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AMR—D. CERTIFICATE OF LIABILITY INSURANCE OP ID L DATE (MM/DDIYYYY) <br /> HIBIS - 2 10 / L5 / 04 <br /> ORODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> R . V . Johnson Agency , Inc . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> _A1 TFR THE rn)LI=RArpl= _ - _ ------- - _ <br /> Stuart FL 34996 <br /> Phone : 772 - 287 - 3366 Fax : 772 - 287 - 4255 INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED INSURER A: Landmark Insurance Company_ <br /> Hibiscus Childrens Center Inc . INSURER B: Markel International <br /> &Hibiscus Childrens Foundation INSURER C: Bridgefield Employers Insuranc <br /> P 0 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 /> POLICY EFFECTIVE POLICY EXPIRATION <br /> LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1 r 000 r 000 <br /> AGETO RENT Ems- -- -- — -- <br /> B X COMMERCIAL GENERAL LIABILITY 3602SS255610 - 0 07 / 12 / 04 07 / 12 / 05 PREMISES ( E aoccurence) $ 200 , 000 <br /> 4s3CLAIMS MADE , Fx ] OCCUR MED EXP (Any one person) $ 15000 <br /> X Abuse / PERSONAL & ADV INJURY $ 110001000 <br /> Molestation $ 1 , 00O , Ooo / $3 , 000 , 000 GENERAL AGGREGATE <br /> , 000 , 000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3 , 0 0 0 r 0 0 0 <br /> POLICY PRO- <br /> JECT I I Loc Emp Ben . $ 1M/ $ 3M <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 11000 , 000 <br /> 1002SS255617 - 0 07 / 12 / 04 07 / 12 / 05 <br /> B X ANY AUTO (Ea accident) <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 AUTOEA ACC $ <br /> OTHER THAN <br /> AUTO ONLY: AGG $ <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE s2 , 000 , 000 <br /> B X OCCUR EICLAIMSMADE 4602SS255623 - 0 07 / 12 / 04 07 / 12 / 05 AGGREGATE s2 , 000 , 000 <br /> RDEDUCTIBLE <br /> X RETENTION $ 10F000 $ <br /> WORKERS COMPENSATION AND TORY LIMITS X ER <br /> C EMP LOYERS' LIABILITY 0830 - 28580 02 / 22 / 04 02 22 <br /> ANY PROPP,IETOR/PARTNEPJEXECUTIVE / / O5 E.L. EACH ACCIDENT $ 500000 <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 /> A Property Section LHD066474 07 / 12 / 04 07 / 12 / 05 <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br /> 30 days notice of cancellation for workers compensation coverage . <br /> Companies have the option to cancel 10 days for non -payment . <br /> CERTIFICATE HOLDER CANCELLATION <br /> IND IA31 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 BOARD <br /> OF COUNTY COMMISSIONERS IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> 1840 25TH STREET REPRESENTATIVES. <br /> VERO BEACH FL 32960 AUT z PR NT I <br /> ACORD 25 ( 2001 /08) © ACORD CORPORATION 1988 <br />