Insurance Form

MCTAGGART, ARMSTRONG, DEWAR & OWEN 

INSURANCE BROKERS 

Home Auto Farm Business 

CERTIFICATE OF INSURANCE 

Dotsy's Entertainment Co. O/B Shelley Summers 

Name of Insured: 

Address: 

111 Ross Street St.Thomas, ON N5R 3X8 

THIS CERTIFICATE IS ISSUED AT THE REQUEST OF 

Name: 

To Whom it may concern 

Name of Insurer: 

Policy No: 

Certain Underwriters As Arranged By Special Risk Insurance Managers Ltd. 

SR006686 

12:01am November 17, 2023 to 12:01am November 17, 2024 

Policy Period: 

LIMITS OF LIABILITY 

$5 000 000.00 INCLUSIVE LIMIT 

$5 000 000.00 AGGREGATE 

BODILY INJURY AND 

PROPERTY DAMAGE COMBINED 

Cross Liability Clause 

Reimbursement Clause: 

$2 500.00 

OPERATIONS AND LOCATIONS TO WHICH THIS CERTIFICATE APPLIES: 

Activities of the named insured with respect to operations of Dotsy's Entertainment Company. 

ADDITIONAL INSUREDS: It is hereby understood and agreed that the following entity shown below is added as Additional Insured, but only with respect to liability arising out of Named Insured's premises or operations, and only with respect to losses which would have been recoverable in the absence of this agreement. The policy limits are not increased by the addition of such Additional Insured(s) and remain as stated in this Certificate: 

The insurance afforded is subject to terms, conditions, and exclusions of the applicable policy. The Insurer will mail to the holder of this Certificate 15 (fifteen) days written notice of any material change in or cancellation of these policies. 

McTaggart Armstrong Dewar & Owen 

Authorized Representative 

Date: 

May 10/2024 

90 Talbot Street West • Aylmer • Ontario N5H 1J8 • Tel: 519-773-8401 • Toll free: 1-800-505-5622 • Fax: 519-765-2368 

INSURANCE 

BROKERS 

ASSOCIATION 

ONTARIO 

mctaggartarmstrong@cmmgbrokers.com • www.mctaggartarmstronginsurance.com 

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