HomeMy WebLinkAboutKOALA - INSURANCE CERTIFICATEACOR CERTIFICATE OF LIABILITY INSURANCE
'DDI""'
0118/
10/18/04
PRODUCER 1-303-534-4567
The IMA Financial Group, Inc.
INA of Colorado, Inc.
1550 17th Street
Suite 600
Denver, CO 80202
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
INSURED
Koala Corporation
7881 South Wheeling Court
Englewood, CO 80112
INSURERA: Steadfast Insurance Company (CRC -TX)
INSURER B:
INSURER C:
INSURER D:
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMIDDAM
POLICY EXPIRATIONLTR
DATE (MMIODNY)
LIMITS
A
GENERAL LIABILITY
SC04274885-00
10/15/04
10/15/05
EACH OCCURRENCE
$ 1,000,000
FIRE DAMAGE (Any we fire)
$50,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
MED EXP (Any one r")
$ Excluded
PERSONAL &ADV INJURY
$1,000,000
X BI/PD Dad: $15,000
X
Each Occurrence
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
$2,000,000
POLICV JFCPROLOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea )
$
BODILY INJURY
(Per Parson)
S
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per awidw*)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per aCCKW)
S
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
S
OTHER THAN EA ACC
S
ANY AUTO
$
AUTO ONLY: AGG
EXCESS LIABILITY
EACH OCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
$
S
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
WCLI _LIMT I OTH-
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
E.L. DISEASE - POLICY LIMIT
$
OTHER
f
f
f
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESJEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Certificate Holder is included as Additional Insured on the General Liability Policy as required by written contract or
agreement per policy terms and conditions.
Re: Fossil Creek Community Park
CFRTIFICATE HOLDER I I AnnlT NAI. INSURFn- rMsuRFR I P A- CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Fort Collins
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
PO Box 580
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80522
USA
ACORD 2" (7/97) SDZM o ACORD CORPORATION 1988
2170934
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IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.