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HomeMy WebLinkAboutTKH REAL ESTATE HOLDINGS LLC - INSURANCE CERTIFICATE�� UP ILI: A1�Ro CERTIFICATE OF LIABILITY INSURANCE DATE 01201 VY) 09/30/2013 IL 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 Phone: PFS Insurance Group -JT Fax: 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 kKf.1J*q INSURED TKH Real Estate Holdings, LLC, INSURER A: National Casually Company and TKH Fitness Ent., Inc. dba INSURER a:Pinnacol Assurance Co 41190 Fort Collins Club 1307 East Prospect Road INSURERC: 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. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR POLICY NUMBER R)D/YVYY MMtD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X Professional SLKK00000003019400 09129/2013 09/29/2013 09/29/2013 09/29/2014 09/29/2014 09/29/2014 EACH OCCURRENCE $ 1,000'em PREMISES Eaocaaranw $ 300,000 MED EXP (My ore Person) $ 6,000 PERSONAL A ADV INJURY f 1,000,0IX X Liquor Liability GENERAL AGGREGATE 4 2,000,001 GEN'L AGGREGATE LIMIT APPLIES PER PRO- LOC X POLICY PRODUCTS-COMP/OP AGG $ 2,000,001 Emp Ben. s 1,000,00 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 16LKK00000003019400 09/29/2013 09/29/2014 COMBINED SINGLE LIMIT (Ea acddent) 11 1,000,00 X BODILY INJURY (Per Person) $ BODILY INJURY (Par accident) S PROPERLY DAMAGE (ParaccWwd) S X X S $ A UMBRELLA DAB EXCESS LIA X OCCUR CLAIMS -MADE BLXK00000003019500 08/29/2013 09/29Y1014 EACH OCCURRENCE s 1,000, AGGREGATE S 1,000, 00( S DEDUCTIBLE RETENTION $ 10,000 X i B WORK ERSCOMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOREXCLUD 0 ECUTIVEY/�N OFF(Mandatory In NH) B yes, describe under DESCRIPTION OF OPERATIONS below N/A 73666 06/01/2013 06I0'U2014 X WC STATU- OTH- S ER E.LEACH ACCIDENT $ 500, EL DISEASE - EA EMPLOYEE S 600, EL DISEASE -POLICY LIMIT S 600,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Rema&, Schedule, If mors space Is required) Certificate holder is named additional insured (per CG2011) for the activities listed on the attached addendum. CITYFOR 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 © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD