CERTIFICATE OF LIABILITY INSURANCE (6) AC C>RV CERTIFICATE OF LIABILITY INSURANCE,r DATE(MM/O¢7^IYY1!)
141�- F 05/10/2016
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 pollcyr(les) 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
NAME:
Todd Carr ptell( 5 23'1J) (AICNo-EEL, 214420-7500 (Adc,N4._214 7420.7501
12655 N Central Expy Ste 425 E-MAIL tc�ii Rpb.elJ Qfarj.Yiersagerlt,com .
INSURER($)AFFORDING COVERAGE NAIC#
Dallas TX 75243-3747 INSURER A: Truck Insurance Exchange 21709
INSURED INSURER B: Farmers Insurance Exchange 2'1652
ALL,AROUND AMUSEMENTS LLC INSURER C: Mid Century Insurance Company i 21687
4001 WILLOW MILLS CT INSURER D Farrnprs Texas County Mutual Insurance Company ! 24382
uNSURER E
PLANO TX 75024 INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY'rHAT 1°8-E POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE: FOR THE POLICY ICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, 'TERM FOR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT'TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED B'r" THE POLJd IES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMIT'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR ....... TYPE OF INSURANCE .AC7ral SIDBsi... ...... ....... .. .... POLICY IEFF PfOL�ICY EXP...I.. ...... LIMITS
.... ,......
LTR POLICY NUMBER MMIJDD/YYYY Niru�IDD/"YYYY
,.,
GEN ER'AL LIABILITY FAEACH OCCUi OCCURRENCE i„�S
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COMMERCIAL GENERAL IA.iRtll'1Y .DEyAIdME.IFAANI SE..1_C 6 R^� Nc T uD ra r�arJ. 4
CLAIMS-MADE ccg.IRt M@ D F XP(Any one person) _
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.,.
G'C•r2SONAC P AUV INJURY $
GENERAL AGGREGATE
GIENFL AC,C IMF GATE.'. A PE PRODUCTS
IE I P C P S FIER ' Q9P AC
CMP/ C, S
c
a Ifl,
POLICY =LOC i
AUTOMOBILE LIABILITY C f NINNEED SINGI.E”L.i
e 1,000,000
ANY AUTO 13O DILY VNJURY(Per I)ersorii 1 i( 0lJ0 00
ALL,D t a I C. WNEEI�✓.�SCHEDULED
AU I'DS AUTOS
Y 605828159 04/0212016 04/02/2017 BODILY INJURY(Pw
c dent)
t1'FF l M DAMAGE $
NOWOVVNED
ma=D AUTOS I P3"FO :F
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$
UMBRELLA LIAR
OCCUR EACH OCCURRENCE
..*.... (%LAIM;i-MAtJE' AGGREGATE
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CTX�ESS LIAB A RE
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WORKERS COMPENSATION WC STATU- OT H-1
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AND EMPLOYERS'LIABILITY YIN'
t N TORY,OMIT
ANY PROPRIE roRI AIR 7 NER/E XFC„`UTIVR _... .N/A E`t f^AChn ACCIDENT �S' , ...
{C7F RCER/MC hAEDkSIi EXC.LLNC:1fl.D' ......... ._. _ ... . ... . ..............
(Mandatory InNHV �_'_ ........ J ..L0.. DISEASE E.A EMPLOYE E: S
I9 yes,descnbe under
DESt;@'di4''r0N OF ti FIERA'H ONS b0 ow I E,L.L'ASEfASE-POI,
.8CY LIMY i'
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DESCRIPTION OF OPERATIONS I LOCATIONS J VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is requirod)
2014 RAM RAM TRUCK;VIN:3C63RRJL.5E G264941
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
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AlP"GFIC3RI .��,rESENTA7,T
ACORD 25(20 10/05) U 11955-2010 ACORD CORPOR TI'ON. All rights reserved.
The ACORD name and logo are registered marks of ACORD