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FROM :RES
<br />ACORD,M
<br />PRODUCER ~' __. .. .
<br />MCGRIFF, 5EIBELS A WII_l..lAMS, INr.,
<br />P.U. E3ox 10285
<br />Birrninyhr+m, AL 35202
<br />800.476 2211
<br />FAX N0. :9528732859 May. 04 2089 04:32PM P2
<br />~CEC I ~~~C +~~ ~F ~NSUIwIM4G ISSUE DATC
<br />/~ n51041nx10
<br />This certificate ie issued as H matter of Information only and confers no rigg. hts
<br />u on the [,ertlflcelo Idoldor. This Certificate does not amend, extend pr rrltur tho
<br />coverage afforded by the policies helnw.
<br />COMPANIES AFFORDING COVERAGE
<br />INSUREp
<br />R F.. S Sperislty Pyrotechnics
<br />21505 286th Street
<br />t3e116 Plrairti~, MN 5801 i
<br />Cn Army dames River Insuraance Cornpdny
<br />Compnpany Rerilend Insurance Company
<br />Company
<br />r..
<br />Company
<br />U
<br />Company
<br />E
<br />'this is to certily that the policies of insuranW dosuibud horoln havo boon issuod to Iho InsuroCl named herein for the pollcy period Indicated. Notwithstanding
<br />any regUll'enl0nt, term or condition of rontract or other d~,cument with respera to Whlrh this rertificale may be issued or may pertain, the insurance allorded try
<br />the policies described herein is subject to all the term R, c;onditionrr rind exr:b;Aionti of such pirlic;ies. Limits shown may have been reciucbd by paid claims.
<br />1~0
<br />LT, TYPE OF INSURANCE POLICY NUMBER EFFECTIVE
<br />EXPIRATION LIMITS OF LIABILITY
<br />_
<br />A " 'GENERAL LIABILITY
<br />Curumarcid Gmin,el LlaGlllly 000376880 05/01/2009
<br />05/01!2010 EACH UCCUFikF.NCF
<br />FIRE DAMAGE
<br />__ _..... $ 1,000,OOQ
<br />:h 100,000
<br />... .
<br /> rj Clnims Madn ~ (k:ruxrnnrr,
<br />'
<br />;
<br />'
<br />l MEDICAL EXPENSE
<br />_ ........... $ EXCLUDED
<br />. .
<br /> wprr~
<br />nntrr~rtnrs
<br />FmtnrtlPP
<br />and i
<br />hi f
<br />ooa
<br />ooo
<br />~rarrrularaAuu.cansy PERS.ANPADVERTISINGIN.IURY $ 1,000,000
<br />
<br />.. ,
<br />,
<br />^
<br />c+nnornr AppNgnta I u,wr ~rnius oar GENER/1L AGGREGATE
<br />NkUDUCT5 AND COMt;. OPER. AGG. $ S,000,UUU
<br />$ 2,000,000
<br />..
<br />,,_.__-
<br />.-
<br /> Pnllry ^ PmJnnt I,LpCngnp ~ ._
<br />.
<br />__
<br />Ei AUTOMOBILE LIABILITY RICCA00037..1fi Uf~li;}112UOt~) COMBINED SINGLE LIMIT $ 1,000,000
<br />~ ~~~~~
<br /> ®AnyiuiMmnrrlle 05/01/2010 -
<br />BODILY IN IURY
<br />(Per person)
<br />. -~~~-~~~ ~~~• ~
<br />~ ..
<br />.
<br />..
<br /> ^ al ownaa AuWmuhliae .
<br />, ............
<br />(Per ecr..icl.9nt)
<br />B01?II
<br />(Y~I~RY
<br />Y
<br />~ _.
<br />_
<br />__
<br />$
<br /> ^ Sul,udukdAutauuLllae
<br />lM~tlirudAutamo6%os ,
<br />,,,__._._.__
<br />..
<br />,.
<br />•
<br />ROPE 'rYDAMAGE F•rprar.Gident $
<br /> ® Nunuwrxd AulumuLilec COMPREHEN
<br />SIV
<br />E :li'I UUU duiluctlblo
<br /> ^ _
<br />_
<br />COLLISION $1000 deductible
<br /> WORKERS' COMPENSATION WC Stanlto Limit Othor
<br />
<br />AND EMPLOYERS' LIABILITY
<br />EL EACH ACCIDENT _
<br />$
<br />®UnnurrnnM ^C4rom^Mntlo
<br />EL DISEASE Palicv Limit~__ ............. '1!
<br />05!0112009 FAGH OCCURRENCE :~ 4,000,000
<br />05/0112010 AGGRCGATC $ 4,000,7 nOQ
<br />W
<br />.... _._.
<br />a ___....__..
<br />The.abova listed arp Additional Insured respects to Gonmal Llablllty pollcy as roqulrod by written contract subject to policy terms, conditions and exclusions.
<br />The Eeriificate Holder is named as Additional Insr.,red wilh reeper.,t t~ General I.iahiliiy qR required by written oonlrart subject to pollcy terms, conditions, and
<br />CERTIFICATE HOLDER
<br />`_ Jalnas & Sonya Carlson
<br />1649 Round Hill Drivo
<br />'l=argo, ND 58104
<br />SHOULD ANY OK' THE A60VE bl=SCRff~ED POLICIGS DE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL CNDEAVUrtTU
<br />MAIL 30 DAYS WRITTEN NOTICE TO THE. C]F..RTIFICATE HOLDER NAML•U 1'U'111C
<br />LEFT, sUT FAILURE 70 DO SO SWALL IMPOSE NO OBLIGATION OR LIABILITY OF
<br />ANY KINl7 UPON THE INSURER, ITS AGENTS OR REPR[SGNTATIVES.
<br />Authorized Representative
<br />~ ..
<br />I~,.,
<br />rocs
<br />- -- .
<br />CnrNnrmn in A HIGFGWOC]
<br />
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