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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 �� OO 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010I05) The ACORD name and logo are registered marks of ACORD