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�`C°� CERTIFICATE OF LIABILITY INSURANCE DATE�MM/DD/YYYY) 4/2/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THF CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE �4FFORDED BY THE POLICIES 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 endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Britton-Gallagher and Associates, IIIC. PHONE FAx 6240 SOM Center Rd ac No eXt:44 -24 -4711 nic No�:44.Q-24�- 406 E-MAIL Cleveland OH 44139 ADDRESS. INSURER(S)AFFORDING COVERAGE NAIC# __ _____,_ _____ _ wsuReR,a:Lexington Insurance�2___— _ ! __ INSURED wsuaeRe.Axis Surplus Ins Com�an� _____ Galaxy Fireworks Inc. �NSUReRC:New Hampshire Insurance Cg. 3841 204 E. Martin Luther King Blvd INSURERD Tampa FL 33603 — - -- - I WSURER E. INSURER F. COVERAGES CERTIFICATE NUMBER:506061824 REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED,480VE 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 7ypE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LTR INSR WVD POLICYNU BER MM/DDlYYYY MMIDDIYYYY LIMITS A GENERALLIABILI7v 64200908-02 ` /10/2012 /10/2013 Z EACHOCCURRENCE , $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED � � �� PREMISES E=a occurrence 550,000 I CLAIMS-MADE � OCCUR � MED EXP(Any one person) $ -- -- i PERSONAL F.ADV INJURY I $1,000,000 � GENERAL AGGREGATE ' $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER� PRODUCTS COMP/0P AGG $2,000,000 � POLICY PR� X LOC 5 C AUTOMOBILE LIABILITY CA0661444302 /10/2012 /10/2013 `' Eaaccident 51,000,000 ' X ANY AUTO BODILY INJURY(Per person) S I ' ALL OWNED SCHEDULED BODILY INJURY Per accident $ 'i AUTOS AUTOS ( � I X HIREDAUTOS X NON-OWNED PROPERTYDAMAGE $ , AUTOS I Peracadent� 5 B UMBRELLA LIAB X OCCUR EAU753159 6/10/2012 0/10/2013 EACH OCCURRENCE $4,000,000 I X EXCESS LIAB CLAIMS-MADE � � i AGGREGATE: � $4,000,000 -�__ i DED RETENTION$ g WORKERS COMPENSATION WC STATU- ' OTH- 'i AND EMPLOYERS'LIABILITY Y I N T RY LIMITS ER ANY PROPRIETORlPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED� ❑ N!A E L EACH ACCIDENT $ ,(Mandatory in NH) E.L DISEASE:-EA EMPLOYEE 5 � If yes,describe under �, , DESCRIPTION OF OPERATIONS below � E.L DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Stand Location. 5943-5953 Gall Blvd Zephyrhills, FI 3542. Additional Insured: City of Zephyrhills, Pasco County Board of County Commissioners, Mark Ayer, and all their agents, representatives and 'I subsidiaries. CERTIFICATE HOLDER CANCELLATION ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Zephyrhills, Pasco County Board of County ACCORDANCE WITH THE POLICY PROVISIONS. Commissioners. Mark Ayer 7162 Reading Rd. Suite 730 AUTHORIZED REPRESENTATIVE Cincinnati OH 45237 �es�*�R�' O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010l05) The ACORD name and logo are registered marks of ACORD - -- -