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ADDITIONAL INFORMATION ISSUE DATE <br /> 12/01/2009 <br /> PRODUCER CERTIFICATE HOLDER <br /> MCGRIFF, SEIBELS & WILLIAMS, INC. Pasco Board of County Commissioners and Zephyr Mark Rider <br /> P.O. Box 10265 5953 Gall Boulevard <br /> Birmingham, AL 35202 Zephyrhills, FL 33542 <br /> 800 - 476-2211 <br /> INSURED <br /> Galaxy Fireworks, Inc. <br /> 204 East Martin Luther King Drive <br /> Tampa, FL 33603 <br /> (continued from previous page) <br /> Stand Location: 5953 Gall Boulevard, Zephyrhills, FL 33542 <br /> Pasco 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 /> subject to policy terms, conditions and exclusions. <br /> Page 2 of 2 <br /> Certificate ID* 98QMK1 Y9 <br />