|
<br /> ,ACORDTII I CERTIFICATE OF INSll'
<br />PRODUCER This certificate is issued as a IT, lit
<br />MCGRIFF, SEIBELS & WILLIAMS, INC. upon the Certificate Holder. Th;
<br /> P.O. Box 10265 coverage afforded by the policill;
<br /> Birmingham, AL 35202 COMPJIN
<br /> 205-252-9871
<br /> Company James River Insll a
<br /> A
<br />INSURED Company FL WC Joint Uncf!
<br /> Galaxy Fireworks, Inc. B
<br /> 204 East Martin Luther King Drive
<br /> Tampa, FL 33603 Company
<br /> C
<br /> Company
<br /> D
<br /> Company
<br /> E
<br />This is to certify that the policies of insurance described herein have been issued to the Insured named'
<br />any requirement, term or condition of contract or other document with respect to which this certificate m r y
<br />the policies described herein is subject to all the terms, conditions and exclusions of such policies. Limr!;
<br />CO TYPE OF INSURANCE POLICY NUMBER EFFECTIVE
<br />LT EXPIRATION
<br />A GENERAL LIABILITY 000319120 06/10/2008 EACH OC::
<br /> IXI Commercial General Liability 06/10/2009 FIRE DAtJi~
<br /> o Claims Made IXI Occurrence MEDICAL F
<br /> o Owners' and Contractors' Protection
<br /> IXI Deductible $2,500 PERS. ANti
<br /> 0 GENERAL
<br /> General Aggregate Lim~ applies per. PRODUC"
<br /> o Policy 0 Project IX] Location
<br /> AUTOMOBILE LIABILITY COMBINED
<br /> o Any Automobile BODILY "':,
<br /> o NI Owned AutomObiles
<br /> o Scheduled Automobiles BODILY "'~'
<br /> o Hired Automobiles PROPER1: I
<br /> o Non-{)Wfll!(j Automobiles COMPREH
<br /> 0 COLLlSIO' I
<br />B WORKERS' COMPENSATION 6FR13UB2835C22A07 12/27/2007 WC Statut,; I
<br /> AND EMPLOYERS' LIABILITY 12/27/2008 EL EACH ,h
<br /> EL DISEA:i
<br /> EL DISEA:i
<br />A EXCESS LIABILITY 000319130 06/10/2008 EACH OCt:
<br /> IX] Occurrence o Claims Made 06/10/2009 AGGREG/;
<br />Stand Location: 5953 Gall Boulevard, Zephyrhills, FL 33542
<br />Pasco County Board of County Commissioners and Zephyr Mark Rider
<br />The above listed are Additional Insured respects to General Liability policy as required by written contract.
<br />CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE [I
<br /> THE EXPIRATION DATE THERE(
<br /> MAIL 30 DAYS WRITTEN NOTIC :
<br /> LEFT, BUT FAILURE TO DO SO :;
<br /> ANY KIND UPON THE INSURER,
<br /> Pasco County Board of County Commissioners and
<br /> Zephyr Mark Rider Authorized Representative
<br /> 5953 Gall Boulevard .~
<br /> Zephyrhills, FL 33542 '. -1,--.-..
<br /> USA '. -/ }-<
<br /> 1
<br /> \
<br /> Paqe 1 of 1
<br />
<br />RANCE
<br />
<br />ISSUE DATE
<br />06110/2008
<br />
<br />er of infurmation only and confers no rights
<br />Certificate does not amend, extend or alter the
<br />below.
<br />
<br />IES AFFORDING COVERAGE
<br />
<br />nee Company
<br />
<br />rwriters Assoc. Inc.
<br />
<br />erein for the policy period indicated, Notwithstanding
<br />be issued or may pertain, the insurance afforded by
<br />shown may have been reduced by paid claims.
<br />
<br />LIMITS OF LIABILITY
<br />
<br />URRENCE $
<br />GE $
<br />:XPENSE $
<br />ADVERTISING INJURY $
<br />AGGREGATE $
<br />:; AND COMP. OPER. AGG. $
<br />
<br />
<br />1,000,000
<br />50,000
<br />EXCLUDED
<br />1,000,000
<br />2,000,000
<br />2,000,000
<br />
<br />$
<br />$
<br />$
<br />$
<br />
<br />$
<br />$
<br />$
<br />$
<br />$
<br />
<br />100,000
<br />500,000
<br />100,000
<br />4,000,000
<br />4,000,000
<br />
<br />$
<br />$
<br />$
<br />$
<br />$
<br />
<br />;ubject to policy terms, conditions and exclusions.
<br />
<br />::SCRIBED POLICIES BE CANCELLED BEFORE
<br />F, THE ISSUING INSURER WILL ENDEAVOR TO
<br />TO THE CERTIFICATE HOLDER NAMED TO THE
<br />HALL IMPOSE NO OBLIGATION OR LIABILITY OF
<br />ITS AGENTS OR REPRESENTATIVES.
<br />
<br />,
<br />l /')9. ~
<br />_" r.' ~,~,,/~1 ,/" . 17
<br />...M..Y .'~:J -' .. ..1::"............0,.,5:. ~_."""-..
<br />
<br />Certificate 10 # UIK02621
<br />
|