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Home My WebLink About260459 PLAY POINTE LLC DBA FORT FUN - INSURANCE CERTIFICATE (2)A�� ® DATE (MM/DD/YYYY) C CERTIFICATE OF LIABILITY INSURANCE 9/25/2018 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 have ADDITIONAL INSURED provisions or 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 CONTACT NAME: Robin Engram Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX 1515 Fortino Blvd Suite 200 A/c No Ex : 719-544-1111 A/C No): 719-545-5120 Pueblo CO 81008 ADDRESS: Robin En ram a' .com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: T.H.E. Insurance Company 12866 INSURED PLAYPOI-01 INSURERS: Pinnacol Assurance Company 41190 Play Pointe, LLC dba Fort Fun Fort Fun INSURER C 1513 E. Mulberry INSURER D : Fort Collins CO 80524 INSURER E: PnvGaAnFc rFRTIFIr_ATF NI IURFR. onz�,?g9g5 RFVISION 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 DL S POLICY NUMBER i�LICY EF / /YY POLICY EXP /YYY LIMITS A X COMMERCIAL GENERAL LIABILITY OCCUR CPP0104255-04 7/1/2018 7/1/2019 EACH OCCURRENCE $1,000,000 DAMACLAIMS-MADE1XI PREMISES Eat occurrence) $100,000 MED EXP (Any one person) $ 0 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PECOT- LOC OTHER: GENERAL AGGREGATE $1,000,000 PRODUCTS - COMP/OP AGG $1,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY CPP0104255.04 7/1/2018 7/1/2019 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS MADE CPP0104255.04 7/1/2018 7/l/2019 EACH OCCURRENCE $2,000,000 AGGREGATE $ 2.000,000 DED I I RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANYPROPRIETOR/PARTNER/EXEW1IVE ❑ OFFICERWEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4032913 9/1/2018 9/1/2019 STATUTE ER E.L. EACH ACCIDENT _ $100,000 E.L. DISEASE - EA EMPLOYEE $10o,000 , E.L. DISEASE-P 'ICYLIMIT $5W.000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is named as an Additional Insured. PCOTICY'ATC L.Il11 111=0 rANCFI I ATInN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Purchasing Division P.O. Box 580 AUTHORIZED REPRESENTATIVE Fort Collins CO 80522 USA U 19BU-2015 ACUHU cUHPUHA I IUN. Ali rignts reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD