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ACORD. CERTIFICATE OF LIABILITY INSURANCE OP ID C DATE (MM/DD/YYYY) <br /> HIBIS - 2 12 / 06 / 05 <br /> PRODUCER r 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 INSURERA: Landmark Insurance Company <br /> HibiscusINSURER B : Markel International <br /> &Hibiscu s Childress Foundation Childress Center Inc , INSURER C: Bridgefield Employers Insuranc <br /> Hibiscu <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 /> AEYDEP /DY)LTR NSR TYPE OF INSURANCE POLICY NUMBER DTMM/D /YY DATE EXPIRATION <br /> MD /YLIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1 , OOO , 000 <br /> B X X COMMERCIAL GENERAL LIABILITY 3602SS255610 - 0 07 / 12 / 05 07 / 12 / 06 PREMISES (Ea occurence) $ 200 , 000 <br /> CLAIMS MADE 1*1 OCCUR MED EXP (Any one person) $ 15000 <br /> X ABUSE /MOLES PERSONAL & ADV INJURY $ 1 , 000 , 000 <br /> $ 1 , 000 , 000 / $ 2M GENERAL AGGREGATE $ 3 , 000 , 000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3 , 0 0 0 , 000 <br /> POLICY PROT LOC Em Ben $ 1M/ $ 3M <br /> JEC <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT $ 1 <br /> B X ANY AUTO 1002SS255617 - 0 07 / 12 / 05 07 / 12 / 06 <br /> (Ea accident) i000 F000 <br /> ALL OWNED AUTOS <br /> BODILY INJURY $ <br /> SCHEDULED AUTOS (Per person) <br /> X HIRED AUTOS <br /> BODILY INJURY $ <br /> X NON-OWNED AUTOS ( Per accident) <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE s2 , 000 , 000 <br /> B X OCCUR � CLAIMSMADE 4602SS255623 - 0 07 / 12 / 05 07 / 12 / 06 AGGREGATE $ 2 , 000 , 000 <br /> RDEDUCTIBLE $ <br /> X RETENTION $ 10F000 $ <br /> TATI 'H— <br /> WORKERS COMPENSATION AND TORY LIMITS X ER <br /> C EMPLOYERS' LIABILITY 0830 - 28580 02 / 22 / 05 02 / 22 / 06 E. L. EACH ACCIDENT $ 500000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> OFFICER/MEMBEREXCLUDED? E. L. DISEASE - EA EMPLOYEE $ 500000 <br /> If yes, describe under <br /> SPECIAL PROVISIONS below E. L. DISEASE - POLICY LIMIT $ 500000 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br /> 30 days notice of cancellation for workers compensation coverage , companies <br /> have the option to cancel 10 days for non payment . Certificate holder is <br /> added as additional insured . <br /> CERTIFICATE HOLDER CANCELLATION <br /> INDIA- 1 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 /> Marion Masterson <br /> 1840 25 Street REPRESENTATIVES. deq <br /> Vero Beach FL 32960 AUT Z PR_F,B�NT I <br /> ACORD 25 ( 2001 /08 ) © ACORD CORPORATION 1988 <br />