ACORD 25 (2010/05) 

AUTHORIZED REPRESENTATIVE 

DATE (MM/DD/YYYY) 

CERTIFICATE OF LIABILITY INSURANCE 

COMMERCIAL GENERAL LIABILITY 

GENERAL LIABILITY 

PREMISES (Ea occurrence) $ 

DAMAGE TO RENTED 

EACH OCCURRENCE $ 

MED EXP (Any one person) $ 

PERSONAL & ADV INJURY $ 

GENERAL AGGREGATE $ 

PRODUCTS - COMP/OP AGG $ 

$ 

RETENTION 

DED 

CLAIMS-MADE 

OCCUR 

$ 

AGGREGATE $ 

EACH OCCURRENCE $ 

UMBRELLA LIAB 

EXCESS LIAB 

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES  (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 

INSR 

LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF 

(MM/DD/YYYY) POLICY EXP 

(MM/DD/YYYY) LIMITS 

WC STATU- 

TORY LIMITS OTH- 

ER 

E.L. EACH ACCIDENT 

E.L. DISEASE - EA EMPLOYEE 

E.L. DISEASE - POLICY LIMIT 

$ 

$ 

$ 

ANY PROPRIETOR/PARTNER/EXECUTIVE 

If yes, describe under 

DESCRIPTION OF OPERATIONS below 

(Mandatory in NH) 

OFFICER/MEMBER EXCLUDED? 

WORKERS COMPENSATION 

AND EMPLOYERS' LIABILITY 

Y / N 

AUTOMOBILE LIABILITY 

ANY AUTO 

ALL OWNED  

AUTOS 

HIRED AUTOS 

COMBINED SINGLE LIMIT 

(Ea accident) 

BODILY INJURY (Per person) 

BODILY INJURY (Per accident) 

PROPERTY DAMAGE 

(Per accident) $ 

$ 

$ 

$ 

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 

ADDL 

WVD 

SUBR 

N / A 

$ 

$ 

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 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). 

The ACORD name and logo are registered marks of ACORD 

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 

INSURED 

PHONE 

(A/C, No, Ext): 

PRODUCER 

PRODUCER 

CUSTOMER ID #: 

ADDRESS: 

E-MAIL 

FAX 

(A/C, No): 

CONTACT 

NAME: 

NAIC # 

INSURER A : 

INSURER B : 

INSURER C : 

INSURER D : 

INSURER E : 

INSURER F : 

INSURER(S) AFFORDING COVERAGE 

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 

ACCORDANCE WITH THE POLICY PROVISIONS. 

LOC 

JECT 

PRO- 

POLICY 

GEN'L AGGREGATE LIMIT APPLIES PER: 

OCCUR 

CLAIMS-MADE 

SCHEDULED 

AUTOS 

NON-OWNED 

AUTOS 

$ 

$ 

Steadfast Insurance Company 26387 

Suite 100 

A 

Thompson Insurance Enterprises LLC 

6/30/11 

Excluded 

Saint Paul, MN 55110 

$1,000,000 

2697 East Ct Rd E PMB 520 

John Ficcadenti 

6/11/12 

inflatable business 

$1,000,000 

$2,000,000 

John ficcadenti 

7129 20th ave N 

centerville , MN 55038 

Included 

6/11/11 

3380 Chastain Meadows Parkway 

DBA: All Around Rental 

Kennesaw, GA 30144 

260080 

CFO9693305-00 

$100,000