CERTIFICATE OF LIABILITY INSURANCE (1129) 712/12/2023
E(MM/DD/YYYY)
ACOR" CERTIFICATE OF LIABILITY INSURANCE
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 CONTACT
NAME: Luke Johnson
Olivier VanDyk Insurance Agency, Inc PHONE FAX
2780 44th St SW AIC No Ext): 616-454-0800 AIC,Noy 616-454-7100
E-MWyoming MI 49519 ADDRESS: certificates@ovdinsurance.com
INSURER(S)AFFORDING COVERAGE NAIC#
License#:0007645 INSURERA: Cincinnati Specialty Underwriters Ins Co 13037
INSURED BIGEVEN-01 INSURER B:
All Around Amusements, LLC DBA Big Event Slides
4001 Willow Hills Ct INSURERC:
Plano TX 75024 INSURER D7
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:67203470 REVISION NUMBER:
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.
INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER MM/DD MM/DD
A X COMMERCIAL GENERAL LIABILITY Y CSU 0205126 3/8/2023 3/8/2024 EACH OCCURRENCE $1,000,000
DAMAGE S( RENTED
CLAIMS-MADE OCCUR
PREMISES Ea occurrence)
ccurrence) $100,000
MED EXP(Any one person) $Excluded
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
POLICY❑ PRO [:]JECT LOC PRODUCTS-COMP/OP AGG $2,000,000
X
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
A UMBRELLA LAB X OCCUR CSU 0205126 3/8/2023 3/8/2024 EACH OCCURRENCE $1,000,000
X EXCESS LAB CLAIMS-MADE AGGREGATE $1,000,000
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVEF—] E.L.EACH ACCIDENT $
OFFICE R/M EMBER EXCLUDED? N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
A Inland Marine CSU 0210341 5/25/2023 3/8/2024 Limit $101,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
City of Clearwater is additional insured on the general liability per the following endorsement.
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.
City of Clearwater
705 N. Missouri Ave. AUTHORIZED REPRESENTATIVE
Clearwater FL 33755 ,. E
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ UTCAREFULLY.
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This endorsement modifies insurance provided undorthafollowing:
COMMERICAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Additional Insured Person(s)or Organization(s):
Any party for whom you are providing ongoing operations and the owner of the
premises where the ongoing operations are being performed.
A. SECTION U ' WHO IS AN INSURED is C. With respect to the insurance afforded to
amended to include as an additional insured these additional insureds, SECTION III - L|K8-
the person(s) ororganizaginn(y) shown in the ITS OFINSURANCE isamended 1ninclude:
Gohadu|o, but only tothe extent that the liabil-
ity
The limits applicable tothe additional insured for "bodily injury, "property Uumu�o^ o/
"personal and advertising injury' is caused nn' are those specified in any agreement orinthe
|y by your negligent ads, errors or omissions Declarations of this Coverage Purt, whichever
in the performance of ongoing operations for is |000. If no limits are specified in the agree-
additional insured shown in the schedule.
Om*additinno|innunedohmwnintheoohndu|*. mant. the limits applicable tnthe additional in-
sured are those specified in the Declarations
B. With mupaot to the insurance afforded to ofthis Coverage Part. The limits of insurance
these additional innunedn, the following addi' are inclusive of and not in addition to the limits
tiona|exclusions apply: ofinsurance shown inthe Declarations.
This insurance does not apply to: D. With respect to the insurance afforded to
these additional inoueUo. SECTION |l/ -
1. "Bodily injury^. "property damage" n/ ^pep COMMERCIAL GENERAL L|AB|L|TYCQN-
aona| and advertising injury" to any om' Q|T|C>NS. 4. Other Insurance is amended to
pkwao of you or to any obligation of the include:
additional insured to indemnity another
because of damages arising out of such Any coverage provided herein will be oxueou
injury. over any other valid and oo||ootib|a insurance
available to the additional insured whether
2. "Bodily injury". "property damage" or "per- p/imory, oxceou, contingent or on any other
oona| and advertising injury^ for which the basis unless you have agreed that this insup
Namad Insured is afforded no ouvamAe anue will be primary. This insurance will be
under this policy ofinsurance. noncontributory only ifyou have uoagreed and
this coverage isdetermined tnbaprimary.
Includes copyrighted material ofInsurance
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