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1360 Town Centre Dr - 2013 Outdorr Fireworks Permit/Tent
® DATE(MM/DDIYYYY) A~ ° CERTIFICATE OF LIABILITY INSURANCE 11/1/2013 4/17/2013 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). PRODUCER Lockton Companies, LLC CONTACT 3280 Peachtree Road NE, Suite 800 PHONE FAX N xt : A/C No): Atlanta GA 30305 E-MAIL (404) 460-3600 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Scottsdale Insurance Co=my 41297 INSURED American Promotional Events, Inc. INSURER B : 1359629 DBA TNT Fireworks, Inc. INSURER C : P.O. BOX 1318 INSURER D : 4511 Belton Drive INSURER E : Florence AL 35630 INSURER F : COVERAGES CERTIFICATE NUMBER: 12307867 REVISION NUMBER: XXXXXXX 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 rADDL SUBR POLICY EFF POLICY EXP LIMITS LTR WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY A GENERAL LIABILITY N CPS1612503 II/l/2012 11/1/2013 EACH REN DAMAGE TO RENTED X MMERCIAL GENER BILITY PREMISES (Ea occurrence) $ 100,000 CLAIMS-MADE XX OCCUR MED EXP An one Person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s 2,000,000 POLICY PRO- $ JECT X LOC AUTOMOBILE LIABILITY NOT APPLICABLE (Ea accident) $ XXXXXXX ANY AUTO BODILY INJURY (Per person) $ X X ALL OWNED SCHEDULED BODILY INJURY Per accident $ XXXXXXX AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIREDAUTOS AUTOS (Per acc dent) $ XXXXXXX $ XXXXXXX UMBRELLA LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX EXCESS LIAB CLAIMS-MADE AGGREGATE XXXXXXX DIED RETENTION $ $ XXXXXXX - WORKERS COMPENSATION NOT APPLICABLE AT"- -TH AND EMPLOYERS' LIABILITY Y / N TORY LIMIT ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ XXXXXXX OFFICER/MEMBER EXCLUDED?. ❑ NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ XXXXXXX If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ XXXXXXX DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Additional Insured: MN 1786 Property located at Wal-Mart # 1360 Towne Centre Drive c 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. 12307867 AUTHORIZED REPRESENTATIVE City of Eagan 3830 Pilot Knob Road Eagan MN 55122 ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD - 1O ACORD CORP TION. All rights reserved MN 1786 101040 AMERICAN PRIDE S/S GIVEAWAY 1 0 MN 1786 101823 BIG BLAST SS-PDQ J09 3 574.56 MN 1786 102044 GOOD TIME BAG SS COM 0 MN 1786 100727 TNT BARGAIN BAG S/S 3 287.76 MN 1786 102046 PYRO PAK BAG SS COM J10 1 239.85 MN 1786 102048 INDEPENDENCE TRAY SS COM J10 3 863.64 MN 1786 102050 HOT ZONE SS COM J10 3 639.8 MN 1786 102052 49'ER SS COM J10 319.92 MN 1786 102199 49'ER SS CT 0 MN 1786 102054 ALL AMERICAN SS COM J10 4 1919.7 MN 1786 102174 ALL AMERICAN SS 8/1 0 MN 1786 101281 BLOCK PARTY 05 SS COM 1 0 MN 1786 102056 PERFECT SHOW SS COM J10 639.92 MN 1786 101808 TNT BIG TIMER SS J09 3 1079.91 MN 1786 102129 THE BIG DELUXE SS-ALLJ11 1 319.98 MN 1786 102130 THE BIG DELUXE SS-COM J11 0 MN 1786 101929 SPECTACULAR SHOW SS-ALL 1 0 MN 1786 200863 CAROUSEL 111 1 57.6 MN 1786 200096 CUCKOO FOUNTAIN 1 230.4 MN 1786 200803 L'IL RED DEVIL J09 1 230.4 MN 1786 200170 KILLER BEE FOUNTAIN 1 384 MN 1786 200883 COLORFUL RAIN J11 1 96 MN 1786 200971 HEATED FOUNTAIN J12 0 MN 1786 200095 CRICKETS FOUNTAIN 1 172.8 MN 1786 200759 PURPLE RAIN FTN 107 2 345.6 MN 1786 200761 LIL PATRIOT J07 1 115.2 MN 1786 200972 PARFAIT FOUNTAIN J12 0 MN 1786 200236 PICCOLO PETE FOUNTAIN 1 307.2 MN 1786 200978 SURFS UP! 259.2 MN 1786 200054 BLISTERING SKIES FOUNTAIN 1 0 MN 1786 200979 SHANGHAI SURPRISE J12 288 MN 1786 200275 SONIC BOOM FOUNTAIN 1 384 MN 1786 200184 MAD DOG FOUNTAIN 1 249.6 MN 1786 200551 NIGHTTREASURE -J05 1 0 MN 1786 200622 MAIN SQUEEZE J06 1 187.02 MN 1786 200821 RAINBOW'S END-J09 1 0 MN 1786 200987 INDEPENDENCE DAY J12 170.52 MN 1786 200616 PINK ICE J06 1 192 MN 1786 200625A FREEDOM EAGLE J06 1 191.88 MN 1786 200855 O-BLIVION J11 287.82 MN 1786 200870 DIZZY TIZZY J11 191.88 MN 1786 200303 SURROUND SOUND FOUNTAIN 1 0 MN 1786 200786 MOLTEN POT J08 1 239.88 MN 1786 200875 STAR VOYAGER J11 1 480 MN 1786 200917 JUMBO PURPLE RAIN J11 1 191.88 MN 1786 200355 T.N.T. FOUNTAIN 1 287.88 MN 1786 200809 LEAPING LIZARDS J09 1 287.88 r - MN 1786 200871 CRAZY COLORS J11 239.9 MN 1786 200985 GAME TIME 191.92 MN 1786 200986 WAKE UP CALL 431.82 MN 1786 200740 LIGHT THE NIGHT J07 1 335.88 MN 1786 200974 AMERICAN LIGHT FOUNTAIN 127.96 MN 1786 200988 SUPER SNAZZY J12 191.94 MN 1786 200792 CASCADING WATERFALL J08 3 319.92 MN 1786 200860 ENCORE J11 1 479.88 MN 1786 200994 OPENING SHOW J12 191.96 MN 1786 200619 STANDING OVATION J06 1 0 MN 1786 200723 COSMIC CREATION J07 1 223.96 MN 1786 230009 JUMBO CALIFORNIA CANDLE 1 230.4 MN 1786 290148 JUMPING JACKS - 12 PK J10 3 576 MN 1786 320536 POP-IT'S TNT 4 576 MN 1786 320476 PARTY TIME PARTY POPPER J07 ST 1 115.2 MN 1786 320478 LIGHTNING FLASH-BOX OF 6 J07 1 80 MN 1786 320480 TNT BLASTS BAG OF 6 J07 1 96 MN 1786 320285 CHICKEN COOP 1 115.2 MN 1786 320487 ASST. COLOR SNAKE-TNT J07 1 102.4 MN 1786 320328 5K CRACKLING THUNDER STRING 1 134.4 MN 1786 320579 HORSESHOE CRAB J12 0 MN 1786 351036 SMOKE BALLS ASST'D TNT J07 2 480 MN 1786 351038 PULLSTRING SMK GRENADE J07 1 240 MN 1786 351037 ASSORTED COLOR AMMO SMOKE 1 172.8 MN 1786 380246 MORNING GLORY TORCH 14 IN J09 1 576 MN 1786 380238 #10 GOLD SPARKLER J09 1 230.4 MN 1786 380088 36.IN MORNING GLORY BAG OF 6 1 537.6 MN 1786 380245 #20 SPARKLER GOLD J09 1 153.6 MN 1786 380069 MORNING GLORY TNT #10 4 768 MN 1786 390014 PUNK JUMBO J07 1 40 MN 1786 679073 COUNTER CASE NOV SS 361.6 MN 1786 679070 COUNTER CASE FTN 0 MN 1786 679071 COUNTER CASE SMK 0 MN 1786 679076 COUNTER CASE SMALL ITEMS 0 MN 1786 679068 COUNTER CASE FTN A 382.4 MN 1786 730148 WATER CAN EXTINGUISHER 1 0 MN 1786 730321E BUNGEE CORD, RED 18 IN X8M 44 658.24 MN 1786 730051 BAG - TNT SMALL - 500 EA 1 12 MN 1786 730058 BAG - TNT LARGE - 500 EA 1 12 MN 1786 730472 SIGN - ROAD RKT HARDWARE J10 2 30 MN 1786 730471 SIGN -ROAD ROCKET J10 2 50 MN 1786 730470 SIGN - ROCKET FLAGGER J10 2 64 MN 1786 930559 TRAY TENT 30, 0 MN 1786 931117E BOX TENT(RED) 8 0 r AcoR ® CERTIFICATE OF LIABILITY INSURANCE F DATE (MM/DDIYYYY) 11/1/2013 6/5/2013 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). PRODUCER LOckton Companies, LLC CONTACT NAME3280 Peachtree Road NE, Suite 800 PHONE FAX Atlanta GA 30305 MA No Ext : A/C No (404) 460-3600 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Scottsdale Insurance Coln all 41297 INSURED American Promotional Events, Inc. INSURER B : 1359629 DBA TNT Fireworks, Inc. INSURER C : P.O. BOX 1318 INSURER D : 4511 Helton Drive INSURER E : Florence AL 35630 INSURER F COVERAGES CERTIFICATE NUMBER: 12381674 REVISION NUMBER: XXXXXXX 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. ILTR TYPE OF INSURANCE ADD SUBR POLICY EFF POLICY EXP LIMITS INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A GENERAL LIABILITY N N CPS1612503 11/1/2012 11/1/2013 EACH OCCURRENCE DAMAGE TO RENTED X MMERCIAL GENERA IABILITY PREMISES (Ea occurrence) $ 100,000 CLAIMS-MADE OCCUR MED EXP (Anyone person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 100-000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG 2,000,000 POLICY PRO- JECT X LOC $ AUTOMOBILE LIABILITY NOT APPLICABLE C (Ea O accident) L IMI $ XXXXXXX ANY AUTO BODILY INJURY (Per person) $ XXXXXXX ALL OWNED SCHEDULED BODILY INJURY Per accident $ XXXXXXX AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ XXXXXXX AUTOS (Per accident) $XXXXXXX UMBRELLA LIAB HOCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX EXCESS LIAB CLAIMS-MADE AGGREGATE $ XXXXXXX DED RETENTION $ $ XXX XXX WORKERS COMPENSATION NOT APPLICABLE W TATU- TH- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER ANY PROPRIETOR/PARTNERJEX OFFICER/MEMBER EXCLUDED? ECUTIVE ❑ N/A E.L. EACH ACCIDENT $ XX {XXXX (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ XXXXXXX describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ XXX}{X'XX DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Parking lot property MN1786 located at Wal-Mart #1360 Towne Centre Drive in Egan and Certificate holder is an additional insured on the General Liability as required by written contract subject to policy terms, conditions, and exclusions. 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. 12381674 AUTHORIZED REPRESENTATIVE CITY OF EAGAN 3830 PILOT KNOB ROAD EAGAN MN 55122 ~!r ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD © 88- 10 CORD CORP TION. All rights reserved