Loading...
HomeMy WebLinkAboutGO PLAY INC - INSURANCE CERTIFICATE``� br CERTIFICATE OF LIABILITY INSURANCE DATE 3/7/2013 �' 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 endorsement(s). PRODUCER Keller -Lowry Insurance Inc 1777 S Harrison St #700 Denver CO 80210 COAM ACT Teresa Hellpel PHONE (303)756-9909 FAX QV.a.(303)7S6-9a19 EMAIL .icanhelp®kellerlowry.com INSURER $ AFFORDING COVERAGE NAIC # INSURER A:Cincinnati Insurance 10677 INSURED Go Play, Inc. POBOX 323 Drake CO 80515 INSURERE:Pinnacol Assurance 41190 INSURER C: INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NIIMRFR:13-14 GL.AU 12-13 WC RFVICIntd NIIMRFP- 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. INSR LTR TYPE OF INSURANCE ADDL SUum POLICY NUMBED POLICY EFF (MMMDNYYYI POLICY EXP IMMtDDNYYY)LIMBS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X� OCCUR _ ENP0131489 /1/2013 /1/2014 EACH OCCURRENCE $ 11000,000 PREMISES sotto Dnce $ 500,000 MED EXP A one erson $ 10,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 S A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS NP0131489 O OWNED AUTOS /1/2013 /1/2014 COMBINED SINGLE LIMIT EE 11000,000 BODILY INJURY (Par person) $dent X BODILY INJURY Per accident; ( ) $ PROPERTY DAMAGE Per Poerern $ S UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMSMADEAGGREGATE EACH OCCURRENCE S $ DED RETENTION S $ B WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE MI OFFICEREMBER EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS Celot, N/A 189704 10/19/2012 1/1/2013 WC STATU- OTH- X I E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,100 E.L. DISEASE - POL!CV LIMIT .$ 1 1000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) City of Fort Collins 300 LaPorte Ave., Fort Collins, CO 80521 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 T Sibelius CIC CRM/TM ---\ ©1988-2010 INS025 (2D1Dos) of The ACORD name and logo are registered marks of ACORD All HOMO reserved. acoRO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM DD 1o/z2/z012o12 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 endorsement(s). PRODUCER Keller -Lowry Insurance Inc 1777 S Harrison St #700 Denver CO 80210 CONTACT NAME' Teresa Heupel PHONE . (303)756-9909 FAX .1301I'156-Ss19 E-MAIL .icanhelp®kellerlowry. cost INSURERS AFFORDING COVERAGE NAIC# INSURERA:Cincinnati Insurance 10677 INSURED GO Play, Inc. POBOX 323 Drake - CO 80515 INSURERS: Pinnacol Assurance 41190 INSURER C: INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER:12-13 GL,AU,WC 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. INSR LTR TYPE OF INSURANCE ADULSUISH ima MAL POLICY NUMBER POLICY EFF 1MM1DDNYYYI POLICY EXP IMM/DDMMLIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR NP0131489 /1/2012 /1/2013 DAMAGES 717PTI17 PREMMED $ 500, 000 EXP (Any one son $ 10,000 PERSONAL B ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 T POLICY PRO LOG S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a acrK.rd 11000,000 BODILY INJURY (Per person) $er A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NP0131489 /1/2012 /1/2013 I BODILY INJURY (Per accident) ) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS N AUTOS OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN X WC STATU- OTH. E.L. EACH ACCIDENT S 1,000,000 ANY PROPRIETOR/PARTNEWEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A 159704 0/19/2012F1/1/2013 E.L. DISEABE-EA EMPLOYE $ 1,000,000 If Kyee, describe under DESCRIPTIONOFOPERATIONS beloo_ - EL.DISEASE-POLICY LIMIT 3 11000.000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remark. Schedule, 0 more apace is required) City of Fort Collins 300 LaPorte Ave., Fort Collins, CO 80521 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 ACORD 25 (201 Sibelius CIC CRM/TM------\� 01988-2010 ACORD CORPORATION. All rights reserved. INS025 (20100$).01 The ACORD name and logo are registered marks of ACORD