11-11927 - Laserfiche WebLink

Browse Search

�� "�'r �-, �„ . � � ��, -�'""1 � ' � � �� j��y�-� '`'�� `•� CERTIFICATE OF LIABILITY INSURANCE OATE(MM/DDMlYY) 3I�1/aoil THIS CERTIFICATE IS ISSUED AS A MATTEft OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CER'fIFICATE' DOES NOT AFFIRMATIVELY UR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICtES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsemenL A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NTA Britton-Gallagher and Associates, Inc NAME: PHONE 6240 SOM Center P,3. A/C No exc:4�9=�4.$=4Z17. �n rvol�4qp_24g_5q_ Cleveland OH 441? 9 E-MAIL ADORESS: PRODUCER CUSTOMER ID #: IN5URER�S) AFFORDING COVERAGE NAIC # INSURED Galaxy Fireworks Inc. iNSURERA:Lexin ton Insurance Co 204 E. Martin Lut,her King Blvd INSURERB:j�1S Su lus Ins Com an Tampa FL 33603 INSURERC:NEW Ham shire Insurance Co. 23841 INSURER D . I INSURER E . INSURER F : COVERAGES CERTIFICATE NUMBER:457682688 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A80VE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - - ---- INSR A L --- ------ �-- -- LTR NPE OF INSURANCE PO IL CY EFF POLICY EXP � --- INSR WVD POLICY NUMBER MMIDD/YYYY MMlDD/YYYY LIMITS � GENERALLIABILITY 64200908-01 �5/10/2011 6/10/2012 EACH OCCURRENCE ,g1,Q00,000 X COMMERCiAL GENE RAL UABILITY A I�A�'� �R�N�E� 50 , 000 CLAIMS-MADE � X� PREMISES�a occurrence) ', S _ i _ _ OCCUR MED EXP (Any one perso�n) ' S �. --- - - -- PER SONALBADVINJURY � 51 -- - GENE �52,000,000 GEN'LAGGREGATELIMIIAPPLIESPER: � PRODUCTS-COMP/OPAGG SZ,Q00,000 POLICY PR � � x LOC ( S C AUTOMOBILELIABILITY CA66144431 6/10/2011 6/10/2012 COMBINEDSINGLELIMIT X ANYAUTO (Eaaxident) � �i3O00,000 BODILY INJURY (Per person) � S ALL 0`NNED AUTOS i BODILY INJURY (Per acddent; � 5 SCHEDUIED AU705 � PROPERTY DAMAGE X HIREDAUTOS i I ; S (Peracadent) X NON-OWNEOAUTO: : S S B UMBRELLtI LIAB X � pC�UR � EAU753159 �6/10/2011 6/10/2012 EACH OCCURRENCE �54,000, X EXCESS LIAB � CLAIMS-MADE � --- - --- � � AGGREGATE j$ 4,OOC,000 _ __ DEDUCTIBLE } I S RETENTION 5 i S WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS' LIABILiTY Y � N � T�RY LIMITS I_1_ER �_____ _ ANY PROPRIETOR/PARTNFRlEXECUTNE I � E.L. EACH ACCIDENT � 5 OFFICERlMEMBER EXCLUDEO? ❑ N I A i � __ (Mandatory in NH) E.L. DISEASE - EA EMPLOYG� S If yes, desaibe under I ----- DESCRIPTION OF OPERATIONS below i I E.L DISEASE - POLICY LIMIT � S DESCRIPTION OF OPERATIONS / LOCATIpNS! VEHICLES �Attach ACORD �Ot, Additio�al Remarks Schedule, if more space is requircd) Stand Location: 5943-5953 Gall Blvd. Zephyrhills, FL 3542 Additional Insured: City of Zephyrhills, Pasco County Board of County Commisionsers, Mark Ayer, and all their agents, representatives and susidiaries. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRtBED POLICIES BE CANCELLED BEFORE THE EXPIRATiON DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of 'Lephyrhills, Pasco County Board of County Commissioners MdT�C Ay22' AUTHORIZED REPRESENTATIVE 7162 Reading Rd. Suite 730 Cincinnat.i OH 45?_37 �� I O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD