2018-685-E DEAPR - Inflate-A-Party Halloween event

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CERTIFICATE OF LIABILITY INSURANCE DATE 10/4/2018 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 policy(ies) must have ADDITIONAL INSURED provisions or 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 INSURED Inflate-a-Party.com, INC. 11781 US Highway 64 Apex, NC 27523 Cossio Insurance Agency PO Box 5987 Greenville, SC 29606 (864) 688-0121 INSURER(S) AFFORDING COVERAGE INSURER A:NATIONWIDE MUTUAL INS CO INSURER B:Berkley Life & Health Insurance Company INSURER C: INSURER D: INSURER E: Contact Name:Larry Cossio Phone (A/C, No, Ext): (864) 688-0121 E-Mail:tammy@cossioinsurance.com Fax (A/C, No): NAIC # COVERAGES 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 SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CERTIFICATE NUMBER: REVISION NUMBER: INSR LTR TYPE OF POLICY POLICY NUMBER POLICY EFF (MM/DD/YY) POLICY EXP (MM/DD/YY) LIMITSADDL INSR SUBR WVD COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR _______________________________ _______________________________ GEN'L AGGREGATE LIMIT APPLIES PER POLICY PROJECT LOC FWC0000028669000 4/2/2018 4/2/2019 X AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident)$ BODILY INJURY (Per Person)$ BODILY INJURY (Per accident)$ PROPERTY DAMAGE (Per accident)$ UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS-MADE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER STATUTE OTH- ER PAI L01200R024703 4/2/2018 4/2/2019Accident MedicalB ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CANCELLATION Orange County Government P.O. Box 8181 Hillsborough, NC 27278 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 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 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 Amusement devices on file with the company for special event(s) dated 10/26/2018 located at 302 West Tryon Street, Hillsborough, NC 27278.Coverage is excluded for Trackless Train, Rockwall, and Mechanical Bull CERTIFICATE HOLDER: © 1988-2015 ACORD CORPORATION. All rights reserved. Y/N XA 23787 64890 OTHER: ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD X X General Agg (Other than Products-Co $5,000,000 Each Occurrence $1,000,000 Products and Completed Operations $1,000,000 Personal and Advertising Injury $1,000,000 Legal Liability to Participants $1,000,000 Professional Liability (for Event Plann $1,000,000 Damages to Premises Rented to You $300,000 Participant Accident - Excess Medical $10,000 Deductible None $100Accident Medical Deductible 52 weeksBenefit Period $500,000Benefit Maximum per Covered AccidentApplies During l Death & Dismemberment Benefits onlyApplies To DocuSign Envelope ID: E568C784-1C2A-4E88-9455-FA25A192FD6B