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OCT- 17- 2005 MON 021144 PM WM , DAY , INC , FAX NO , 772 546 5772 P . 04 <br /> Florida Retail Federation Bonrci of Trusrees <br /> Self Insurers <br /> Ge , gill" ICundrat, iceChpirurnrt <br /> George Sandcfcr, Vice C'Iruir'urlrrr <br /> FJohn i ). I tansehn;ut <br /> Nis Nissen <br /> nrpnhrivirrrJ ht, Sn„rnd! Nhrre 1979 <br /> p,('). Box 988 • L.akc hni.1, 1• 1. 33801,098Rutirtcsrrrnrnrth �lc/Lrgs. ccurr Thomas S . <br /> ('ht�rlcs k ., WiWz WinU. <br /> Ycleph011e ( 863 ) 66:)• 6060 nr 1 -800-282-7648 • Pix (863) 666- 1958 <br /> certificate of insurance <br /> RE : 0520 - 25864 <br /> ISSUED TO : Indian River County Board of county Commissioners <br /> 1840 25th St <br /> Vero Beach , FL 32960 - 3365 <br /> This is to certify that Bgys & _Qirl5 G.Ili6 of IndL2RIvcLCounty, I_[1cLp B.0 c1L3 yero Beach , 1. 32964 being subject to <br /> the provisions of the Florida Workers' Compensation Law , has secured the payment of any workers ' compensation benefits <br /> due by insuring their risk with the Florida Retail Federation Self Insurers Fund . <br /> POLICY NUMBER : 052.0:2 6154 Statutory L_lmits - - State of Florida <br /> Employers liability <br /> EFFECTIVE DATE ; $ 500 , 000 ( Each Accident) <br /> $ 500 , 000 (Disease - - Each Employee ) <br /> EXPIRA'T'ION DATE ; Selggrler 1.3 , ? 006 $ 500 , 000 ( Disease - - Policy Limit) <br /> This certificate is not a policy and of Itself does not afford any insurance . NoL'hing contained in this certificate shall <br /> be <br /> construed as amending , extending , or altering coverage not afforded by the policy shown above or affording Insurance to any <br /> Insured not named above . <br /> The policy of insurance listed above has been issued to the named insured for the policy period indicated . Notwithstanding <br /> any requirement , term or condition of any contract or other document to which this certificate may pertain , the Insurance <br /> made available by the described policy in this certificate is subject to only the terms , exclusions and conditions of such policy <br />. <br /> Paid claims may have reduced the shown limits , <br /> If the policy described above is cancelled before the expiration date indicated , the issuing company will attempt to mail 30 <br /> days ' written notice to the certificate holder named above, although if cancellation is for nonpayrnent of premium , then the <br /> issuing company will attempt to mail 10 days ' written notice to the certificate holder . In any event, the issuing company, <br /> its <br /> agent's , and representatives accept no obligation or liability of any kind for failure to mail such notice , <br /> Date 10/ 17/ 2005 <br /> Summit, ndminisinator - ~ <br /> Florida Retail I� edoratioll Self Insurers fund <br />