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DATE(MMIDDNYM ACCOR" , CERTIFICATE OF LIABILITY INSURANCE 11151 m' 019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: Britton-Gallagher and Associates, Inc. PHONEIAIC.No _ Ne: _ _ One Cleveland Center, Floor 30 E-MAIL 1375 East 9th Street ADDRESS: Cleveland OH 44114 INSURERS AFFORDING COVERAGE NAIC# INSURER A:EVereSt Indemnity Insurance Co. 10851 INSURED INSURER B:AXIS Surplus Ins Company 26620 Phantom Fireworks Eastern Region,LLC INSURER C-Arch 2445 Belmont Avenue INSURER D: Youngstown OH 44505 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:2099500159 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR I SR WVD POLICY NUMBER MMIDD MMIDD LIMITS A GENERAL LIABILITY S18GL00643-191 10/30/2019 10/30/2020 EACH OCCURRENCE $11000,000 DAMAGE TO X COMMERCIAL GENERAL LIABILITY PREMISES EaENTED occurrence) $500,000 CLAIMS-MADE X OCCUR MED EXP(Any one person $ X Non-Owned Stand PERSONAL&ADV INJURY $1,000,000 End't Included GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PROJEC X LOC $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident C UMBRELLA LIAR X I OCCUR UXP0057739-05 10/30/2019 10130/2020 EACH OCCURRENCE $4,000,000 PiED XCESS LIAR fl CLAIMS-MADE AGGREGATE $4,000,000 RETENTION$ $ WORKERS COMPENSATION WG STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE� N J A E.L.EACH ACCIDENT $ OFFICERtMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ B Excess Liability#2 P-001-000046155-02 10130/2019 10130/2020 Each Occl Aggregate $5,000,000 Total Limits $10,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) The Certificate Holders are named as Additional Insureds with respect to General Liability as required by written contract subject to policy terms,conditions and exclusions. Tent Location:Townview Square-7246-7422 Gall Blvd.-Zephyrhills, FL 33541 Dates of Operation: December 16,2019 through January 10,2020 Provest Townview,LLC CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Provest Townview, LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 158 Union Turnpike ACCORDANCE WITH THE POLICY PROVISIONS. Hudson NY 12534 AUTHORIZED REPRESENTATIVE 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD