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HomeMy WebLinkAbout260459 PLAY POINTE LLC DBA FORT FUN - INSURANCE CERTIFICATE (4)A�� DATE (MM/DD/YYYY) � CERTIFICATE OF LIABILITY INSURANCE 7/1/2015 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 CONTACT Carlie Genova NAME: _ CENTENNIAL INSURANCE AGENCY, LLC. PHONE (719)544-1111 FAx (719)545-5120 (A/C, No, M; _- (A/C, No): 1515 Fortino Blvd. 2nd Floor E-MAIL ADDRESS: cgenova@centennial-ins.com INSURER(S) AFFORDING COVERAGE NAIL / Pueblo CO 81008 INSURERA:THE Insurance Company_ INSURED INSURERB:Pinnacol Assurance 41190 Play Pointe, LLC, DBA: Fort Fun INSURERC: 1513 E . Mulberry INSURER D : INSURER E : Fort Collins CO 80524 INSURERF: COVERAGES CERTIFICATE NLJMRFR-15-16 RFVISION NIIMRFR- 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 DADA DL'.SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER M D/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE -1 OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) 50 OOO $ , X Manufacturers and X CPP0104255-01 7/1/2015 7/1/2016 MED EXP (Any one person) _ $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ,PRO LOC JECT PRODUCTS - COMP/OPAGG $ 1,000,000 OTHER Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIrr$ ;SEa accident) _-_— -- $ A ANY AUTO LBOIDILY INJURY (Per person) ALL OWNED SCHEDULED AUTOS AUTOS CPP0104255-01 7/1/2015 7/1/2016 BODILY INJURY (PeraccideM) $ X NON -OWNED PROPERTY DAMAGE _ $ - HIRED AUTOS AUTOS .(Per accident) XI I HIRED & NON -OWNED AUTO $ 1,000,000 X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 2 000 000 --- A EXCESS LIAR - _ _ CLA_I_MS-MADE. AGGREGATE $ 2,000,000 DED (RETENTION$ ELP0011671-01 7/1/2015 7/1/2016 $ WORKERS COMPENSATION P OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE t ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.LEACH ACCIDENT $ ZOO 000 OFFICER/MEMBER EXCLUDED? ] N f A _--- _- B (Mandatory in NH) 4032913 9/1/2014 9/1/2015 E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under - _-- _1-� — DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 I 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. CtK I IFICA I t HULUtK CANCELLATION City of Fort Collins Purchasing Division P.O. 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 rk Swanson/CARLIE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)