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HomeMy WebLinkAbout260459 PLAY POINTE LLC DBA FORT FUN - INSURANCE CERTIFICATE (6)A�!��® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 8/7/2017 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 NAME: Robin En ram Arthur J. Gallagher Risk Management Services, Inc. PHONE 719-544-1111 FAx 719 545-5120 1515 Fortino Blvd, Suite 200 E-MAIL Pueblo CO 81008 ADDRESS; Robin_Engram@ajg.com INSURER(S) AFFORDING COVERAGE NAIC # _ INSURER A:T.H.E.Insurance Company 12866 INSURED INSURER B: Pinnacol Assurance Company _ 41190 Play Pointe, LLC INSURERC: Fort Fun 1513 E. Mulberry INSURER D Fort Collins CO 80524 INSURER E rnWIZDA(]rc rCDTIFIrATF IUIIMRFD• 1332791039 D9z11IRI01U 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - INSR TYPE OF INSURANCE R-- POLICY EFF POLICY EXP LIMITS LTR WVD POLICY NUMBER MMIDDJYYYY MMIDD/YY A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1 X OCCUR CPP0104255-03 7/1/2017 7/1/2018 EACH OCCURRENCE $1,000,000 PREMISS (Ea occurrence MED EXP (An one person) PERSONAL & ADV INJURY $100,000 $ $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT [�] LOC OTHER: GENERAL AGGREGATE $ 2,000,000 %( PRODUCTS - COMP/OP AGG $1,000,000 Employee Benefi $1,000,000 A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY CPP0104255-03 7/1/2017 711/2018 Ea accidern $1,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) OPEIITY� JPeraccid_ent_ $ $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ELP0011671-03 7/1/2017 7/1/2018 EACH OCCURRENCE $2,000,000 AGGREGATE $2,000,000 DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y /N OFFICER/MEMBER EXCLUDED? �N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4032913 9/1/2017 9/1/2018 H X 1 PESTATUTE ER E.L. EACH ACCIDENT $100000 E.L. DISEASE - EA EMPLOYE $100000 E.L. DISEASE -POLICY LIMIT 1 $500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is named as an Additional Insured. lrrDTlClr` ATr unI nrD CANr f:l I ATInN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins Purchasing Division THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 580 Fort Collins CO 80522 USA AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AC� ® DATE (MMIDD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 7/27/2017 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 NAME: Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX 1515 Fortino Blvd, Suite 200 No, E,) 719-544-1111 (arc. No): 719-545-5120 Pueblo CO 81008 ADDRESS; INSURER AFFORDING COVERAGE NAIL B INSURER A:T.H.E.Insurance Company 12866 INSURED INSURER a:PInnacol Assurance Company 41190 Play Pointe, LLC INSURERC: Fort Fun 1513 E. Mulberry INSURERD: Fort Collins CO 80524 INSURERE: INSURER F : cnvFRAr.Fc r97DTICICAT9: All IRAMCD. 1 A7n7RriRl S w111RAOCn. 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 TYPE OF INSURANCE POLICYEFF POLICY EXP LIMITS LTR i INSD WV POLICY NUMBER MM/DDIYYYY MM/DDNYYY A X COMMERCIAL GENERAL LIABILITY Y CPP0104255-03 7/1/2017 7/1/2018 EACH OCCURRENCE $1,000,000 To KEN I LU PREMISES Ea occurrence E 100,000 CLAIMS -MADE ^ i OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X PPRO- ❑ POLICY JECT LOC PRODUCTS - COMP/OPAGG $1,000,000 Employee Benefi _ $1,000,000 OTHER: A AUTOMOBILE LIABILITY CPP0104255-03 7/1/2017 7/1J2018 Eaaccide.BINED $1,000,000 BODILY INJURY (Per person) ANY AUTO - -- f OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY BODILY INJURY (Per accident) $ — $ X Per accident) E A X UMBRELLA LIAB X OCCUR ELP0011671-03 7/1/2017 7/1/2018 EACH OCCURRENCE $2,000,000 AGGREGATE - - $2,000,000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N