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11L oz �-Z
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(mMIDDn )
<br />05/09/2013
<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 is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER Allied Specialty Insurance, Inc.
<br />CONTACT
<br />NAME
<br />10451 Gulf Boulevard
<br />Treasure Island, FL 33706 -4814
<br />L. Exit FAX No:
<br />A DRIESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />1. 800 - 237 -3355
<br />INSURER A: T.H.E. Insurance Company
<br />12866
<br />DAMAGE TO
<br />PREMISES( . occurrnenca
<br />INSURED
<br />Pyro Engineering, Inc.
<br />dba: Bay Fireworks N-aG)a -G %
<br />INSURER a:
<br />$
<br />NSURERC:
<br />51,000,000
<br />999 South Oyster Bay Rd., Suite 111
<br />Bethpage, NY 11714
<br />INSURER O:
<br />NSURER 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 NAMED 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 ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />IITR
<br />TYPE OF INSURANCE ADOL
<br />MD
<br />POLICY NUMBER
<br />POLICY D/YYYY
<br />POLICY M'YV
<br />LIMITS
<br />A
<br />BENERALLIABILITY
<br />MESCAL GENERAL LIABILITY
<br />CLAIMS-MADE OCCUR
<br />CPP0101284.03
<br />05/14/2013
<br />05/14/2014
<br />EACH OCCURRENCE
<br />$1,000,000
<br />DAMAGE TO
<br />PREMISES( . occurrnenca
<br />$100,000
<br />MED EXP(Any one person)
<br />$
<br />PERSONAL &ADV INJURY
<br />51,000,000
<br />GENERAL AGGREGATE
<br />S 2 000 000
<br />GENLAGGREGATELIMIT
<br />APPLIES PER
<br />PRODUCTS - COMP /OP AGG
<br />$2,000,000
<br />POLICY
<br />PRO LOG
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />CPP0101284.03
<br />05/14/2013
<br />05/14/2014
<br />COMBINED BINaccident D SINGLE LIMIT
<br />1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />ALL
<br />AUTOS NED /( SCHEDULED
<br />BODILY INJURY (Per accident)
<br />$
<br />u
<br />NON -OWNED
<br />HIRED AUTOS a AUTOS
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />ELP0010292 -03 (GL & VL)
<br />05114/2013
<br />05/14/2014
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />)C
<br />AGGREGATE
<br />$4,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DIED RETENTION$
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY YIN
<br />ANY PROPRIETOR /PARTNER/EXECUTIVE
<br />WC134166
<br />05/14/2013
<br />05114/2014
<br />X VJC STATU- ETN-
<br />ER
<br />E L EACHACCIDENT
<br />$1,000,000
<br />OFFICER /MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />E. L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />If Yes, describe under
<br />DESCRIPTI ON OF OPERATIONS below
<br />E. L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />A
<br />EXCESS LIABILITY/ OCCUR
<br />ELP0010296 -03 (GL)
<br />05/14/2013
<br />05/14/2014
<br />EACH OCCURRENCE $5,000,000
<br />AGGREGATE $5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is req ulred)
<br />Display Date: 6130113 Rain Date: NIA Location: Centennial Regional Park, Santa Ana, CA.
<br />RE: General Liability, the following are named as Additional Insured in respects to the operation of the Named Insured only: The City of Santa Ana, it's
<br />officers, employees, agents & volunteers; Orange County Fire Authority, their officers, agents, employees and servants.
<br />With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this
<br />policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City f Santa Ana
<br />y
<br />Thirty (30) Days Notice of Cancellation Applies
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />26 Civic Center Plaza
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE, DELIv1SRP IN
<br />Santa Ana, CA 92701
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />CERT #2131 (Revised 519/13)
<br />ACTH ZED R P.RESE ATIVE
<br />©1988.2010 ACORQ,ffl?R9,:CION. A0, rilf tb rpMffft
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD X133.. gg�r,,((;;,,CCJJ VV YY 1lli .AA 4+
<br />LISA EµSTORCK ^ (/-,
<br />
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