UPDATED-CERTIFICATE OF LIABILITY INSURANCE_REDACTED.PDF

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CERTIFICATE OF LIABILITY INSURANCE

DATE (MMIDDIYYYY)
05/05/2022

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 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 have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on

PRODUCER

Ryder, Rosacker, McCue & Huston
509 W. Koenig St.

this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

Grand Island NE 68801 INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A; Travelers Assigned Risk
INSURED INSURER B:
Randy Reyman dba INSURER C :
Reyman Pyrotechniques/Any Pyro INSURER D :
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE 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 ADDL|SUBR| POLICY EFF | POLICY EXP
LTR TYPE OF INSURANCE INSD| WyD POLICY NUMBER. {MM/DDIYYYY) | (MM/DD/VYYY) LIMITS:
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
[J DAMAGE TO RENTED
CLAIMS-MADE occur PREMISES (Ea occurrence) | $
MED EXP (Any one person) _| $
PERSONAL &ADVINJURY__| $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY FBS: Loc PRODUCTS - COMP/OP AGG | $
OTHER: s
COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY COMBINED § $
ANY AUTO BODILY INJURY (Per person) | $
OWNED, SCHEDULED 1
SNE MLY SCHED BODILY INJURY (Per accident) | $
HIRED NON-OWNED PROPERTY DAMAGE $
|__| AUTOS ONLY AUTOS ONLY (Per accident)
$
UMBRELLA LIAB occur EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
vep | [retentions $
WORKERS COMPENSATION PER ‘OTH
AND EMPLOYERS! LIABILITY YIN x [SSune |_[ER 7000000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
A |OFFICER/MEMBER EXCLUDED? NIA 6JUB-5R86638-5-22 06/01/2022 |06/01/2023 rr
(Mandatory in NH) E.L. DISEASE - EA EmpLoyee| s 1,000,000
Ifyes, describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L. DISEASE - Pouicy Limit | s 1,000,

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

CERTIFICATE HOLDER

CANCELLATION

Anthem Community Council
3701 W Anthem Way Ste #201

Anthem, AZ 85086

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE : - <KW>
Wolf ef.
Pye

ACORD 25 (2016/03)

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