CERTIFICATE OF LIABILITY INSURANCE (2)
I
ACORD TM CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYY)
7/25/2007
PRODUCER
CERTIFICATE is ISSUED AS A MATTER OF INFORMATION
AND CONFERS NO RIGHTS UPON THE CERTIFICATE
THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
AFFORDED BY THE POLICIES BELOW
COVERAGES
:THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
REQUIRMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 'NIHT RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE
:INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AL.L THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITE
iSHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF POLICY POLICY NUMBER POLICY EFFECTIVE
LTR DATE i~.'I~':DOiY(
Cassia Insurance Agency
PO Box 188
Simpsanville, SC 29681
(864) 688-0121
INSURERS AFFORDING COVERAGE
INSURED
Ultimate Bounce, LLC
3300 11th Ave N
St. Petersburg, FL 33704
Burlington Insurance Company
A
GENERAL LIABILITY
IX] COMMERCIAL GENERAL LIABILITY
D D CLAIMS MADE [Xl OCCUR
D
D
Pg~~EY(~~hRD~~~NI LIMITS ....... I
:EACH OCCURRENCE I
iFIRE DAMAGE (And onefire)'i
iMED EX? (anyone person) ...."i...
-............................. . ,. i
!PERSmIAL & ADV INJURY !
[GENERAL AGGREGATE
i I
PRODUCTS - COMPIOP AGG I
Ig~~8~~~S~~ACH ...... '!
TBD
7/25/2[IIJ7
7/25/2008
GEN'L AGGREGATE LIMIT APPLIES PE
IX] POLICY 0 PRO- D LOC
JECT
AUTOMOBILE LIABILITY
D ANY AUTO
D ALL OWNED AUTOS
D SCHEDULED AUTOS
D HIRED AUTOS
D NON-OWNED AUTOS
D
D
PROPEPTY DAMAGE
(PET accident)
CCMBINED SINGLE LIMIT
I(Ee accident)
IBODIL Y INJURY
(PE r Person)
BCDIL Y INJURY
(P,,'r accident)
GARAGE LIABILITY
D ANY AUTO
D
$
:$
i$
$
$
$
$
I. ~~RtC~~~sn~H-
iE.I. EACH ACCIDENT :$
:EJ.[)ISEASE'::E.AEry1PLQYE :L
E'. "'~'^". POUCY UMH I'
AUTO ONLY - EA ACCIDENT
OTHER THAN
AUTO ONLY.
EA ACC
AGG
EXCESS LIABILITY
D OCCUR 0 CLAIMS MADE
D DEDUCTIBLE
D RETENTION $
WORKERS COMPENSATION AND
EMPLOYER'S LIABILITY
EACH OCCURRENCE
N" GREGATE
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEcAENT/SPECIAL PROVISION
Amusement devices on file with company for special events dated throughout the policy ')nly located at One Causeway Blvd.; Clearwater Beach, FL 33767.
Certificate Holder As Additional Insured
CAN CEIl.,,,, T:O~j
$1,000,000.00
$50,000.00
$5,000.00
-.........................-.......-...--........,..,.."...,.-...........
$1,000,000.00
$2,000,000.00
$1,000,000.00
$5,000.00
$
$
9;
,
$
SHOULD .~NY OF THE ABOVE DESCRIE,ED POLICIES BE CANCELLeD
BEFORE THE EXPIRATION DATE THREOF, THE ISSUING INSURER WILL
ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE
HOLDER NAMED TO THE LEFT, BUT FJJLI,JRE TO DO SO SHALL IMPOSE NO
OBLiGATION OR LIABILITY OF ANY KIN~/UPQ JHE INSURER, IT'S AGENTS
OR REPf-,ESNETf\TIVES ' /(
IAUTHORIZED REPRESENTATIVE ~)
ACORD 25 (2001/08)