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1 J <br /> Certificate of Insurance <br /> 104784 Issue Date: 8/26/2011 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF <br /> Deborah Merlino INFORMATION ONLY AND CONFERS NO RIGHTS UPON <br /> THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT <br /> Combined Specialties International, Inc. AMEND,EXTEND OR LATER THE COVERAGE AFFORDED <br /> 205 San Marin Drive, Suite 5 BY THE POLICIES BELOW. <br /> Novato, California 94945 <br /> INSURERS AFFORDING COVERAGE <br /> INSURED <br /> Wolverine Fireworks Display, Inc. INSURER A: Underwriters, Lloyd's London <br /> 205 W. Seidlers Road INSURER B: <br /> Kawkawlin, MI 48631 <br /> INSURER C: <br /> INSURER D: <br /> COVERAGES <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE NAMED INSURED ABOVE FOR THE PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF <br /> ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERIN IS SUBJECT TO ALL THE TERMS, <br /> - EXCLUSIONS AND CONDITIONS OF SUCH POLICIES INCLUDING,BUT NOT LIMITED TO THOSE FOLLOWING:UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,ADDITIONAL CONDITIONS AND EXCLUSIONS:1)THE <br /> INSURANCE EVIDENCED BY THIS CERTIFICATE IS LIABILITY INSURANCE ONLY,IT IS NOT A BOND OR ANY FORM OF SURETY AGAINST WHICH SOMEONE OTHER THAN INSURED'MAY ASSERT A CLAIM OR BRING ANY ACTION. <br /> SUBJECT TO POLICY TERMS,CONDITIONS,DEFINMONS AND EXCLUSIONS THE INSURANCE ONLY INDEMNIFIES AN INSURED AGAINST CERTAIN LEGAL UABIUTY.2)THE INSURANCE DOES NOT COVER CLAIMS FOR BODILY <br /> INJURY OR PROPERTY DAMAGE OF THE NAMED INSURED'S SHOOTER(S)ASSISTANT(S)OR ANY OTHER PERSON(S)INCLUDING ANY VOLUNTEER(S)PARTICIPATING IN ANY WAY IN ANY DISPLAY OR SPECIAL EFFECT <br /> PERFORMED OR EXECUTED BY THE NAMED INSURED.3)COVERAGE DOES NOT APPLY TO CLAIMS FOR BODILY INJURY OR PROPERTY DAMAGE ARISING OUT OF THE INSURED'S FAILURE TO FOLLOW NFPA OR OTHER <br /> APPLICABLE REQUIREMENTS,LAWS OR RECOMMENDATIONS,INCLUDING THOSE RELATING TO POST DISPLAY OR SPECIAL EFFECT SEARCHES OR CLEAN UP. <br /> CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br /> LTR DATE(DD/MM/YY) DATE(DD/MM/YY) <br /> A GENERAL LIABILITY CSI-897952-11 2/1/2011 2/1/2012 EACH ACCIDENT $5,000,000 <br /> CLAIMS MADE <br /> MEDICAL EXP(any one person) $5,000 <br /> FIRE LEGAL LIABILITY $50,000 <br /> GENERAL AGGREGATE $5,000,000 <br /> PRODUCTS-COMP/OPS AGG $1,000,000 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> ANY AUTO (Each accident) <br /> ANY OWNED AUTO <br /> SCHEDULED AUTOS BODILY INJURY(Per Person) <br /> HIRED AUTOS BODILY INJURY Accident) <br /> NON-OWNED AUTOS (Per <br /> PROPERTY DAMAGE <br /> (Per person) <br /> EXCESS LIABILITY EACH ACCIDENT <br /> FOLLOWING FORM <br /> AGGREGATE <br /> WORKERS COMPENSATION WC STATUTORY OTHER LIMITS <br /> AND <br /> EMPLOYERS'LIABILITY E.L.EACH ACCIDENT <br /> E.L.DISEASE-EA EMPOYER <br /> E.L.DISEASE-POLICY LIMIT <br /> OTHER <br /> DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> City of Everett, agents, employees &officers, ATIMA; Henry M Jackson High School and Everett School District#2 are <br /> Additional Insured as respects the September 30, 2011 Fireworks Display at Memorial Stadium, Everett, WA <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE <br /> ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO <br /> THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON <br /> City of Everett THE COMPANY,IT'S AGENTS OR REPRESENTATIVES <br /> 2930 Wetmore <br /> Everett, WA 98201 n <br /> �, -A. /91bd <br /> AUTHORIZED REPRESENTATIVE <br /> 98 <br />