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i <br /> REC�IIJED 65/02l201? 62:01PM 72?819@9@5 PA7RIC�T2CFZREWQRKS � <br /> G9 05-02-241J 12:06 AM Fax 3 2 F <br /> i <br /> A�'"�� CERTIFICATE OF LIABILITY INSURANCE DA�`���r��y <br /> 5�tizo,r <br /> THt&GERliFicalE 19 Issti�A A3 A NlAT7ER r�F lNFOR#A'�csrs 4NLY ANO c�uFERg NO RIaH'rs !lAGPi THE CER7IFICA'TE MdLD�R.T�IS <br /> CER'RFiCA"fE DDE9 NOT AFFlRt�QAIiVEtY OR NEOAl1VELY AMENt7, EXTEND OR ALTEft 'ME COVERACiE APfORDED 8Y ?HE POLiCiES <br /> BELOW. TFII9 GER'TIFICATE OF INSURANGE DOE9 NOT G4N3TITUTE A CON'PRACT 6ETWEEN 7NE 183U1N0 INSURER�3), AUTHORIZED <br /> t�EPREBENTAtiYE QR PRQDUCER,AND TF�E CER'11FlCATE NOLQER. <br /> )MPORTANT, if tha cectlflcat0 hoid¢r ts art ADiSi'TiORAL INSUii�D,the poNcy{Ies)muat�e endoraetl, p`Sl{HROGA7tON IS tNAtVEo,subjeci to I <br /> ti�tetme and�ondttlona oi rhe pollcy,cortaln pollGes may requl�e an endorsement. A etatemant on thla certlflcate dos�not confer rtahte to the <br /> csrtfflcafe hoider!n llau of 6uch endoraer�ent{e. <br /> p�ouCER <br /> NAAAE: <br /> Britton Cauagher PNON6 F <br /> One CleYeland Gen�r,�(aor 34 - �c Ne• -658-7101 � <br /> 3375 EasE 9th Sireek ADDRESB: 1 <br /> Clevelsnd bH 44114 iNBURER 9 APFORbING COLERAGE wucM � <br /> iHaua�it a: 0651 � <br /> IN3iiRlA lN9URER 9: � <br /> PaVioliC FireWprks Inc, iNaua�rso: <br /> t314 S.High Schaoi Raad tt�suRsao: <br /> lndia�tapolis IN 46243 <br /> �n�auR��e: <br /> 1NaU1TER F: <br /> C4VEl2AGE3 GEEt'[tFICATE NiSMB�7t:g23D3r3192 R�V�SION NltMBEi� <br /> TMIS�S TO CSRTIFY THAT THE POLICIES OF 1N8URANCE LI&lED 9ELOW HAVF BEEN ISSUEO TO THE INSURED NAM6D ABOVE FOR THE POLI P�R(04 � <br /> INDICqTED. NOTWITHSTANOfN�ANY REQUIREMENT,TERM OR CONDITIQN OF ANY CONTRACT OR OTHER DOCUMENT W(TN RESPEGT TO WNICN THIS <br /> CER7tFtGATE MAY HE iS'3UE0 OR MAY P�RZAt�i,7ti�iNsifRANCH AFfORbEb 8Y 7N�POLlGtES DESCR3BE� HEi2EiN 15 SUB,IEGT TO ALL TH6 7ERM5, <br /> ExC(.USi�NS ANO CONDt7tONS Of suCH PoticiE5.l�Mt73 3kowN MAV HAVE B£EN REDUCEO 9Y PAtO CtA)nrS. j <br /> IN6R yypQoFiNBURAN[� IN9R WVD PONCYN�IMHER Mo C p0 L1MIT9 I <br /> GE?tERALL1A81il7Y Sf8G�Q0429-171 511t2097 371{2D1$ �p�H 4CCUftRENCB g1.000.000 <br /> X <br /> x S Ea acni,anm SSOO:OGO. � <br /> COMMERCW�GENERAL uq91�TY <br /> _�....arao_ n�_....� - <br /> I <br /> CLAIMSMAD� ��CGUR MEDEXP An anop. <br /> PERSQNAiBADVINJURY 5100�.Od0 � <br /> GENEftALAGGREGa7E S2.ODo.000 � <br /> QEN'tA40REt#ATEIiMtTAFPllE3PE{Y PR9IriJCT3.COMPpPAfi¢ 32044000 <br /> POutr X L4C S i ( <br /> AUTONOBII.L LIABILI7Y I <br /> I <br /> HUY AtlT'0 EO[nLY iNdURY{flTr p¢r�On� i j ' <br /> f <br /> �.ro9 H�9 WT�Q.�.^S��O E�OI�Y 1NJURY(Pe�acciQenlJ Ei'_ I 'I <br /> HlR�OAVTQ3 AUT�SWNEO P�oaccltle�n��AaB = <br /> S <br /> UMBREU.d LG9 ���a EACh OCCURRENCE S <br /> EXceBgLus ��g,�p� AGGfiEGATE S <br /> OE� REFEN7i0NE S � <br /> WORKeiSGCMPPJV3A114N 'n A�• � � <br /> A�EMPWYERS'LIAHILITY <br /> �tNY AROPRi£TO€uPnRYHERrexetuTive Y� �a A E.L.FACH ACCl6ENT S I <br /> oF�et'�n+BMe€t��xc�uo�ar <br /> (Moneeroryl�NH) &I.D�SEASE•EA�MFl,OYEE 1 � <br /> ( IIy es d¢svibe unEer '--""'—"' , <br /> UESCRIPiiON KOP£ YI bBbW E.L.DtSEASE.POIICY LIMIT S � <br /> I � ( � <br /> , � i <br /> 023cR1P7mN aP op�rtAT10N81 tACAT10ti8 t V[ii1CLEs tAKech ACOR0101,Aea2t{oeet Rematke SchadWa It more epace ia repWredt ' � � <br /> Addidanal lnsured exraneion of coverage is provided by above referenced General Liabi(ity policy where required by written agreement. � <br /> �ate ot Coverage;49-24-2�17 <br /> Location;�aphyr Park 35116 Sth Avd Zephyrhills,Fl,335d2 <br /> Additlonzl Insured;City of Zaphyrhills,Simply Ev�nt,�,PatrioCic Firaworks Inc. I <br /> G�R73�IC LD�E� \ CANCELLA'itON � <br /> 3NOULD ANY OF 7HEABOVE�ESCRIBED POUG6S BG CANCGLLED BEFORE � <br /> 5imply Events tnc. �ttE �XF2RATIOH DATE TldEREOF. NC1tCE WILI 9E D8Lt1tlRED !N <br /> '13C3�S8P11ii1a19$SVd. ACCORDANCE WITN'St3E PCUCY PRCViBtOTtB. ! <br /> Largo F�,33770 <br /> A4lTHOR¢E4 REpRE9EH5A iNE � <br /> .i�3 / / � � <br /> �5888.201Q AGORd CORPORA'fiON_ AIE rights resesved. � i <br /> ACORD 25(2010105) The ACORD name and iago are regizCered marks of ACORD � I <br /> � � <br /> � <br /> I <br /> 901�0 3Jt1d S?i�lOM3�lI�aZlOI�lldd 90606 LBL�L WaLO�I� G t0�/G0190 <br />