908 <br /> Pt Pierce FL 34979 <br /> COVERAGES <br /> THE POUGES OF INELMNCJ U.1'PF.D BOLOW KAVII NVEN ISSUW TD TME INSURED NAMED ABOVE FOR THE POLICY P@RI06 W WCATEC, NOTVJITW3TANCIING <br /> ANY AI=OUNiEMENT, T&.RAI OR CONDITION oFaMv CONTRACTCR OTHEK DOCUMENT WITH RESPECT TO wHiCM TMi& CERTFICATE MAY BR LABi lm OR <br /> MAY PERTAIN. THE INS RANCEAPFORMSYTHEPOUCICBCOSCRIBRpHEREINiBSUL=rTOALLTMETfnJtMFW(CLUSIONSANDCONDITIONSOF $UCH <br /> PQLr.W, AQ0AEGA7E LIMITS SHOWN MAY HAVE BEEN REDWo p 8Y PAID CLAIMS, <br /> 6TR NSR TVP@ OFINEURU01 P41.iQY NUMBER ---� <br /> QATS " Ip <br /> 6E11ERAL <br /> EAC" OCCURRENrD 1 000 Opp <br /> 1L 7L X Q EnCIALf d ALLIAB PH79044130 03 / 26 /03 03 ,/' 35 / 1) 4 p aacaaenee sic add <br /> CLAIMSMADE 3( OCCUR MPMt" (ARyOftlPerrwl) tg+ Opp <br /> A Se7Gu /ka]_ e9tatia PER50NAL & ADV1NJURY i 1 000 000 <br /> G&4RRALAt3gNBrsATE A 2 8pp 000 <br /> GEN'L AGf.REf311TE LMAR APPLIsad PER, PRODUCTS - COMPopp AGG1621000 0 0 0 <br /> POWOY LOG f <br /> wTOMQSILE UAMLITV <br /> ANY SAI D Imo] SINGLE UMIT i <br /> ALL OVNG D AUTOS +� <br /> SCHEDUIJSD AUT03 BODILY i W URY <br /> HItEDAUTOB (Parr Po W) <br /> Nps AKIRIEDAUTOS <br /> U7'oB BODILY INJURY <br /> (pwa w"o <br /> PROPERTY DAMAGE <br /> -- (pwarbeenl) & <br /> GARAGE LIAMLny <br /> aNYAUro <br /> AUTO ONLY • FA ACCIDENT i <br /> arHEI� TWIN EA ACO 6 <br /> AUTO ONLY: ABG & <br /> E�ICESSNMBRELLA LIAlILITI' <br /> OCCUR CLAIMS MADE EACH OGOIitWFJICE i <br /> �� AGGREGATE i <br /> I DEDUCTIBLE <br /> p <br /> t <br /> WORKERS COMPRA&TION AMID = <br /> $ y 2111bDu9567 7 LYI VAMP <br /> LIM X <br /> 3 Z / CJS / 02 1Z / 0 �./ 03 LL FACHAr4AOENP Z35000000 <br /> ONSbofgw F.L. DISGA58 - EAEi+IPLo i 500 000 <br /> DTaER ��� E1 DI&EASE . POLICYL a 50p p00 <br /> Profeaaional Liab S+ <br /> 1C044130 03 ( 26 / 03 03 /26 / 04 palaurxend L 000 , 000 <br /> DESCRlP710N OF DPE LK1CATi0N2 / VElOGL66 f FJCCursiDii6 ADDED �r ENWIREMENr t a r� to 2 d 0 0 <br /> Company A : Employee Dishoreoty , Poliex FpapX01944C , �03 /26 / 0342 /26 / 04 , <br /> $ 1000000 .blanket , CertL9tQate holder Le an additional insured for goneral <br /> l3abi13ty 'with re9pectp to Value Visite , } 10 Daya notica for <br /> can <br /> wp4vzmeut of <br /> premium . <br /> CER1"IFIGATQ HOLbER CANCEW1TIoN <br /> ZMIA. 2 8NOULD ANY OFTHE MOVEDESCRIBEDPOI,ICMAMgCAN , NVORK THEO,MATION <br /> Indian Rivera Cougaty DAT& THEREOF, THE wsur401Ns1MFtW LI. ENAEAvoR To MAL go * � DAYS WN"p , <br /> CoaBmia n ionere1 NOTICE TO THE CERMC,AYe IIC"gR MAMI9c to TKE LEFT, eUr FAQ TQ DD SO aHALL <br /> 1640 26th Stromt ,`0�11 I3 I Q �SJ�, MPD&E No CBLAGII,TIONORLIQOFANYKINDLIPCWTREir URgR, iYzAGEMTSOR <br /> Vero Eeach FL 32960C� lam' RE 21MTATKL <br /> � <br /> � R <br /> ACOR.D 26 (2001/001 <br /> � <br /> Lr� V A 0 CORPO TION 1886 <br /> C3 <br /> 6 <br /> v <br />