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JSELLERS ACORD, ,, CERTIFICATE OF . LIABILITY INSURANCE °11/27/ 1°2 Y " 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 pol (cy(ies) must be endorsed . it 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 endorsements . PRODUCER CO AC SMALL COMMERCIAL UNIT K & K Insurance Grvup , Inc . NAME; _ P . O . Box 2338 PRONE ' 877 - 783 - 1161 260 - 459 - 5870 Fort Wayne , Tn 46801 AIGNo_ Ext : LAIC. No): L ADDRESS: SCUOKANDKZNSURANCR . COM INSURERS} AFFORDING COVERAGE NAIC A INSURER A: NATIONWIDE LIFE INSURANCE COMP 66869 INSURED C&H EVENTS , INC . INSURERS: NATIONAL CASUALTY COMPANY 11991 160 W . CAMINO REAL , # 231 INSURER C: BOCA RATON , FL 33412 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1670516 REVISION NUMBER: T1THR 15 TO CERTIFY THAT THE POI IES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER10 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 . NC=NOT COVERED TYPE OF INSURANCEAWULZV POLICY NUMBER POLICYEP POLICY EXP LIMITS LT INSR WVD_ MMIDDIYYYY MMIDDIYYYY ETR GENERAL LIABILITY EACH OCCURRENCE 1000000 , B rG.SNL MERCIALGENERALLIABIUTY 12 : 01AM 12 : 01AM PREMISES occurrence 300000 CLAIMSMADE OCCUR I Y KK00002424100 4 / 21 / 12 4 / 21 / 13 MED EXP (Anyone person) 5000 ners & Contractors PERSONAL SADV INJURY 1000000 i I GENERALAGGREGATE NONE GREGATE LIMIT APPLES PER: PRODUCTS•COMPIOP AGG 1000000 PROJECT F7LQC Part L131;E Liab 1000000 COMBINeguMIT AUTOMOBILE LIABILITY i Accident 1000000 12 : 01AM 12 : 01AM 60DILYIWURY (Perperson) KK00002424100 4 / 21 / 12 4 / 21 / 13 ALL OWNED AUTOS SCHEDULED BODILY INJURY (Per accident) AUTOS JANYAUTO HIREO AUTO$ X NON-OW NEO PROPERTY OAMAGE AUTOSPer aceiden UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS•MAOE AGGREGATE OED RETENTION WORKERS COMPENSATIONA OTHER AND EMPLOYERS' LIABILITY a TORY LIMITS ,T ANY PROPRIETORIPARTNERI EL EACH ACCIDENT EXECUTIVE OFFICERIMEMBER N I A EXCLUDED? E.L. DISEASE - EA EMPLOYEE (Mandatory in NH) N yes describe under F.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS below 12 : 01AM 12 ; OIAM AD&D NC A Participant Accident SPX0025353300 4 / 21 / 12 4 / 21 / 7.3 Primary Medical NC ExCeSS Medical 25000 Weekly Indemnity NC DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101 , Additional Remarks Schedule, it more space i5 required) CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED BUT ONLY WITH RESPECT TO ,.I✓�- :,1 ; - I` LIABILITY ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED . EVENT : JAKE OWEN NOV 2 s �Ol � FOUNDATION BENEFIT CONCERT . DATE : 12 / 12 - 16 / 12 . LOC : VERO BEACH SPORTS VILLAGE L45K Mi�$EII1CIlt": CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE ELIVERED I INDIAN RIVER COUNTY ACCORDANCE WITH THE POLICY PROVISIO St 1 1 ATTN : COUNTY RISK MANAGER INDIAN RIVER COUNTY AUTHORIZED S AT 1800 27TH STREET VERO BRACH , FL 32960 ACORD 26 {2010106) O 1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD