HomeMy WebLinkAbout14060053 Certificate of Insurance '�c R� CERTIFICATE OF LIABILITY INSURANCE °°TE,"'M,°°�"�"
5/14/2014
7HIS CER7IFICATE IS lSSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEN� OR ALTER THE COVERAGE AFFORDED BY 7HE POLlCIES
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 be endorsed, If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certifiwte holder in lieu of such endorsement s). .
PROOUCER CONTACT
NAME: ___ __
Britton Gallagher
One Cleveland Center, Floor 30 P�o�E x . 1 - - 1 ac Ho: - -
E-MAIL
1375 East 9th Street ADDRESS:
Cleveland OH 44114 IN511RER 5 AFFOR�ING COVERAGE NAICJt
__ INSURERA:(aXiS S�[jJl
iHSUaeo INSURER B�T hn i I � n
USA Halloween Planet Inc. wsuaeRC: v r I � In r n 1
dba USA Fireworks INSURER D:
7800 Records St..Ste.A
Indianapolis IN 46226 �NSURERE:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1720729855 REVISION NUMBER:
THIS IS TO CERTIFV THAT THE POLICIES OF INSUR4NCE 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 MAV PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. I
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BV PAID CLAIMS.
INSR A OLS POLILYEFF POLICYEXP �
LTR TYPE OF MSURANCE INSR NND POLILY NUMBER I MMID�IYYVY MMID�IVYYY LIMRS I
C GENERALLIABIUrv GLbind¢r IV2014 6/1/201$ EqCHOCCURRENCE $t,000.000
jX COMMERGAL GENERAL LIABIIITV �AMA E TO REMED
PREMISES Eaacurrence 3500,000
� CIAIMS-MADE � OCCUR MEO EXP(qny one permn) , 8
IPERSONA�$AOV INJURV $1,000,000
GENERALAGGREGATE $2,000,000
GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $2,000,0�0 �
� POLICV� PRO- X LOC $
AUTOMOBILE LIABILITY �
Ea accident
ANV AUTO BO�ILY INJURY(Par person) _ $
' ALL OWNED SCHEDULE� BODILY INJURV(Per accidenp $
AUTOS AUTOS
NON-OWNEO PROPERTV�AMAGE $
HIREO AUTOS AUTOS I Per accitlent
S
A UMBRELUUAe X OCCUR EAN53088 $/V2014 /V2015 EACHOCCURRENCE $4,000,000
X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000
DE� RETENTION$ � $
g WORKERSCOMPENSATION ARIN333B8(IN) 10I2014 2/10/20�5 X �'CSTATLL X OTH-
ANO EMPLOYERS'LIABILITY ��H �
ANVPROPRiETOPoanRTNEft/EXECUTIVE❑ H�A ELEACHACCIOENT $500,000
OFFlCERiMEMBER EXCLUDEO?
(Mantlamry in NH) E.L.DISEASE-EA EMPLOYE $500,000
f yes tlescribe untlar
DESCRIPTIONOFOPERATIONS�elow E1.01SEA5E-POLICYLIMIT $5�0.000
DESLRIPTION OF OPERATION51 LOCATIONS I VEHICIES (Atlach ACORD 101,Adtlitianal Ramarks Schetlule,if more space is requi�eA�
"Additional Insured*`
Stantl Location: 4004 W.96th St., Indianapolis, IN 46268
Stantl Operator's Name: USA Halloween Planet, Inc.
Landowner's Name: A&A Development Corporation
Additional Insured: Pyramid Corner North &ASA Development Corporation
CERTIFICATE HOLDER CANCELLATION
SHOULO ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLEO BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
A&A Development Corporation ACCOR�ANCE WITH THE POLILY PROVISIONS.
9699 N. Michigan Road
Indianapolis IN 46268 ppTHORIZEDREPRESENTATIVE
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