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0 1 DATE(MMIDO/YYYY) <br /> ACOORL)i CERTIFICATE OF LIABILITY INSURANCE <br /> 164� 1 1122r2O2O <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 tenns,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 ofsuch endorsement(s). <br /> TREEND <br /> - C <br /> PRODUCER c,0QN.TA;LT ERJ <br /> ACRISURE LLC PHONE <br /> JAIC No V�n_- (000.)748-0351 <br /> 1375 EAST 9TH STREET,30TH FLOOR,SUITE 3000 RiMAIL)BRESS. eric:treend@btfttongellagher-com <br /> INS )AFFORDING COVERAGE NAIC# <br /> CLEVELAND OH 44114 INSURER A: FWCJUA <br /> INSURED INSURER 8,'- <br /> GALAXY FIREWORKS INC <br /> INSURER C. <br /> 204 E MARTIN LUTHER KING BLVD INSURER 0: I <br /> TAmPA FL 336030000 INSURER E. <br /> FEIN:593092878 <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMIOER., 200I220005 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 Okc6NDITION 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.LIMITSSROWN MAY HAVE 13EEN REDUCED BY PAID CLAIMS. <br /> INSR ADDLSUBR PoLICYEFF POLICY EXP' <br /> LTR TYPE OF INSURANCE -jam-wa POLICY NUMBER fMM1DD7YYYY) (MWDDNYYY) LIMITS <br /> COMMERCIAL GENERAL LMSM EACH OCCURRENCE $ <br /> CLAIMS-MADE F7 OCCUR PREIASES(Ea o=rrenw) $ <br /> MED EXP UVw onewson) $ <br /> PERSONAL,&ADVINIURY $ <br /> GENL AGGREGATE.LIMIT APPLIESPEIt GENERAL AGGREGATE $ <br /> 7 L02C PRODUCTS-COMPIOP AGG $ <br /> Policy E SECT <br /> OTHER: $ <br /> AUTOMOBILE-LIABILITY STN LIMIT 3 <br /> ANYAUTO BODILY INJURY(Per wison) $ <br /> OWNED SCHEDULED BODILY INJURY(Per semlerd) S <br /> AUTOS <br /> HIRED ONLY MOT&NED (PPROFER <br /> AUTOS ONLY AUTOSONLY <br /> UMBRELLA LIAB OCCUR EACHOCCURRENCE, $ <br /> EXCESS LIAR HCIAIMSMADE AGGREGATE $ <br /> DED RETENTION 5 $ <br /> R <br /> ---Fs I <br /> WQRKERS COMPENSATION DA 1.ffE� I EON" <br /> AND EMPLOYERS'LIABILITY YIN <br /> ANY PRQPRIF-70R/PARTNE R`P�ECUTIVE E.L_EACHACCIDENT 500,000.00 <br /> A OFFICEWAiEMBEREXCLUDED3 FN 2E637021 1/1912020 1/1 MIA 9/2021 <br /> (Mandatory in Nri) EL DISEASE-EA EMPLOYE -$ 500,000-00 <br /> II�ygi M gtundar <br /> OF OPERATIONS below EE E.L.DISEASE-POLICY LIFAIT $ 50000-00 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Rernariu;Schedulei May be attached if more SPaCe Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Zephyrhills SHOULD ANY OF THE ABOVE DESCRIBEDPOLICIES BE CANCELLED BORE <br /> 5335 M 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)7$0_000d <br /> O 1988-2015 ACORD CORPORATION. Ali rights reserved. <br /> ACORD 25(2016f03) The ACORD name and logo are registered marks of ACORD <br />