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HomeMy WebLinkAbout260459 PLAY POINTE LLC DBA FORT FUN - INSURANCE CERTIFICATE (7)DATE (MM/DD/YYYY) A4 "R" CERTIFICATE OF LIABILITY INSURANCE 7i3i2018 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 En ram Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX 1515 Fortino Blvd Suite 200 AA/c No Ext : 719-544-1111 ac No): 719-545-5120 Pueblo CO 81008 E-MAIL Robin EngramiMaia.com INSURED Play Pointe, LLC dba Fort Fun Fort Fun 1513 E. Mulberry Fort Collins CO 80524 PLAYPOI-01 AFFORDING COVERAGE INSURER A: T.H.E. Insurance Cc INSURERS: Pinnacol Assurance INSURER D : INSURER F : COVERAGES CERTIFICATE NIIMRFR-17371553Fi9 REVISION NIIMRFR- NAIC If 12866 41190 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. IN8R I TYPE OF INSURANCE POLIO EFF POLICY EXP LIMITS TR POLICY NUMBER MM/DD/YYYY MMIDD/YYY A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR AGGREGATE LIMIT APPLIES PER: POLICY 1-1JECOT- LOC OTHER: CPP0104255-04 7/1/2018 7/1/2019 EACH OCCURRENCE $1,000,0o0 -DAMAGE TO RENT PREMISES Ea occurrence $100,000 MED EXP (Any one person) $ 0 PERSONAL & ADV INJURY $1,000,0D0 GEN'L GENERAL AGGREGATE $1,000,000 X PRODUCTS - COMP/OP AGG $1,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY CPP0104255-04 7/1/2018 7/1/2019 COMBINED SINGLE LIMIT Ea accident $1000000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTYDAMAGE Per accident $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CPP0104255-04 7/1/2018 7/1/2019 EACH OCCURRENCE $2,000,000 AGGREGATE $ 2,000,000 DE D RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTIONOFOPERATIONS.below N / A 4032913 911/2017 9/1/2018 X I PER OTH- STATUTE ER E.L. EACH ACCIDENT $100,000 E.L. DISEASE - EA EMPLOYEE $100,000 $500,ODD E.L.. DISEASE -POLICY LIMIT 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