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HomeMy WebLinkAbout260459 PLAY POINTE LLC DBA FORT FUN - INSURANCE CERTIFICATE (8)ACORO0 DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE F7/27/2017 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 endorsements . PRODUCER CONTACT _ _ Arthur J. Gallagher Risk Management Services, Inc. NAME: ONE — �FAX 1515 Fortino Blvd, Suite 200 Ne �719-544-1111 A1 PHcNot, 719-545-5120 E-MAIL Pueblo CO 81008 ADDRESS - INSURED Play Pointe, LLC Fort Fun 1513 E. Mulberry Fort Collins CO 80524 INSURERS AFFORDING COVERAGE NAIC k INSURER A:T.H.E.Insurance Company 12866 INSURER B : Pinnacol Assurance Company 41190 INSURER D : R(IVFPAnFC CFRTIFIr-ATF fW IMRFR- 1470786815 AF11ICIr11U NI IMRFR- 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 15 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 INSD WVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EX� MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X❑ OCCUR Y CPP0104255-03 7/1/2017 7/1/2018 EACH OCCURRENCE $1,000,000 PI PREMISES Ea occurrence) $100,000 MED EX (An)Lne person) $ PERSONAL & ADV INJURY $1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: PRO. PRO - POLICY c LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $1,0001000 Employee Benefi — $1,000,000 A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY IX AUTOS ONLY CPP0104255-03 7/1/2017 7/1/2016 Ea accident $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ $ X �ROPERTP Per accident) $ A X EXCESS LIAB UMBRELLA LIAiL OCCUR CLAIMS -MADE ELP0011671-03 7/1l2017 7/1/2018 EACH OCCURRENCE $2,000,000 AGGREGATE $2,000,000 DED RE $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4032913 9/1/2016 9/1/2017 X STATUTE ERH E.L. EACH ACCIDENT -- $100000 E.L. DISEASE - EA EMPLOYE $100000 E.L. DISEASE - POLICY LIMIT - $500000 I � 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. CERTIFICATE HOLDER CANCELLATION City of Fort Collins Purchasing Division P.O. Box 580 Fort Collins CO 80522 USA 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 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD