The following exclusions are contained in the commercial general liability coverage provided by this program.
Abuse, molestation, harassment or sexual conduct; Aircraft/hot air balloon; Airport; Amusement devices (the
ownership, operation, maintenance or use of: any mechanical or non-mechanical ride, slide, or water slide, any
inflatable recreational device, any bungee operation or equipment, any vertical device or equipment used for
climbing-either permanently affixed or temporarily erected, or dunk tank. Amusement devices do not include
any video or computer games.); Animals (injury or death to, or injury, death or property damage caused by any
animal owned, rented or hired by you); Asbestos; Commercial general liability standard exclusions (CG0001
12/04 edition); Employment-related practices; Fireworks; Fungi or bacteria; Haunted attractions; Lead; Nuclear
energy liability; Outside concessionaires and vendors in conjunction with your business; Performers; Rodeos;
Saddle animals; Snowmobile; Those operations listed as ineligible: Concert promoters, Event production
companies, Rental companies, Talent agencies/companies, Travel agencies.
WARRANTY AND DISCLOSURE
I understand that the insurance company, in determining whether to provide insurance coverage, will rely on the
information contained in this form and all other information being submitted. I hereby warrant, represent and
confirm that, to the best of my knowledge, all information provided is complete, true and correct.
Cossio Insurance Agency as managing general underwriter for the insurance company, receives compensation
from the insurance company in consideration for its performance of insurance services that include, but are not
limited to; underwriting, policy/certificate issuance, administration and claims handling. The insurance company
compensates Cossio Insurance, based on a predetermined calculation of thirty-three percent of the total premium.
I understand that, subject to applicable laws, Cossio Insurance Agency will invest the premium and, in accordance
with the permission of the insurer, will receive any interest or other income that the premium generates prior to
remittance to the insurer.
I am aware that the insurance company expects accurate reporting for my premium calculation. I understand that
my books and records may be examined or audited by the insurance company at any time during the coverage
period and up to three years thereafter. Intentional misrepresentation or misreporting may jeopardize coverage.
I further acknowledge that, I have reviewed all information provided with this enrollment form and understand the
exclusions which apply, as well as the activities and operations for which coverage is not provided.
Terms of Agreement: