%PDF-1.4
%
4 0 obj
<>
endobj
xref
4 26
0000000016 00000 n
0000000997 00000 n
0000001057 00000 n
0000001349 00000 n
0000001863 00000 n
0000002230 00000 n
0000002660 00000 n
0000002695 00000 n
0000009128 00000 n
0000009259 00000 n
0000011907 00000 n
0000012020 00000 n
0000012089 00000 n
0000012173 00000 n
0000018274 00000 n
0000018540 00000 n
0000018794 00000 n
0000018819 00000 n
0000019199 00000 n
0000029433 00000 n
0000029686 00000 n
0000039797 00000 n
0000040050 00000 n
0000058847 00000 n
0000059098 00000 n
0000000816 00000 n
trailer
<<98F215E9EF8A45759C32668B3F53A1DF>]/Prev 83375>>
startxref
0
%%EOF
29 0 obj
<>stream
hb``g``a```46d@@A IT$ؗpm`tsb0gf9KdC
<,V7et1Yć a
endstream
endobj
5 0 obj
<>
endobj
6 0 obj
<>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/Type/Page>>
endobj
7 0 obj
<>
endobj
8 0 obj
<>
endobj
9 0 obj
<>
endobj
10 0 obj
[/ICCBased 13 0 R]
endobj
11 0 obj
<>stream
/CS0 cs 1 1 1 scn
/GS0 gs
0 0 612 792 re
f
BT
0 0 0 scn
/TT0 1 Tf
18 0 0 18 36 726 Tm
(Signature Live! )Tj
0.475 0.503 0.514 scn
16 0 0 16 161.0771 726 Tm
[(Pyrotechnic Supplemental )54.9(Application Form)]TJ
0 0 0 scn
/TT1 1 Tf
10 0 0 10 36 489 Tm
(2)Tj
/TT2 1 Tf
(. Please share the qualifications and experience of the company performi\
ng the show: )Tj
/TT1 1 Tf
0 -7 TD
(3)Tj
/TT2 1 Tf
(. Please describe the show site and precautions being taken:)Tj
/TT1 1 Tf
27.462 0 Td
( )Tj
-27.462 -6.8 Td
(4)Tj
/TT2 1 Tf
[(. Will the Pyrotechnics Company provide a Certificate of Insurance \(COI\
\) for this Event? )249.8( )-3322(Y)91.8(es )-1690.7(No )]TJ
/TT1 1 Tf
0 -2.7 TD
(5)Tj
/TT2 1 Tf
[(. Will the local Fire Department be present during the Event? )-1174.8( )-3322(Y)91.8(es )-1690.7(No )]TJ
/TT1 1 Tf
0 -2.8 TD
(6)Tj
/TT2 1 Tf
(. What will be the duration of the Pyrotechnics Show: )Tj
/TT1 1 Tf
0 -2.7 TD
(7)Tj
/TT2 1 Tf
[(. Will all required permits be in place? )-547.7( )-2766.3(Y)91.8(es )-1690.7(No)]TJ
/TT1 1 Tf
26.478 0 Td
( )Tj
ET
q
33.5 22.7 545 17 re
W n
BT
0.475 0.503 0.514 scn
/TT0 1 Tf
10 0 0 10 36 27 Tm
(\251 2018 Signature Risk Partners Inc.)Tj
40.214 0 Td
( Page 1 of 1)Tj
ET
Q
q
37.5 660.2 538 27.8 re
W n
BT
/TT0 1 Tf
10 0 0 10 40 677 Tm
(Name of Insured:)Tj
ET
Q
q
37.5 631.4 268.5 27.8 re
W n
BT
/TT0 1 Tf
10 0 0 10 40 648 Tm
(Pyrotechnic Company:)Tj
ET
Q
BT
/C2_0 1 Tf
10 0 0 10 309 641 Tm
<000D001E0025001A002A00230025001F0026000100120024001A002500170027002300250001000A001A00250027001E002D001A00190008>Tj
/TT0 1 Tf
12 0 0 12 437.3691 641 Tm
( )Tj
10 0 0 10 460.707 641 Tm
[(Y)91.8(es No)]TJ
ET
q
37.5 602.6 268.5 27.8 re
W n
BT
10 0 0 10 40 620 Tm
(Date of Event:)Tj
ET
Q
q
307 602.6 268.5 27.8 re
W n
BT
10 0 0 10 309 620 Tm
(Location of Event:)Tj
ET
Q
q
35 600.5 543 90 re
W n
/CS0 CS 0 0 0 SCN
4 M
q 1 0 0 1 306.5 660.2 cm
0 0 m
0 -58.6 l
S
Q
q 1 0 0 1 36.5 659.7 cm
0 0 m
540 0 l
S
Q
q 1 0 0 1 36.5 630.9 cm
0 0 m
540 0 l
S
Q
q 1 0 0 1 37 689 cm
0 0 m
0 -87.4 l
S
Q
q 1 0 0 1 576 689 cm
0 0 m
0 -87.4 l
S
Q
q 1 0 0 1 36.5 688.5 cm
0 0 m
540 0 l
S
Q
q 1 0 0 1 36.5 602.1 cm
0 0 m
540 0 l
S
Q
Q
0.754 0.754 0.754 scn
36.125 590 540 -18 re
f
/CS0 CS 0 0 0 SCN
0.75 w 4 M
q 1 0 0 1 36.125 590 cm
0 0 m
540 0 l
540 -18 l
0 -18 l
h
S
Q
q
34.125 571 544 20 re
W n
BT
0 0 0 scn
12 0 0 12 44 577 Tm
(Event Information)Tj
ET
Q
36 715 540 -18 re
f
q 1 0 0 1 36 715 cm
0 0 m
540 0 l
540 -18 l
0 -18 l
h
S
Q
q
34 696 544 20 re
W n
BT
0 0 0 scn
12 0 0 12 44 702 Tm
(General Information)Tj
ET
Q
36.72 235.667 540 -18 re
f
q 1 0 0 1 36.72 235.6667 cm
0 0 m
540 0 l
540 -18 l
0 -18 l
h
S
Q
q
34.72 216.667 544 20 re
W n
BT
0 0 0 scn
12 0 0 12 45 222 Tm
(Declarations)Tj
ET
Q
BT
0 0 0 scn
/TT1 1 Tf
10 0 0 10 37 198 Tm
[(I/W)18.2(e declare that:)]TJ
/TT2 1 Tf
( )Tj
1.8 -1.7 Td
[( 1. )-132.4(The information in this application is true and correct and I/we have no\
t withheld any relevant information. )]TJ
0 -1.3 TD
[( 2. )-132.4(I/W)18.2(e understand that any statement made in this application will be treated\
as a statement made by all of the )]TJ
0 -1.4 TD
[( )-410.7(people to be insured. )]TJ
T*
[( 3. )-132.4(All Submitted )55.3(Application Forms become part of the Insurance Policy and is the basis o\
f Coverage provided. )]TJ
ET
q
33.927 104.994 545.586 104.465 re
W n
BT
10 0 0 10 55 127 Tm
[( 4. )-132.4(If any of the questions have been answered fraudulently or with the inte\
nt to conceal or misrepresent any material )]TJ
ET
Q
BT
10 0 0 10 55 113 Tm
[( )-1522(fact or circumstance concerning this )55.3(Application for insurance, the entire Policy shall be void. )]TJ
ET
0.754 0.754 0.754 scn
36.72 95.667 540 -40 re
f
q 1 0 0 1 36.72 95.6667 cm
0 0 m
540 0 l
540 -40 l
0 -40 l
h
S
Q
BT
0 0 0 scn
/TT0 1 Tf
10 0 0 10 38 72 Tm
[( Signature of )54.9(Applicant:)]TJ
36 0 Td
( Date:)Tj
ET
q
144.72 63.722 266.2 2.764 re
W n
q 1 0 0 1 145.72 65.111 cm
0 0 m
264.2 -0.014 l
S
Q
Q
q
453.72 63.722 119 2.764 re
W n
q 1 0 0 1 454.72 65.111 cm
0 0 m
117 -0.014 l
S
Q
Q
BT
/TT1 1 Tf
10 0 0 10 36 554 Tm
(1)Tj
/TT2 1 Tf
(. Please describe the planned Pyrotechnics show: )Tj
ET
q
453.7 349.3 10.2 10.2 re
W n
1 w
q 1 0 0 1 455.2 358 cm
0 0 m
7.2 0 l
7.2 -7.2 l
0 -7.2 l
h
S
Q
Q
q
487.7 349.3 10.2 10.2 re
W n
1 w
q 1 0 0 1 489.2 358 cm
0 0 m
7.2 0 l
7.2 -7.2 l
0 -7.2 l
h
S
Q
Q
q
260.36 553.708 m
260.36 550.948 l
577 550.969 l
577 553.729 l
h
W n
q 1 0 0 1 261.36 552.3333 cm
0 0 m
314.64 0.011 l
S
Q
Q
q
35.72 532.015 m
35.72 529.255 l
577 529.265 l
577 532.025 l
h
W n
q 1 0 0 1 36.72 530.64 cm
0 0 m
539.28 0 l
S
Q
Q
q
421.299 487.207 m
421.303 484.448 l
577.002 484.627 l
576.998 487.386 l
h
W n
q 1 0 0 1 422.301 485.8333 cm
0 0 m
153.699 0.167 l
S
Q
Q
q
346.9 321.39 10.2 10.2 re
W n
1 w
q 1 0 0 1 348.4 330.09 cm
0 0 m
7.2 0 l
7.2 -7.2 l
0 -7.2 l
h
S
Q
Q
q
380.9 321.39 10.2 10.2 re
W n
1 w
q 1 0 0 1 382.4 330.09 cm
0 0 m
7.2 0 l
7.2 -7.2 l
0 -7.2 l
h
S
Q
Q
q
416 743 162 27 re
W n
q
/Perceptual ri
161.9360156 0 0 27.0165229 416.0542248 743.0273905 cm
/Im0 Do
Q
Q
q
278.346 295.755 m
278.352 292.995 l
396.572 293.254 l
396.566 296.014 l
h
W n
q 1 0 0 1 279.3489 294.3825 cm
0 0 m
116.22 0.244 l
S
Q
Q
q
238.26 267.39 10.2 10.2 re
W n
1 w
q 1 0 0 1 239.76 276.09 cm
0 0 m
7.2 0 l
7.2 -7.2 l
0 -7.2 l
h
S
Q
Q
q
272.26 267.39 10.2 10.2 re
W n
1 w
q 1 0 0 1 273.76 276.09 cm
0 0 m
7.2 0 l
7.2 -7.2 l
0 -7.2 l
h
S
Q
Q
q
35.72 510.415 m
35.72 507.655 l
577 507.665 l
577 510.425 l
h
W n
q 1 0 0 1 36.72 509.04 cm
0 0 m
539.28 0 l
S
Q
Q
q
35.72 465.775 m
35.72 463.015 l
577 463.05 l
577 465.81 l
h
W n
q 1 0 0 1 36.72 464.4 cm
0 0 m
539.28 0.025 l
S
Q
Q
q
35.72 444.175 m
35.72 441.415 l
577 441.448 l
577 444.208 l
h
W n
q 1 0 0 1 36.72 442.8 cm
0 0 m
539.28 0.023 l
S
Q
Q
q
309.759 417.208 m
309.761 414.447 l
577.001 414.633 l
576.999 417.393 l
h
W n
q 1 0 0 1 310.7604 415.8333 cm
0 0 m
265.24 0.174 l
S
Q
Q
q
35.72 395.935 m
35.72 393.175 l
577 393.185 l
577 395.945 l
h
W n
q 1 0 0 1 36.72 394.56 cm
0 0 m
539.28 0 l
S
Q
Q
q
36.221 374.335 m
36.221 371.575 l
577.5 371.585 l
577.499 374.345 l
h
W n
q 1 0 0 1 37.2201 372.96 cm
0 0 m
539.28 0 l
S
Q
Q
q
447.9 639.2 10.2 10.2 re
W n
1 w
q 1 0 0 1 449.4 647.9 cm
0 0 m
7.2 0 l
7.2 -7.2 l
0 -7.2 l
h
S
Q
Q
q
481.9 639.2 10.2 10.2 re
W n
1 w
q 1 0 0 1 483.4 647.9 cm
0 0 m
7.2 0 l
7.2 -7.2 l
0 -7.2 l
h
S
Q
Q
endstream
endobj
12 0 obj
<>
endobj
13 0 obj
<>stream
HyTSwoɞc
[5laQIBHADED2mtFOE.c}088GNg9w߽ '0 ֠Jb
2y.-;!KZ ^i"L0-
@8(r;q7Ly&Qq4j|9
V)gB0iW8#8wթ8_٥ʨQQj@&A)/g>'K t;\
ӥ$պFZUn(4T%)뫔0C&Zi8bxEB;Pӓ̹Aom?W=
x- [ 0}y)7ta>jT7@tܛ`q2ʀ&6ZLĄ?_yxg)˔zçLU*uSkSeO4?c. R
߁-25 S>ӣVd`rn~Y&+`;A4 A9 =-tl`;~p Gp| [`L`< "AYA+Cb(R, *T2B-
ꇆnQt}MA0alSx k&^>0|>_',G!"F$H:R!zFQd?r9\A&GrQhE]a4zBgE#H *B=0HIpp0MxJ$D1D, VĭKĻYdE"EI2EBGt4MzNr!YK ?%_(0J:EAiQ(()ӔWT6U@P+!~mDeԴ!hӦh/']B/ҏӿ?a0nhF!X8܌kc&5S6lIa2cKMA!E#ƒdV(kel
}}Cq9
N')].uJr
wG xR^[oƜchg`>b$*~ :Eb~,m,-ݖ,Y¬*6X[ݱF=3뭷Y~dó tizf6~`{v.Ng#{}}jc1X6fm;'_9 r:8q:˜O:ϸ8uJqnv=MmR 4
n3ܣkGݯz=[==<=GTB(/S,]6*-W:#7*e^YDY}UjAyT`#D="b{ų+ʯ:!kJ4Gmt}uC%K7YVfFY.=b?SƕƩȺy
چk5%4m7lqlioZlG+Zzmzy]?uuw|"űNwW&e֥ﺱ*|j5kyݭǯg^ykEklD_p߶7Dmo꿻1ml{Mś
nLl<9O [$h՛BdҞ@iءG&vVǥ8nRĩ7u\ЭD- u`ֲK³8%yhYѹJº;.!
zpg_XQKFAǿ=ȼ:ɹ8ʷ6˶5̵5͵6ζ7ϸ9к<Ѿ?DINU\dlvۀ܊ݖޢ)߯6DScs
2F[p(@Xr4Pm8Ww)Km
endstream
endobj
14 0 obj
<>
endobj
15 0 obj
<>
endobj
16 0 obj
<>stream
H:D1Y^ ,
endstream
endobj
17 0 obj
<>stream
H}PTϽ aYsaQXvQDp?v]aB$ZCl%1mccj:i3N'M4}=-Rp?w9w{`nv V0 ظ閸Y ۭ0
LD!4>aru~M Mn8Zú
L%8.Ta>>0'!9 ʧslrLKV/>xB7-`=
H3p.l
KDQ.B#[4tHwZ W;Myu'`KsayV!xHcA.8Ell@ J1d'96_W3vr\auJIA>+ߍ qgH+O:Ǹ|Z6r
/M3/N-ZYeoHjOUrܢTJ+Xfʡ v3̄ލv9_%0_# J{-YJI99W/LZG70`l1[ú]b-RTn!W\7?Wa~/%]Gw]O}~~o{0qd2fgxo @^7C`iV).VkХOR6b0ɕC og'a
wySrmD!';+3ÚnI{4uRJ4!)1hxQvT\J@C`/h#~MDƻ