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/ , ® DATE(MWDD/YYYY) <br /> ACIORV CERTIFICATE OF LIABILITY INSURANCE 1 1/0712 01 8 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY.AND CONFERS NO RIGHTS UPON THE.CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED . <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT:If the vertlficate holder Is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on <br /> this certificate does not confer rights to the certificate holder in Ileu of such endorsements. <br /> PRODUCER CONTAUT NAME: Melanie Allen <br /> MCGRIFF,SEIBELS&WILLIAMS,INC. PHONE 800.476=2211 AX <br /> P.O.Box 10285 A/C No <br /> Birmingham,AL 35202 &MAIL mall rlH:com <br /> ADDRESS �c9 <br /> INSURERS AFFORDING COVERAGE NAIC <br /> INSURER A.ContlnentalIndemnl Company 28258 <br /> INSURED INSURER B: <br /> Pyrotecnico Fireworks,-Inc. <br /> P.O:Box 149 INSURER C: <br /> New Castle,PA 16103 <br /> INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:T5S6F4JY REVISION NUMBER: <br /> THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH_RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> 1LTR TYPE OF INSURANCE POLICY NUMBER POLICY EYFF' POLICY EXP UMW <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE. $ETORERTED <br /> - <br /> CLAIMS-MADE DOCCUR PREMISES a occurrence) $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $- <br /> POLICY❑JPERO- El LOC PRODUCTS-COMP/OP AGG $ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMB <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PRO Y DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> $ <br /> UMBRELLA LLA O EACH OCCURRENCE $ <br /> EXCESS LIAB HCLCACIUMBS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> A WORKERS COMPENSATION 738720960414 08/07/2018 06/07/2019 X PER OTH- <br /> AND EMPLOYERS'.LUU911ITY YIN (Blanket Waiver of Subrogation Incld) TAT <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ 1.000,000 <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000_ <br /> tl yS describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE.POLICY LIMIT $ <br /> $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,AddlUonai Remarks Schedule,may be attached If more space Is required) <br /> Fireworks Display Date:Dec.2,2018 <br /> Location:Florida Hospital Zephyrhills <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Florida Hospital Zephyrhills <br /> PO BOX 149 AUTHORIZED REPRESENTATIVE <br /> 7050 Gall Blvd. <br /> Zephyrhills,FL 33541 <br /> Page 1 of ©1988-2016 ACORD CORPORATION. All rights reserved. <br /> A/`ADn OC 19Ai R/A1% Tho Art%Dn Henn—A Inns era—11.0...A—11—n1 APA10111 <br />