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AC40® CERTIFICATE OF LIABILITY INSURANCE DA,E(MM.DD",,,,,Y' <br /> 6/6/2019 <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 certificate 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 lieu of such endorsement(s). <br /> PRODUCER CONTACT NAME ERIC TREEND <br /> ACRISURE LLC PHONE . (800)607-4711FAX <br /> AI No <br /> 1375 FAST 9TH STREET,30TH FLOOR,SUITE 3000 ADORFSS: ERIC.TREEND@BRITTONGALLAGHER.COM <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> CLEVELAND OH 44114 INSURERA: FWCJUA <br /> INSURED INSURER B <br /> GALAXY FIREWORKS INC <br /> INSURER C <br /> 204 E MARTIN LUTHER KING BLVD INSURER D: <br /> TAMPA FL 33603 INSURERE: <br /> FEIN:593092878 INSURERF: <br /> COVERAGES CERTIFICATE NUMBER: 1906060016 REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> TR POLICY NUMBER MMfDD MID <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S <br /> AGE TO RENTED <br /> CLAIMS-MADE OCCUR PREMISES SES occurrence S <br /> MED EXP(Anyone person) S <br /> PERSONAL 8 ADV INJURY S <br /> GEN'L AGGREGATE LIMIT APPLIES PEP: GENERAL AGGREGATE S <br /> POLICY EP T F I LOG PRODUCTS-COMPIOPAGG S <br /> OTHER S <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S <br /> a accident <br /> ANYAUTO BODILY INJURY(Per person) S <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) S <br /> HIRED NON-OWNED PROPERTY DAMAGE S <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> S <br /> UMBRELLA LIAR HOCCUR EACH OCCURRENCE S <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE S <br /> DED I I RETENTIONS $ <br /> WORMERS COMPENSATION X STTATUTE OT <br /> AND EMPLOYERS'LIABILITY <br /> JER <br /> ANY PROPRIE10RIPARTNEREXECUTIVE YIN N E.L.EACH ACCIDENT S 500,00D.00 <br /> A OFFICERIMFMBER EXCLUDED? N/A 2E637021 1/19/2019 1/19/2020 <br /> (Mandatory on NM E.L.DISEASE-EA EMPLOYEE S 500,000.00 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E-L-DISEASE-POLICY LIMIT S 500,000.00 <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Zephyrhills SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 5335 8th Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Zephyrhills FL 33542 AUTHORIZED REPRESENTATIVE <br /> Phone Number (813)780-0000 <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />