CERTIFICATE OF INSURANCEPRODUCERYOUR INSURANCE COMPANY111 MAIN STREETYOURTOWN, PA 00000555-555-5555INSUREDJOHN DOE EXHIBITOR1234 MAIN STREETANYWHERE, PA 00000COVERAGESTHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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.COLTRAAATYPE OF INSURANCEGENERAL LIABILITYCOMMERCIAL GENERAL LIABILITYOWNERS & CONTRACTOR’S PROT.ANY AUTOALL OWNED AUTOSSCHEDULED AUTOSHIRED AUTOSCLAIMS MADEAUTOMOBILE LIABILITYNON-OWNED AUTOSGARAGE LIABILITYEXCESS LIABILITYUMBRELLA FORMOTHER THAN UMBRELLA FORMWORKER’S COMPENSATIONANDEMPLOYER’S LIABILITYOTHERCERTIFICATE HOLDEROCCURMOTOR TREND AUTO SHOWS, LLC6375 FLANK DRIVEHARRISBURG, PA 17112POLICY NUMBERXXXXXXXXISO FORM: XXXXXXXXXXXXXXISO FORM: XXXXXXXXXXXXXXISO FORM: XXXXXXPOLICY EFFECTIVEDATE (MM/DD/YY)CANCELLATIONAUTHORIZED REPRESENTATIVEcompanies affording COVERAGEISSUE DATE (MM/DD/YY)xx/xx/xxTHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERSNO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.companylettercompanylettercompanylettercompanylettercompanyletterABCDEMY INSURANCE COMPANYPOLICY EXPIRATIONDATE (MM/DD/YY)limitsEACH OCCURRENCE$ 2,000,000.DAMAGE TO RENTED PREMISES(EA OCCURENCE)$ 2,000,000.MED EXP (ANY ONE PERSON) $ 2,000,000.PERSONAL & ADV INJURY $ 2,000,000.GENERAL AGGREGATE $ 50,000.PRODUCTS–COMP/OP AGG $ 5,000.$ 2,000,000.COMBINED SINGLE LIMIT(EA ACCIDENT)BODILY INJURY(PER PERSON)BODILY INJURY(PER ACCIDENT)PROPERTY DAMAGE(PER ACCIDENT)EACH OCCURRENCEAGGREGATESTATUTORY LIMITSEACH ACCIDENTDISEASE–POLICY LIMITDISEASE–EACH EMPLOYEE$ 1,000,000.$ 1,000,000.$ 1,000,000.SAMPLEDESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMSMOTOR TREND AUTO SHOWS, LLC (A DIV OF SOURCE INTERLINK COMPANIES, INC.), CONVENTION CENTER AND AUTO DEALERS ASSOCIATION ARENAMED AS ADDITIONAL INSURED ON ALL POLICIES EXCEPT WORKER’S COMPENSATION. SEE ATTACHED FORM CG2010 INSURANCE TO APPLY ONPRIMARY BASIS. AUTO SHOW: ABC AUTO SHOW, 1000 MAIN STREET, WHEREVER, PA. DATES OF SHOW INCLUDING MOVE IN & MOVE OUT.SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TOMAIL ____ 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THELEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION ORLIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENT OR REPRESENTATIVES.$$$$$
POLICY NUMBER:THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.ADDITIONAL INSURED – OWNERS,LESSEES OR CONTRACTORS – SCHEDULEDPERSON OR ORGANIZATIONThis endorsement modifies insurance provided under the following:commercial general liability coverage partSCHEDULEName of Person or Organization:MOTOR TREND AUTO SHOWS, LLC6375 FLANK DRIVEHARRISBURG, PA 17112COMMERCIAL GENERAL LIABILITYCG 20 10 03 97(If no entry appears above, information required to complete this endorsementwill be shown in the Declarations as applicable to this endorsement.)WHO IS AN INSURED (Section II) is amended to include as an insured the person ororganization shown in the Schedule, but only with respect to liability arisingout of your ongoing operations performed for that insured.SAMPLECG 20 10 03 97 Copyright, Insurance Services Office, Inc., 2000 page 1 of 1
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