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HomeMy WebLinkAboutTKH REAL ESTATE HOLDINGS LLC DBA FORT COLLINS CLUB - INSURANCE CERTIFICATEOP ID: RC 144c"MCERTIFICATE OF LIABILITY INSURANCE DATE 912014YI 05/19/2014 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 PFS Insurance Group -JT 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 John Hintzman CONTACT PHONE FAX INC, No, Ezt: INC, No), E-MAIL ADDRESS: CUSTOMeR ID a: TKHRE-2 INSURERS AFFORDING COVERAGE NNC M INSURED TKH Real Estate Holdings, LLC, INSURER A: National Casualty Company and TKH Fitness Ent., Inc. dba Fort Collins Club INSURERS: Pinnacol Assurance Co 41190 1307 East Prospect Road INSURER C: Fort Collins, CO 80525 INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER- 1 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 POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXI OCCUR X Professional KK00000003916500 09/29/2013 09/29/2013 09/29/2013 09/29/2014 09/29/2014 09/29/2014 EACHOCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 300,00 MED EXP(Any one Person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 X Liquor Liability GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOG PRODUCTS-COMPIOP AGO $ 2,000,00 Emp Ben. $ 1,000,00 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS KK00000003916500 09/29/2013 09/29/2014 COMBINED SINGLE LIMIT Ca accident) $ 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accitlenl) $ PROPERTY DAMAGE (PER ACCIDENT) $ X X $ A UMBRELLA LWB EXCESS LIAR X OCCUR CLAIMS -MADE XK00000003916500 09129I2013 09I2912014 EACH OCCURRENCE $ 1,000,0013 AGGREGATE $ 1,000,00 DEDUCTIBLE RETENTION $ 10,000 § X $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4073666 06/01/2014 06/01/2015 X WC STATU- OTH- MTER EL EACH ACCIDENT $ 500,00 E L DISEASE - EA EMPLOYEE $ 500,00 E. L. DISEASE -POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aeach ACORD 101, AddiBanal Remarks Schedule, if more space is mqulred) If required by written contract or written agreement, City of Fort Collins is included as additional insured for ongoingg operations under. General Liability for the following events:Triathlon/Duathlon May 11th and September 7th. Kids Triathlon August 24th. Dig or Die Volleyball Tournament August 2nd 6 3rd. 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. AUTHIORRED REPRESENTATIVE © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD