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DocuSign Envelope ID: 2D9E6BC7- 988D- 44E9- BF00- 8A99EE6E6E17 DATE <br />CERTIFICATE OF LIABILITY INSURANCE 3/6/2018 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Contact Name: <br />Larry Cossio <br />Cossio Insurance Agency <br />Phone <br />(864) 688 -0121 Fax <br />PO Box 5987 <br />(A /C, No, Ext): <br />(A/C, No): <br />Greenville, SC 29606 <br />E -Mail: <br />tammy @cossioinsurance.com <br />(864) 688 -0121 <br />$ <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />BODILY INJURY (Per Person) <br />INSURER A: <br />NATIONWIDE MUTUAL INS CO 23787 <br />INSURED <br />PROPERTY DAMAGE <br />164890 <br />Inflate- a- Party.com, INC. <br />INSURER B: <br />Berkley Life & Health Insurance Company <br />11781 US Highway 64 <br />Apex, NC 27523 <br />INSURER C: <br />INSURER D <br />INSURER E <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR TYPE OF POLICY ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br />LTR INSR WVD (MM /DD/YY) (MM /DD/YY) <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE X OCCUR <br />A <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />X POLICY PROJECT LOC <br />OTHER: <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS NON -OWNED <br />AUTOS <br />UMBRELLA LIAB OCCUR <br />EXCESS LIAB CLAIMS -MADE <br />DED RETENTION $ <br />X FWC0000028012600 4/2/2017 4/2/2018 <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR /PARTNER/EXECUTIVE Y/N <br />OFFICER /MEMBER EXCLUDED? -i N/A <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />Products & Completed Operations $1,000,000 <br />Damage to Premises Rented to You $300,000 <br />General Agg (Other than Products -C $5,000,000 <br />Each Occurrence <br />$1,000,000 <br />Personal & Advertising Injury <br />$1,000,000 <br />Legal Liability to Participants <br />$1,000,000 <br />Professional Liability (for Event Plann <br />$1,000,000 <br />Participant Accident - Excess Medical <br />$10,000 <br />Deductible <br />None <br />COMBINED SINGLE LIMIT <br />$ <br />(Ea accident) <br />BODILY INJURY (Per Person) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />$ <br />(Per accident) <br />PER OTH- <br />STATUTE ER <br />Accident Medical Deductible $100 <br />Benefit Period 52 weeks <br />B Accident Medical PAI L0120OR024702 4/2/2017 4/2/2018 Benefit Maximum $500,000 <br />Applies During per Covered Accident <br />Applies To Death & Dismemberment Benefits only <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Party Equipment Rentals Operations located at 11781 US Highway 64 Apex, NC 27523. Certificate Holder is listed as additional insured per form CG2011. The certificate holder <br />is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured <br />Amusement devices on file with the company for special event(s) dated 03/24/2018, located at 140 East Margaret Lane, Hillsborough, INC 27278.Coverage is excluded for <br />Mechanical Bull, Rockwall, Trackless Train <br />CERTIFICATE HOLDER: CANCELLATION <br />Orange County Government SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />P.O. Box 8181 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Hillsborough, NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />@ 1988 -2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />