CERTIFICATE OF LIABILITY INSURANCE (9) ,aC CERTIFICATE OF LIABILITY INSURANCE =A1 �'
THIS CERTIFICATE IS ISSUED ASA 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 CONTACT
NAME Sam Muradyan
Litre United Insurance Services,Inc PHONe FAx
704 S Victory Blvd,Shite 204 E-MAIL 8187618888 _ i tv888285666s
---
Burbank, CA 91502 ADDRESS: Sam@libertyunitedinsurance.com_
License##: 01=89€341 __.--�ryssrRERL5I AFfORDIN £OVERA µ NAIC#
---
INSURERA: Admiral Insurance,Company
INSURED
INSURER B
All Around Amusements INSURER C.
4001 Willow Hills Ct. INSURER_D_:
Plano,TX 75024 INSURER
IN F: _
COVERAGES CERTIFICATE NUMBER: 00000400-435181 REVISION NUMBER: 143
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 CONTRACTOR 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
INSR AooL ssadR" POLICY EFF POLICY UP '
LTR_. TYPE OF INSURANCE POLICY NUMBER MM-06YYYY MNM70D,rYYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY Y N i CA0000299192-01 !03/16/2018 0311612019'.G^
EACH OCCURRENCE 5 13000,000 _
E I OCCUR j
CLAIMS-MAD AMr"+GE TO FtEh1TBD --
�..._ �PREhISESLEaoccurraince} S ,. _. 50,000
MED.EXP(.Anyone person)
_. ( PERSONAL&AD'd INJURY S _1,000,000
,.GEN"LAGGREGATE LIMIT APPLIES PER: I GENERAL AGGREr.RTE......__.__.._S 2,000,000"..
,Ix POLICY: �° --'LOC PROtDUCTS COMP:OP AG-'-�--,5 _.2,000,000
OTHER. S
AUTOMOBILE LIABILITY -_ � COMBINED SINGLE LI MMT
ANYAUTO ( BODILY INJURY(Per person) $
.� Csb,YYTAUT05ONLY SCHEDULED j (AUTOSBODILY INJURY(Per acudenf} $ -.
HIRED NON-OWNED � I PROPERTY DAMAGE I$
AUTOS ONLY AUTOS ONLY (Per accident) __. _ ...
I$
A ( (UMBRELLA LIAR H-CIL-A-1-
OCCUR i GX000001'187-01 0311612018 0361612[113 EAr OCCt)RRENGE-_—-t$ 4,{[00,000
X EXCESS LIAB_,...... NBS-MA[7_E' ! (AGGRE�'rArE .... $ 4,000,000
- -_._
DED RETENTIpNS .....�$
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS"LIABILITY YIN ..STATUTE i.... ,.E.R ..._ ..-_.—.
�
ANY PROPRIETOR�PARTNER'EXECUTIVB I � E L EACH ACCIDENT $
OFFICER'MEMBEREXCLpDED'? NIA, .... _._ ,. __._..
(Mandatory in NHI E L.DISEia.SvE EA EMPLQYE $
If yes.describe under _ --.
DESCRIPTION OF OPERATIONS below 1 :.EL-DISEASE-POLICY LIMIT $
I
(
i
( j
DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES IACORD 741,AdcI tional Remarks Schedule,may be attacked K mare space Is required)
Certificate Walder Is An Additional Insured
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Clearwater THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
708 N Missouri Avenue, ACCORDANCE WITH THE POLICY PROVISIONS.
Clearwater, FL 33755 AUTHORIYED REPRESENTATIVE
.-'-- I R— ( J
SMS
— @ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2416103) The ACORD name and logo are registered marks of ACORD
Printed by SUIS on April 16,2018 at 11:30AM
a
ACC111rR ---------
i DATE{N1 M/D D/YYY Y
CERTIFICIIATEOFLIABILITY INSURANCE 04/1612018
THIS CERTIFICATE 15 1 SS UED AS A MATTE R 0 F IN FORM ATIO N 0 N LY AND CONFERS NO RIGHTS U PON THE CERTIFICATE I 10 1-D E R.T1 115 CERTIFICATE DOES N OT AFT I R M ATIV E LY OR NEGATIVELY
i AMEND,EXTEND OR ALTER THE COVERAGE ATFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THEIS SUING INSURFR(S),
AUTHORIZED REPRESENTATIVE OR PRODUCER,AND TH E CERTIFICATE HOLDER-
. ..............
IMPORTANT,Ifthe certificate holder is an ADDITIONAI INSU RPD,the policy(las)must have ADDITIONAL.tN5URFD 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 of5uch endorsernent(s).
PRODUCER CONTACT
NAME
Todd Campbell(355231J)
PHONE FAX
12655 N Central Expy Ste 425 (A/C,NO,EXT).214-420-7500 1 (A/C,NO):214-420-7501
E-MAIL
ADDRESS� tcamp
Dallas TX 75243-3747 befl2@farmersagent.com
INSURER(S)AFFORDING COVERAGE NAIL 9
.....,..m ........ _'_""""''_'-_'_ __1'-_-_1'-- A
INSURED Truck insurance Exchange 21709
INSURERS: Farmers Insurance Exchange 21652
ALL AROUND AMUSEMENTS LLC
4001 WILLOW HILLS CT INSURER; M.id.Century Insurance Company 21187
----------
INSURER D: Farmers Texas County Mutual insurance Company 24392
INSURERE:
PLANO TX 75024 INSURER F.
.........
--—-------------
COVERAGES CERTIFICATE NUMBER; REVISION NUMBER:
I HIS IS 10 CERI IFY THAT THE POLICIES OF INSURANCE 1_1�1 ED BELOW[]AVE BE EN ISSUED FO I HE INSURED NAME,Ae','VE FOR-HE PULICY PERIL-'INDICATED,NO]NI I HSANDING ANY
RFOUI.M MFN T.1 FRM(_J'R CONDI 1-1,1_3N OF ANY CON TRA C'I OR 01,HFR f)OCUDAF N1 V47,H RFSPFCT To W CH,THIN CRTIHCAIT MAY 91 _VT D-";R MAY PFRTMN,THF lNSJRAN1,,-F AF i(;nl)FD EY ji-
POLICIES CESCRI.BED HEREIN IS SUBJEC 1 TO ALL THE TERMS,EXCLUS10%AND CONDITIONS Or SUCH POLICIES.LIMITa SHO'WN MAY HAVE BEEN k"'DUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDTL SUBR POLICY NUMBER POLICY EFF POLICYE XP
LTR I INSD WVD I / LIMITS
(MM/DDYYYY) �MM/DD/YYYY)
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE i5 I
L
OAMAGr.TO RENILD
-1-AIMS-MADE OCCJR
PREMISES(LaOccurrence)
MID EXP(Any olie p(_,rsonl IS
...........
r. PI-RSONAL&ADVINIU
i U-A' Is
C[�N.
GENIRALAGG AT E
PULICY PR,_'_�Cl LOC
PRODUC'iS-COMP/OPA"G
..........-
$
AUTOMOBILE LIABILITY COMINF I',SING[F LIMIT
(Ea K,cide n Q 1,000,0001
ANY AU T,)
BODILY INJURY tPer oersno) 1$
OWNI1)AUTOS x i SCHEDULED BODILY INJURY'Per accicent)Is
D I ONLY AUTOS` y 1 605828159 1 04102/2019
!-JiRFDAUT��.S NON-OWNFD� 04/02/2018
PROPERTY DAMAGF IS
-')N,Y AU 7'Q S 0 NL.Y
$
UMBRELLALIAB OCCUR $
EXCESS LIAO C I A W,S-Ni A Of:'
t__t .............. .......
DLD NTION S
--------- .......
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY PFR
A SEAL U I DTHLK
ANY PROPRIETOR/RARTNFR/ Y,N E.L.TACH ACCIDENT is
EXECUTIVEOrTICER/ME MEER __ N/A
EMPLOYEE
E.L_DISEASE-EA L
EXCLUDiED7(Mandatory in NH)
Ifyes,de;cribe under DESCRIPTION OF
OPERATIONS below F-1. DISEASE.POLICY LIMIT
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLE5ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
2016 RAM RAM TRUCK,VIN:3C63RRJUX 639117
................ --—---- ...............
CERTIFICATL EHOLDER CANCELLATION
..........
iF DkIRWATtR SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
706 N MISSOURI AVE DATE TH FRFOF,NOTI C E WILL BE.DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
i AUTHORIZED REPRESENTATIVE MAG IE KIRK
33755_____ ........... ..............
ACORD 25(2016/03) t)1988-2015 ACORD CORPORATION..Al I Rights Reserved
31-1769 11-15 The ACORD name and logo are registered marks of ACORD
------------------
-fY
6✓ LAru �� �i1d l �' i1 1 � _' a�jgeTi,{Md��+A,)sa,'(r��^�{ryp
04/1 !2'� E 8
P1447DISC€FL' - - - - - 5"#{3S CERTiFI.DATE.ISI 3LJEt7 ASA tA'I"1'ER OF INFORMATION.
TNT Only One insurance Agency ONLY AND CONFERS NO;RIGKTS UPON THE G>RTIFIOATE.
951 Q Ilan Buren Blvd # Qt3 Is I r r aES g T AMEND, XTEND OR
RI.TER THE COVEFRAGE ArFE3RpEC9 GY THE 'OL
ICI S SSL OW
Riverside, CA 92508
951 789-6375 Office 951 781 -1348 Fax INSURERS AFFORDING COVERAGE �NAfiC9
-- _ ®_
- INSURED _.._..._ _.__. .,.w_....-
I }131IdER, Texas �Ituq_ nE Lgran6
All Around Amusements I S
N
I1��13Rs:
4281 E. Hwy 380INSIIRG
Princeton, TX 75497
f INSURER E: .
:COVERAGES
THE CI ISE&.t3F iRI6L9Fw ICE I ISTI I5$EL(5W I vE BEI f�ISSUEE7 Tp THE f�tSUR90I NAMED.ABOVE FORI-POLICY PERIOD INDICATED.NOTVATHSTAADING
ASi45"f I ClE 9REI lI h{T, d RI4I CkR CgNDITEQhi F APIY GL3RR E ADr IJCHER I cUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED'OR
ir4AY.f'4:FtTAiIS 7h3$3da6`LI€iAHG AEI•{3TtC�Ei3 I3Y TdiC#*R7LiCIL°i C}C+SC:�''ttQCCk ltG6i1~IN 13 SU13JF-CT To ALL THE TERMS,EXC:LUS1OHS AND CONDITIONS Or 5UCH
3a{�L;fCIES.A{3IaREGA'CE L.IMTTS SI-I�4 IVIAY H�tVE$EEI`I I�ET}I.3CE#�BY PAIIa'r.�AI�sS.
F�R.ICY NUI4R3F.14 "PCbi.ICY 4FFEiC"C71E PCrI.H;Y E7CR1iyTWESN
LIMITS
aErrErLpL uaHli.r+Y . , EA MICE
t. `Cf34R I
i Iu
OCCURj A4ED E9�IA S
t
Gf
rI PERSONALiAWNJURY s.
GC,M4AGGI �i'[-'aEL116SP`tTvPPLY£SPER{ s ,RC7DUCTS-CommP AUG S
t r
POLICY I !.(TCS f ...,W...- .,._._...
A3TOMO'BfI E L"UTr I I
- pVf I C 811WEt3$I G41E UMITANY AUTO
-
ALLOWNUDAUTOS BODILY Ii4•UAY 1
{
It SCHEFALH. DAUTCS 3 ( ;ptwPC )
MON-OWNED AUTOS {I�a6iY
i 1 {4 &a;37snt$
n
gARA83E L.IAaUJTY `..-. ,. .. -_. Alf'CU034LY_AAC(`DENT S -
ANY AUTiS fI -
t 1 f 1 aT1aExI TFi+aa EA ACC s
AUTQ ONLY; AW, s
_. E C SIU REtkA�LITY € r EACH ..URRENCE 5
L_re, OCCUR E I`CLAM S MADE" ° CATT AS. $ --
s I E, i
fDEDUUCTBELE
WOR)MRSCOMPERSAT"AND -. '� STAn OT}I-I
KPILffVR S*UA8tUTY SBP0001257469 104104/201704/04/201 .� , T II i , •...a _.._
ATI4Y PRC)PA�TCR�RAATFdCT§PEP4FCUT1VE @ LL.EACHACt DeNT s 1 IACD �7
€aFP E}€L�.LiDkD9
i Kyes.Uu « lL•D€snsE; n snap 4 sy} { � {
'3PECiALPF4C1Y15€ON56a' ? I. I EJ-DIS E.paJOYL)MIT $ I,u LFU
t OTHER
I
Property Section i
t5 SC:T4d,'{514 OFUPE� n SLOVAT4CNMSIVEHIC: ! LS 146'ISE€} Y Ni70T€SPE PptOV[SI - -. - -
eNITlclte Mo er Is nam;ra's coni IonaY fnsurec as RIelr Interest may appear..
CERTIFICATE F3C5WER CANCtLLAT10N
SHOULD ANY CSP THE MOVE DESCRIBED POLICI HE,CANCEUX0 OU ORE TtsE'..EXPIRATION
City off Clearwater QA-M TR€REOF,THE I SUING INSURER NUI:.9+6p�s VOR TO MAi1...!3)_,DAYS WRIMN
706 Ny Missouri
rI�}Avenue
w3ve n u a NOTW E TO TM CERTIFICATE li(XM NAMED TO YHE LETT.OUT FAXURE TO DO BO$14AL.L.
. '.
learwa Leri L s7J T VAPOaE SO OB.R1GAMN OR UAeIUTY Of ANY MUD UPON THE INSUMR..ITS AGENTS OR
' RR.PA'.F.SEN3`RT7VE;5.
AJJTHOMUD REPRE$ENTAT'v
Nioka Marks
A OR + (;00110,3) 0ACOR 3 cORPIORATION 1988