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HomeMy WebLinkAboutTemporary Use Permit Dennis Brewer - Missing Field Values03/12/2024 Brown & Brown Insurance Services, Inc. License #0D04053 1001 Mark Avenue, Suite 201 Carpinteria CA 93013 Kim Magno (805) 965-0071 (805) 690-3200 Kim.Magno@bbrown.com Fellowship Church 2450 Highway 121 North Grapevine TX 76051 Church Mutual Insurance Company, S.I.18767 Texas Mutual Insurance Company 22945 23-24 GL BA UMB Prof A Y Y 035149925556015 04/03/2023 04/03/2024 1,000,000 1,000,000 5,000 1,000,000 3,000,000 1,000,000 A 035149909556048 04/03/2023 04/03/2024 A 10,000 035149985556040 04/03/2023 04/03/2024 10,000,000 10,000,000 B 0002074882 03/02/2024 03/02/2025 1,000,000 1,000,000 1,000,000 A Professional Liability Abuse/Molestation 035149925556015 04/03/2023 04/03/2024 Aggregate $3,000,000 Aggregate $5,000,000 RE: 2450 Hwy 121 North City of Grapevine is included as Additional Insured under the General Liability per the attached form CMCG 12 03 12 19, as required by written contract. Waiver of Subrogation applies to the General Liability per the attached form CMCG 12 03 12 19, as required by written contract. City of Grapevine 200 S. Main St. Grapevine TX 76051 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER LIMITS(MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) POLICY EFF POLICY NUMBERTYPE OF INSURANCELTR INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY Preschool & Kinder Egg Hunt 1st – 5th Egg Hunt Toddler & Sp Needs Eggs Pi z z a Te n t s Ch i c k -Fi l -A Te n t s Drink Tent 1 Drink Tent 2 Petting Zoo Flag Rope on Poles Flag Rope on Poles Drone Take Off Zone Bounce Houses Bounce Houses ST A G E Good Friday – Grapevine Map In f l a t a b l e Ar c h e s = Light Tree = PA Speakers Generator Balloons = Cone Info/First Aid = Windmaster This one goes in front of small baptistry Drone Seating Area