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r ° OP ID: CJ <br /> ACICP/W _ 1 DATE(MMIOD/YYYY) <br /> �•.r. CERTIFICATE OF LIABILITY INSURANCE 12117/10 <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 le an ADDITIONAL INSURED, the pollcy(les) mist be endorsed. N SUBROGATION 16 WAIVED, subject to <br /> the farms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the <br /> olntillcate holler In lieu of such endoi on1. M(. <br /> PRODUCER 386 - 2624601 CONTACT <br /> Brown & Brown of Florida, Inc. 386239 -5729 rim <br /> ISM; <br /> Daytona Beach Office IT No. EI t1; INC. No): <br /> P.Q. Box 2412 -' .j ] <br /> Daytona Beach, FL 32116 -2412 c 11TOMe m uGALAX-3 _ <br /> NI :UR AAWICROING COVERAGE NAIC r _ <br /> INSURED GALAXY FIREWORKS, INC. A; FL Retail Federation W0006 <br /> RUBY SPELL INSURER a <br /> 204 E. MARTIN LUTHER KING BLVD <br /> TAMPA, FL 33603 INSURER C : - <br /> INSURER D : <br /> INSURER E : •... <br /> INSURER F : <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEb ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION 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 AU. THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UMrrS SHOWN MAY HAVE BEEN REDUCED DY PAID CLAIMS. <br /> TYPE OF INSURANCE <br /> INIIR %DEL EMIR POLICY NUM ( LIMITS <br /> GENERAL UABILITY <br /> EACH OCCURRENCE S <br /> COMMERCIAL GENERAL LIABTY I»A1P IORENTED • <br /> ILI <br /> F!REWSEE IEaaaame„eel S <br /> CLAIMS 0 OCCUR MED EHP Wv,ens person) $ <br /> PERSONAI. B ACV INJURY S <br /> GENERAL AGGREGATE S <br /> GERI AGGREGATE UMIT APPLIES PER: PRODUCTS - COMPIOP AOG S <br /> — 1 POLICY JEppMI�t:T I I LPG S <br /> AUTOMOMILE UASIUTY - COMBINED SINGLE OMIT <br /> _ ANY AUTO <br /> (G eoddand <br /> ALL AWNED AUTOS BODILY INJURY (Par Xmas) S — <br /> DOOILY INJURY (Pit MOMS S <br /> SCNEDULED AUTOS PROPERTY DAMAGE <br /> HIRED AUTOS (Pm scC dint) S <br /> NON-OWNED AUTOS S <br /> S <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE <br /> q(CESSU4B CLAJMB -MADE <br /> AG(3RpOATE S <br /> _ DEDUCIBLE S <br /> ,■u.• 5 S — <br /> WORKERS COMPENSATION _ UU.. <br /> D EMPLOYERS' LMBIUTY X I wit FR <br /> AN <br /> A PIeoPNSToRtPARiNEWEXECU IVE Y/ N 0196- 23706 11118110 11/18/11 EL EACH CH AC,(,'IDENT $ 100,000 <br /> OFFICERSiEAy SR EXCLUOE07 ❑ Ni <br /> IM inntd,staryln EL. DISEASE -EA EMPLOYEE S 100,000 <br /> O ESCRIP OPERATIONS SMiF E.L. DISEASE - POLICY UNIT 5 500.000 <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Rohs" Schedule, If more space is !squired, <br /> CERTIFICATE HOLDER CANCELLATION <br /> CITZE01 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE V$1LL. BE DELIVERED IN <br /> CITY OF ZEPHYRHILLS ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 5335 STH ST <br /> ZEPHYRHILLS, FL 33542 AUTHORIZED REPRESENTATIVE <br /> , I 7"r Ml <br /> ® 1988 -2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD <br />