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OCT- 17 - 2005 MON 02144 PM WM , DAY , INC . FAX NO , 772 546 5772 P , 04 <br /> Florida Retail Federation RoartlorTrusrees <br /> Self Insurers <br /> W. " e CCundrat, C 'huirnrnn <br /> (;targge Sandcfcr, Vice C'buiruunv <br /> FJohn i ). 1 LIWi lJ11nn <br /> ArAnini�'rrrrdAp5rrr,rnob .,Jrrcr 1979 Nis ( 1i , scn <br /> 1',O. Dk)%x 94 • L.akt hnd , 1. 1. 33802 . 0988 • Tholwla S . Pctco (I <br /> TcicpLnne ( 863 ) 66 '5- 6060 or 1 -800-M ,7649 • F'ax ( 863) 666- 1958 C'htu'lcs H . Wintz <br /> Certificate of lnsurance <br /> RE : 0520 - 25 £364 <br /> ISSUED 'TO ' Indian River CoLnty Board of county commissioners <br /> 1840 25th 5t <br /> Vero Beach , FL 32960 - 3365 <br /> This is to certify that aoy & irl _G.li! b of .Indian R-jve _County , IIPO., Eli c�306 $ N. _Cga ach ,.11., 3296 } , being subject <br /> 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 : 0524_25664 Statutory Limits - - Stake of Florida <br /> Employers Liability <br /> EFFECTIVE DAI-E : Sep tuber.X .3._2005 $ 500 , 000 ( l=ath Accident) <br /> $ 500 , 000 ( Disease - - Each Employee ) <br /> EXPIRATION DATE : geptgrrl.ber 1. 3 , 2006 $ 500 , 000 ( Disease - - Policy Limit) <br /> This certificate is not a policy and of Itself does not afford any insurance . Nothing contained in this certificate shall <br /> be <br /> construed as amending , extending , or altering coverage not afforded by the policy shown above or affording lnsuranco to any <br /> Insured not earned 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 <br /> policy . <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 <br /> 30 <br /> days ' written notice to the certificate holder named above , although if cancellation is for nonpayment of premium , then the <br /> issuinca company will attempt to mail 10 days ' written notice to the certificate holder . In any event, the issuing company, <br /> its <br /> L and representatives accept no obligation or liability of any kind for failure to mail such notice . <br /> Date 10/ 17/ 2005 <br /> 1� <br /> Summit, Adininisti-ator _ . <br /> l' loricla IZelail Federation Self Insurers Fond <br />