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HomeMy WebLinkAboutTKH REAL ESTATE HOLDINGS DBA FORT COLLINS CLUB - INSURANCE CERTIFICATEOP ID: KH CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1 05/11/12 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 endorsements . -- PRODUCER ��� - -... 970-635-9400 CONTNAMEACT ' - PFSlnsurance Group''-JT 1 970-635-9401 4848 Thompson Pkwy; Ste 260 Johnstown, CO'80534 .... ... - .--"! John Hintzman PHONE FA%- A/c No Eat: A/c No: E-MAIL ' ADDRESS:PRODUCER CUSTOMER IDR:TKHRE-2 INSURERS AFFORDING COVERAGE NAIC # INSURED TKH Real Estate Holdings, LLC, INSURER A:PInnacol Assurance CO 524210 and TKH Fitness Ent., Inc. dba Fort Collins Club INSURER B: 1307 East Prospect Road INSURER C Fort Collins, CO 80525 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. IN$R rypE OF INSURANCE ADD L�SUB ftI POLICY NUMBER MMIDDTYT)Y MMIDDIIYYYY POLICY EFF POLICY EXP LIMITS LTRINRR GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 171 OCCUR - _- -- EACH OCCURRENCE $ T RENTED PREMISES Ea occunence $ MED EXP(My one person) $ PERSONAL & ADV INJURY S GENERAL AGGREGATE $ GEH L AGGREGATE LIMIT APPLIES PER: POLICY PRO-IFr.T.. LOC PRODUCTS -COMP/OP AGO $ $ AUTOMOBILE LIABILITY ANY AUTO ', ALL OWNED AUTOS -. SCHEDULED AUTOS HIRED AUTOS NONOWNEDAUTOS _ COMBINED SINGLE LIMIT'-- $ -- '- BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE (Per accident) $ $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE .RETENTION $ $ $ B WORKERS COMPENSATION ANDEMPLOYERS'LIABILITV ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4073666 06/01/12 06/01/13 _ X WC STATU- OTH- T RY LIMIT ER E.L. EACH ACCIDENT $ 500,00 E. L. DISEASE - EA EMPLOYEE $ 500,08 E.L. DISEASE - POLICY LIMIT $ 500,08 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) FORTCOL City of Fort Collins Risk Management PO Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 4 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD