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<br />CERTIFICATE OF INSURANCE <br /> <br />This certificate of insurance is NOT an insurance policy and does not amend. extend or aner the coverage afforded by the <br />policy listed herein. The terms. conditions and exclusions of the polley govern the rights and obligations of the Company to the <br />named insured and any other insureds and may substantially limit coverage. Provisions of any other contract. including <br />agreements betWeen the insured and anyone else. cannot and do not amend, extend. or aller any terms. conditions or <br />exclusions in the policy. Additional Insured and other endorsements may be authorized only by the Company or its appointed <br />General Agent. Where reference is made to an Aggregate limit. such limit is the Company's maximum liability under the <br />Policy for the entire policy period regardless of the number of insureds. claimants or occurrences. <br /> <br />Date 0511912009 <br /> <br />. <br /> <br />NAMED INSURED Hollvwood Pvrotechnics. Inc. <br />NAMED INSURED'S ADDRESS 1567 AnUer Point <br /> <br />Eeoan. MN 55122 <br /> <br />INSURANCE COMPANY NAME: <br />INSURANCE COMPANY ADDRESS: <br /> <br />POLICY <br />NUMBER <br /> <br />National.Fire & Marine Insurance Company <br />3024 Harney Street. Omahe, Nebraska. 68131-3580 <br /> <br />TYPE OF INSURANCE <br /> <br />LIMITS <br /> <br />INCEPTION DATE <br />EXPIRATION DATE <br /> <br />72LPS010835 <br /> <br />COMMERCIAL GENERAL LIABILITY - Occurrence Form <br /> <br />05/1512009 <br />05/15/2010 <br /> <br />IliI Premises-Operations <br />181 ProductslCompleted Operations <br />o Other (Specify) <br /> <br />Each Occurrence Limit <br />Damage to Premises Rented <br />Medical Expense Limit (Any One Person) <br />Personal & Advertising Injury Limit <br />General Aggregate Limit <br />Products-Completed Operations Aggregate Limit <br /> <br />$ 2.000.000. <br />$ 100,000. <br />$ 5.000. <br />$ 2.000,000. <br />$ 2.000.000. <br />$ 2,000.000. <br /> <br />POLICY INCLUDES COMPANY-SPECIFIC NON-STANDARD <br />ENDORSEMENTS WHICH MAY BE RESTRICTIVE OR <br />EXCLUSIONARY IN NATURE. <br /> <br />This Certificate is nol evidence of addiliona' insurad status for the certificate holder nor Is it descriptive of ooverage for any additional insured. The Certificateholder has <br />been nemed as an additional Insured under the terms of a M-5350 (10/2008) endorsement to the policy. For a description of the ooverage. please refer to the policy. <br />FJreworl<s Display Show Date: 08107/2009 (Rain Date: 08/0812009) <br />Fireworks Display Show location: Laurie Lamotte Park, Centerville, MN <br />Fete des Lacs, CentervlUe Festival Committee, City of Centerville, MN and The Lions (Sponsof"$) are added as additional insureds per the attached endorsement. <br /> <br />In the event of any material change in or canceUation of said policy, the Company's appointed General Agent may, but is not <br />obligated 10, notify the party 10 l>t1om this Certificate is issued of such change or cancellation. The COMPANY undertakes no <br />responsibility by reason of any failure to provide such notification. <br /> <br />This Certificate IIIllUed to: <br /> <br />ThiS~bY: ~ <br />By ?no ~'i::I <br /> <br />Northern States Aaencv Inc. (ComDanv General Aaent) <br />Retail Producing Agent: <br />Ryder, Rosacker, McCue & Huston <br />509 W Koenig Street <br />P.O. Box 1228 <br />Grand Island, NE 88802 <br /> <br />Fete des Lacs. Centerville Festival Committee <br />7155 Brian Drive <br />Centerville. MN 55038 <br /> <br />M-5238a (0212007) <br /> <br />34 <br />