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<br />Insured Name: CALDWELL FIRE DEPARTMENT, INC <br />Tuesday, March 11, 2025 Page 17 <br />The organization sells alcohol at special events. <br />Describe events(s): <br />Total Receipts: <br />License/Permit required by state: Yes No <br />License/Permit obtained: Yes No <br />The organization permits alcohol on the premises or at sponsored functions, but does not <br />sell it. <br />The organization provides bartenders to serve alcohol provided by others at functions. <br />The organization prohibits alcohol on the premises and at sponsored functions. <br />Fundraising or other special events: <br />If yes, indicate all that apply: <br />Carnivals or field days with <br />mechanical amusement rides <br /># days held annually: <br />Are rides operated by an amusement ride contractor? Yes No <br />If yes, does the contractor carry at least $1 million in <br />liability limits? Yes No <br />If yes, does the contractor name this client as an <br />Additional Insured and provide them with a COI? Yes No <br />Conventions # days held annually: <br />Fireworks # days held annually: <br />Fireworks detonated by: Qualified outside contractor <br /> Applicant <br />If detonated by outside contractor, does the contractor <br />carry at least $1 million in liability limits? Yes No <br />If yes, does the contractor name this client as an <br />Additional Insured and provide them with a COI? Yes No <br />Bingo # of days held annually: <br />Motorized event # days held annually: <br />Hall rentals # days rented annually: <br />Written agreement signed by renter? Yes No <br />COI obtained from renter if other than an individual? Yes No <br />Any boats greater than 100hp? Yes No If yes, how many? <br />If physical damage is desired, please be sure to schedule coverage under Portable Equipment. <br />Any grandstands or bleachers? Yes No If yes, how many? <br />U <br />U <br />U <br />Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF