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J Bonfill 8 Associates <br /> RFC)d12-04-02 Page95 <br /> Iiiill CERTIFICATE OF INSURANCE <br /> I SUCH INSURANCE AS RESPECTS THE.INTEREST OF THE CERTIFICATE HOLDER NAMED BELOW WILL NOT BE <br /> CANCELED OR OTHERWISE TERMINATED WITHOUT GIVING 10 DAYS-PRIOR WRITTEN NOTICE TO THE <br /> CERTIFICATE HOLDER, BUT IN NO EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM <br /> THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE DOES NOT CHANGE THE COVERAGE PROVIDED BY <br /> I ANY POLICY DESCRIBED BELOW. <br /> This certifies that ® STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, Illinois <br /> 0 STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois <br /> 0 STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXAS of Dallas,Texas <br /> I ❑ STATE FARM INDEMNITY COMPANY of Bloomington, Illinois, or <br /> ❑ STATE FARM GUARANTY INSURANCE COMPANY of Bloomington, Illinois <br /> has coverage in forte for the following Named Insured as shown below: <br /> I NAMED INSURED: VITAL ENGINEERING INC <br /> ADDRESS OF NAMED INSUREO: 7100 SW 99TH AVE STE 202 HIAHI, FL 33:73 <br /> POLICY NUMBER 620 1250-F.16-59N 632 1309-D11-59E <br /> I EFFECTIVE DATE <br /> OF POLICY 11/16/11-06/12/12 10/_1/1_-_0/11/12 <br /> DESCRIPTION39 LE%US ES 350 <br /> OF <br /> ENOL <br /> 1 VEHICLE(Includig VIN) JIBBJ46G:92299:44 <br /> LIABILITY COVERAGE ®YES ❑NO ®YES ❑ NO ❑YES ❑ NO ❑YES ❑NO <br /> LIMPTS OF UABILITY <br /> I a.Bodily Injury <br /> 300,00C 300,300 • , <br /> Each Person <br /> Each Accident 350,000 - 1300,000 <br /> I b.Property Damage <br /> Each Accident 500,000 I 500,000 <br /> • <br /> c.Bodily Injury& _ <br /> Property Damage' <br /> I Single Limit <br /> Each Accident <br /> PHYSICAL DAMAGE <br /> COVERAGES ® YES ❑ NO ❑YES ®NO ❑YES ❑ NO ❑YES ❑ NO <br /> I a.Comprehensive $25C.00 Deductible $ Deductible $. __ Deductible $ .. Deductible <br /> ® YES 0 N ❑YES ®NO ❑YES 0 N ❑YES 0 N <br /> b.Collision $250.CO Deducible S Deductible $ Deductible $ Deductible <br /> EMPLOYERS <br /> ❑ YES ® NO ®YES ❑NO ❑YES ❑ NO ❑YES ❑NOCAIm <br /> COVERAGEHIRED CAR LIABILm ❑YES ® NO ®YES ❑NO ❑YES ❑ NO ❑YES ❑ NO <br /> FLEET-COVERAGE FOR <br /> MOTOR VEHICLES am- (//DES ® NO ❑YES ®NO ❑YES ❑NO ❑YES ❑NO <br /> 1?-a -)-7-1) �J ttai may' CSR 2360 . 04/25/2012 <br /> 1 Signature of Authorized Representative <br /> Title Agent's Code Norther Dale <br /> Name and Address of Certificate Holder Name and Address of Agent <br /> INSURED: <br /> I VITAL ENGINEERING INC GwPan figlnd Apw <br /> 7100 SW 99TH AVE STE 202 MIAMI, FL 33173 1.1155LYHLy Sren Lop me <br /> raaI R UM= <br /> lanE Xli <br /> _. pudsSMiAlingibmlrk•r <br /> INTERNAL STATE FARM USE ONLY: El Request permanent Certificate of Insurance for liability coverage. <br /> 122425.3 Rev.o7-26-2c06 til Request Certificate Holder to be added a5 an Additional Insured. <br /> I • <br /> I <br />