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' ESSEX INSURANCE COMPANY <br /> mmm <br /> COMMERCIAL LIABILITY DECLARATIONS <br /> 3 CH4 314 Policy Number <br /> Renewal of Number 3 CK3 3 0 8 <br /> Item 1 . Named Insured and Mailing Address : a�cPL`�` LI ' Ic`' <br /> r,. i irnn;is e t . gown <br /> _ r� *' '-.l3GUE2 iGi f ` S <br /> SuiiC =< 7 <br /> Cultural Council of Indian River Co . , Inc Casseiuerry FL 32707 <br /> 2145 14th Avenue Ste : 11 <br /> Vero Beach , Fl 32960 PRODDAGISid Banack <br /> cITv�0 Bo 132 , FL <br /> This insurance is d u -jrto the <br /> FlonCeSurplus �ine5 � �• so. : insured <br /> rwve <br /> Item 2 . Policy Period From : 03 / 10 / 2003 To : 03 / 10 / 2004 Term : J!heyeartn of tile F: ., ; .7l-yinsi it ante <br /> IIdialSifT7,7 oT'tTe c, � . � tt Ci -.r.y r!ght of <br /> 12 : 01 A. M . Standard Time at the address of the Named Insured as stated herein. recovery for the oi,ligat on 01 any in ,olac;nt <br /> unlicensed insurer. <br /> File # <br /> Item 3 . Retroactive Date : <br /> Item 4. Business Description : Promotes the arts & cultural activities & programs <br /> Item 5 . In return for the payment of the premium , and subject to all the terms of this policy, we agree with you to provide <br /> the insurance as stated in this policy. <br /> This policy consists of the following coverage parts for which a premium is indicated . Where no premium is shown , there is <br /> no coverage . This premium may be subject to adjustment. <br /> Coverage Part (s) Form No . and Edition Date Premium <br /> Commercial General Liability Coverage Part $ 4 , 2 2 7 . 0 0 <br /> Professional Liability Coverage Part g <br /> Policy Fee $ 35 . 00 <br /> Service Fee $ 12 . 79 <br /> Tax $ 213 . 10 <br /> $ <br /> $ <br /> $ <br /> Audit Period Annual unless otherwise stated : Total $ 4 , 4 8 7 . 8 9 <br /> Item 6 . Forms and endorsements applicable to all Coverage Parts : 011 - 1054 ( 04 - 00 ) , 011 - 1061 ( 08 - 02 ) <br /> SHOW NUMBERS <br /> Agent Name and Address : Crump Insurance Services of Florida , Inc . 1211 Semoran Blvd , Ste : 227 Casselberry , <br /> FL 32707 <br /> Agent Number: 104990 <br /> Countersigned 03 /25 /2003 kp By <br /> DATE <br /> r <br /> THIS COMMERCIAL LIABILITY DECLARATIONS AND THE SUPPLEMENTAL DECLARATION , OGE TH ER�WiITH THE COMMON POLICY CONDITIONS, <br /> COVERAGE FORM (S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED POLICY. <br /> 011 - 1056 (9-93) <br /> INSURED <br />