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<br />~ SPECIALTY INSURANCE INC.
<br />10451 GULF BOULEVARDL TREASURE IsLANDt FL. 33706
<br />Toll Free 1-~OO-237-3355 NatIonal
<br />1-800-282-6776 Florida
<br />
<br />Certlflca~e Number:
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<br />
<br />CERTIFICATE OF INSURANCE
<br />FIREWORKS DISPLAY
<br />
<br />NAME & ADDRESS OF INSURED:
<br />8ell '8 t:'.treworks
<br />":!Cil N. ,A.rmenlB A'J;::!'1ue
<br />'7.' aIr!!' a
<br />FL~3ti4
<br />
<br />ADDITIONAL INSURED:
<br />Pasco County; EastaPasco Family
<br />YMCA; Silver Oaks VilLage;
<br />Zephyrhills High School
<br />
<br />_P!},!,~A RI_", __.CO ~~~EA_G~___ ____E><;f~ S_<;Q V E fift.GE__._
<br />
<br />COMPANY;
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<br />C' -:,:01 i r;; a n '/
<br />
<br />POLICY NO,:
<br />
<br />~\1 \.~~ ~~' '.:; 9 S .'J
<br />
<br />LIABILITY LIMIT: I
<br />HI/PD t3CC: 'cs 1. ..YOU ')00 .
<br />AG(~: ?rJ~~'p~r:tQ:~~.'~~9~27_-=~~~'.'
<br />
<br />Class I
<br />Products: $'.;
<br />POLICY PERII}D:---
<br />Fre'ID:
<br />10:
<br />
<br />$0
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<br />00/00/00 00/00/00
<br />00/00/00 00/00/00
<br />· - COMBINED SINGLE LIMIT
<br />:-'jnY..I.,at.,'?t".i.;:l change Inl or cance118tion of ~3aid pOlicy(j':;f.',
<br />pnde9VO? to ~ive wrlt~en notice to the party whom thIS
<br />s3ueG, but fCllure to ~lve such notlC9 shall lmpo~e no
<br />.;2':~t J.c:;n upon t:ce company.
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<br />NAME & ADDRESS OF CERTIFICATE HOLDER:
<br />Zephyrhills Hi]h School
<br />6335 12th St.
<br />Zephyrhills. PL 33510
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<br />z;j" :~t;e ~(i~icv t~8t ~11 ~15p13YS :)8 r9p0rtf~d to tne (~GmpariV a
<br />advance at the dlsPlay date,
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<br />:.1 '."':)~': :..!t,Lc~I tr-;? :;lls:play is hel.J. i,./ttllln" '~e terms of the '.I,~'1ic'i
<br />lJp a d pOllcln@ of the displ~y are the responslblllty ~f t0~
<br />
<br />DATE OF DISPLAY:
<br />RAIN DATE:
<br />DISPLAY AMOUNT:'
<br />LOCATION OF
<br />DISPLAY: East Pasco Family YlviCA
<br />In lar~e open field in front of
<br />the YMCA.
<br />
<br />OS/25/2001
<br />N eX"E"--AVaIT"iI'b 1 e
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<br />;" ,;. ~:ld':.tl')(:.Jl Insureds: any fair (,1 i?xhlblti(lt!, aSSOclati,:.'n,
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<br />~-y as 'Espects aCCIdents arising Gut oft e neQll~ence 0f the
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<br />Theif ~~f, V~ent" Also, 8S additlona Named Insure1, any Independent
<br />"',',--::':C;l I,"..: ,,0:''> t~ie cJ,~:pl";y .n b~half of the l:/ame.j Lislir'ed.
<br />'Pi::: ;'(;;:'.,,:3.'..: .,." .",tlt. apply to F:.;':Y tElllure t':1 po.. C2 or c.,eanl,l!? ;;tH? ')~"f::;:1:r;
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<br />.'" -. (\::.'1 ,:,rd: t~,tl,:,;,el F.'-e F'rotectibn AGSOc2Htlon INFPA) c''"j:je!:. arie
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<br />This certlflcate is not valid unless an ori~ln81 si~nature appears balow.
<br />(Copies Not Valid.)
<br />
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<br />. -l)FtR'6r'~ I~~~:~~~~:~~~RANCE, INC.
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<br />----...----'"A\JTHO R1:zh'1J-sTGNATO"RE--".
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