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Home My WebLink About13040180 Certificate of Insurance • kA ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYYI si 44/W13 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 pblicy(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 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Britton Gallagher NAME: One Cleveland Center;Floor 30 PHONE et s.E,nc216-656-7100 FAx 1375 East 9th Street EMAIL IA Ic•N° 216_658-7101 ADDRESS,_ Cleveland OH 44114 INSURER(S(AFFORDING COVERAGE NAIL a INSURED '- INSURER A:LeXIlI�iQRlLfan o INSURER a:Axis_SurplusJ_ns Company USA Halloween Planet Inc. C dbaiUSA.Fireworks INSURER 0- 7800 Records St.,Ste.A INSURER D: Indianapolis IN 46226 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:597864192 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'SUCHPOLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED•BY PAID CLAIMS. INSR I ADDLTSOBBI LTR TYPE OF INSURANCE I INSR I WVD I POLICY NUMBER I(MM/OD/YWFY)I(MM/DELNYVY)I LIMITS A I GENERAL LIABILITY 5379127-04 511/2013 5/1/2014 X _EACH OCCURRENCE 1$1,000.000 I COMMERCIAL GENERAL LIABILITY DS4Mis YO RENTED I� _PREMISE�Ea occurrence)_($50,000 I-1 CLAIMSMgDE I" (OCCUR MEO EXP(Any one person) I$ j PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS-COMP/OP AGG 1 $2,000,000 POLICY Pi PIF9 k I LOC r S I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea ILY INJURY g ANY AUTO I BODILY INJURY(Per person) g I ALL OWNED I SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS I NON-OWNED PROPERTY DAMAGE $ AUTOS (Per acc,den0 I5 B I UMBRELLA LIAB Ix OCCUR EAU7S3088 5/1/2013 5/1/2014 EXCESS LIAB EACH OCCURRENCE I X $9,000.000 _ CLAIMS-MADE DED I AGGREGATE $9,000,000 RETENTION$ WORKERS COMPENSATION I$ AND EMPLOYERS'LIABILITY WC STATU- OTH- ANY PROPRIETORPARTNER/EXECUTING V/N l-TQI31'LI CIDEN—LEE_ OFFICER/MEMBER EXCLUDED? I N/A E.L.EACH ACCIDENT $ (Mandatory in NH)- T- II yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) **Additional Insured" StandLocation: 13670-13672 N. Meridian St., Carmel, IN 46032 StandlOperator'sName: USA Halloween Planet. Inc. Landowner's Name: Brixmor HTG SPE 5 LLC Additional Insured: Brixmor HTG SPE 5 LLC CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION, DATE THEREOF, NOTICE WILL BE DELIVERED IN Brixmor HTG SPE 5 LLC ACCORDANCE WITH THE POLICY PROVISIONS. 420 Lexington Ave, 7th Floor I New York NY 10170 AUTHORIZED REPPRESENTATWE k g1 I ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD • • „C ® DATE(MMIDDIWYY) � ' CERTIFICA'TB'OF LIABILITY INSURANCE 4/24/2013 _ THISICERTIFICATE IS ISSUED AS A MATTERIOF 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. I IMPORTANT: if the,certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endOrsed. If SUBROGATION IS WAIVED,subject to the terms and'condi< conditions of the ender certain policies may require anlentlorsement..A s[atementon this certificate does.not confer rights to the -certificate,holder in lieu of suchendorsement(s). PRODUCER CONTACT -. NAME:' Britton Gallagher PHONE FAX One,Cleveland_Center, Floor.30 IA/C No.Fxn:216-658-7100 I(Arc,No):216-658-7101 1375East9th Street_. ADDRESS: Cleveland OH 44114 INSURER(S).AFFORDING COVERAGE NAIC# INSURER A:Lexington Insuran eCo INSURED INSURER B:Axis Sarkis Ins.Company USA Halloween Planet Inc. INSURER c: dba USA Fireworks 7800'.Records(St:'„Ste. A INSURER D: Indianapolis IN 46226 -INSURER E: .INSURER F: COVERAGES CERTIFICATE'NUMBERi"597864192' 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 OTHERI 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 PAIDCLAIMS. INSR - AODLSUBR1 LM TYPE OF INSURANCE INSR I NAM I POLICY NUMBER. I POLICY EFF POLICY EXP (MMIODIYVYVL IMMIDDM'VVf LIMITS A GENERAL LIABILITY 5379127-04 /1/2013 .11/2014 EACH OCCURRENCE I$1,000,000 ® COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) $50,000 ■ CLAIMS-MADE X OCCUR MEDEXP(Any one person) $ PERSONAL&'ADV INJURY $1,000,000 ■ GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 POLICY I I jEGT X LOC I $ AUTOMOBILE LIABILITY k COMBINED SINGLE LIMIT (Ea accident) $ .ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED IN - (AUTOS _'AUTOS BODILY INJURY(per accident) $ .HIRED AUTOS NON-OWNED. PROPERTY DAMAGE AUTOS” (Per accident)' $ H B 'UMBRELLA LIAB X OCCUR EAU75308B 5/1/2013 5/1/2014 EACH OCCURRENCE $9,000,000 X `EXCESS LIAB CLAIMS-MADE AGGREGATE $9,000,000 'DED I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY VIN TORY LIMITS ERA ,ANY=PROPRIETOR/PARTNER/EXECUTIVE' OFFICER/MEMBER EXCLUDED? N/A E L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ If yes,describe under DESCRIPTION OF OPERATIONS below I E .DISEASE-POLICY LIMIT I$ DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule;if more space is required) *"Additional,Insured** Stand'Location: 13670-13672'N. Meridian-St., Carmel, IN 46032. Stand Operator's Name: USA Halloween Planet, Inc. Lando`wner's Name:. Brixmor'HTG,SPE'5 LLC Additional Insured:,Brizmor HTG SPE 5 LLC CERTIFICATE HOLDER CANCELLATION _ SHOULD ANY.OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,.'NOTICE WILL BE DELIVERED IN BriXmor HTG.SPE.5 LLC' ACCORDANCE WITH THE POLICY PROVISIONS. 420 Lexington AVe, 7th Floor New York NY 10170 "- AUTHORIZED REPRESENTATIVE 4 I ©1988.2010 ACORD-CORPORATION.. All rights reserved. ACORD,25(2010/05) The ACORD-name and.logo are registered marks of ACORD.