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Nov t) 4 1.) %.i : ? yY <br /> CERTIFICATE OF INSURANCE <br /> SUCH INSURANCE AS KiiS -r _CI-S fHE ! NTEREST OF THE CERTIFICATE HOLDER WILL NOT .BE CANCELED OR OTHERWISE <br /> ENI <br /> WITHOUT atvtNG 10 DAYS FRIAR WRITTEN NOTICE TO THE CERTIf3CATE HOLDEP, NAMED BELOW, BUT IN NO <br /> THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE <br /> ANGE THE COVERAGE PROVIDED BY ANY POLICY DESCRIBED BELO . <br /> t: fa STATE FARM NVJ JAL AUTCM081LE INSUPWNCE COMPANY of Btoomigion. ! Ilinois . or <br /> 3T.ATE FAR .0 F! RE AND CASUA_T'e COMPANY of 6!oo-dnaton , 111incis <br /> hers .overage in torte -or :he fo.iowing Nameu InSLred as shown below : <br /> riarnen Invural St , Peters Missionary Baptist Ch ,jrch Inc. — <br /> Ad Tress of t•lamed Inst. rea 4250 38 `"` A•✓= . <br /> Vero Beech . FL 32567 <br /> NUMB 8102332C0959f f 127 0534403. 59A u?3 5141 .827-59 1340 2E32•Q09 59 <br /> EFFEC NE GATE 0= + 1010510405!091'05 0r09104-04109f05 <br /> 1994 POOGE 6350 VAN i 1961 INTEL BUS 1 1996 FORD ' 994 00OGE <br /> DESCRIPTGN OF EiiO 'dAN 8350 VAN <br /> VEHIC _- <br /> _ta81Ll`Y CO`JRRAGe -�yYa; IANC O'fES ❑ NC - - YES ] NO — EYES ]N ^ - <br /> -10 T S OF LiMiLM! <br /> a . Bodily lnrury <br /> t <br /> i"cn Person —_ - •--- <br /> a. ewiiy lnjcr e I ! <br /> Each Acddent <br /> b. Prcpe" Damage I I <br /> c. Bodily n. ury -- <br /> Froaerty Damage 51 ,000 ,000 . 00 i $1 ,006, 000 .00 1 $ 1 ,0000000 . 00 a1 ,flCfl , DOD .CO <br /> Single Licht Esch <br /> _ - - ---- - -- --_ _ i <br /> Acc.dnt _ <br /> � N_O lYES �YCSiYStCA GtirAGc ]NO ZYES - - <br /> i;UvEib4GE5 5250 00 Deductitl0 $21C .0f7 Deductible i $250 00 Dep.4ucvtmlE $ 2500 0 Ded t0ble <br /> a. Comprehensive — <br /> YES 0P4 -[RYES ONO olYSS ONO AYES ❑ Nt7 <br /> b. C�tlsion S O . 00 OeduclibiA X00 D&Juctible ( 500 . Or` Deductible 500 -00 Deductible <br /> :f,APLOYMS <br /> 4 N •OWNERSHIP ❑ Y .5 UO ❑YES ENC I ] YES Z.. t,4o ❑YEs gNO <br /> COVERAGE _ <br /> HIRED CAR COVEFL4GE l iY £ a K IvQatt_ YES ," NO YES NO - _ 0y =3LN0, <br /> I-LAt ) Agem 2733 11104/04 <br /> Igr al.Ir9 of A�Ii*,orized Repr _ntatfve , y itle Agr nt 's Cade Number Date — <br /> Name and Address of Certificate Hofer- Name and Address of Agent <br /> David E . Fledges , Ste?e Farm insurance Agency <br /> lildian River County 2601 20`" Street Suite S <br /> Vero Beach , FL 32960 <br /> Check if a permanent Certificate ;;f insurance for liability .overage is needed : <br /> r"7: eck if the Certificate Huir ei should be acded as ai Additional Insured: ] <br /> Reria-Ks . <br /> 14.9 - • .B � F. 6.. J-}t n,vra] fn � : .;,. <br />