NIA 4032913 9/1/2016 9/1/2017 X PE OTH- STATUTE ER L. EACH ACCIDENT E $100000 E.L. DISEASE - EA EMPLOYE $100000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $500000 i 1 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. I.CK 1Irn m1t rlVLUCK GANGtLLAI IUN City of Fort Collins Purchasingg 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 All 1!1W14,1, _4�1�_ f © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD A ® DATE (MM1DDfYYYY) CERTIFICATE OF LIABILITY INSURANCE 8/712017 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 riahts to the certificate holder in lieu of such endorsement(s). PRODUCER 4rthur J. Gallagher Risk Management Services, Inc. 1515 Fortino Blvd, Suite 200 pueblo CO 81008 INSURED Play Pointe, LLC Fort Fun 1513 E. Mulberry Fort Collins CO 80524 ill. 719-544-1111 Robin_EngramCc 719-545-5120 INSURER AFFORDING COVERAGE NAIC # INSURER A : T. H. E. Insurance Company 12866 I INSURER a,Pinnacol Assurance COmDanv 141190 INSURER E: rnvrDAr_cc r`rDTIrIf ATr wIIIA017D. 1332791039 DrVICInNI NI IMRFD- 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 AUUL INSD 5UBR WVD POLICY NUMBER POLICY EFF DIYY POLICY EXP MWDD/YY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51 OCCUR CPP0104255-03 7/1/2017 7/1/2018 EACH OCCURRENCE _ $1,000,000DAMAGE $100,000 S $1,000,000 TO RENTED PREMISES Ea occurrence MED EXP (Any one person) PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JPER _ LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OPAGG $1,000,000 Employee Benefi $1,000,000 A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY CPP0104255-03 7/112017 7/1/2018 COMBINED SINGLE Li (Ea accident) $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Alper accident $ S A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ELP0011671-03 7/1/2017 7/1/2018 EACH OCCURRENCE $2,000,000 AGGREGATE 52,000,000 DED RETENTIONS $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECU I IV Y❑ OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A' 4032913 9/1/2017 9/1/2018 X STATUTE ERH E.L. EACH ACCIDENT -- $100000 E.L. DISEASE - EA EMPLOYE $100000 E.L. DISEASE - POLICY LIMIT $500000 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. CER I IF IGA I E HOLDER GAIVGELLA I IUN 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 (2016103) The ACORD name and logo are registered marks of ACORD ACoR" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 7/27/2017 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 NAME: Arthur J. Gallagher Risk Management Services, Inc. PHONE 719 544 1111 FAX 719-545-5120 1515 Fortino Blvd, Suite 200 MAIL Pueblo CO 81008 ADDRESS INSURED Play Pointe, LLC Fort Fun 1513 E. Mulberry Fort Collins CO 80524 INSURER(S) AFFORDING AJ.H.E. Insurance Comp, B:Pinnacol Assurance Coi C: INSURER E : rnVGDAGFC r DTIPICATG IUI IMRFG• 1470786815 DFVICIrIIU NIIMRFD- NAIC # 2866 1190 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 IN WVD POLICY NUMBER POLICY EFF MWDDIYYYY POLICY EXP MMIDDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X❑ OCCUR Y CPP0104255-03 7/1/2017 7/1/2018 EACH OCCURRENCE $1,000,000 PREMISES Ea occurrence E100,000 MED EXP (An one person) $ PERSONAL & ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: X POLICY PRO- ❑ JECT LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS •COMP/OP AGG E1,000,000 Employee Benefi $1,0oo,000 A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON OWNED AUTOS ONLY X AUTOS ONLY CPP0104255-03 7/1/2017 711/2 118 COMBINED $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAG� Per accident $ E A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ELP0011671-03 7/1/2017 7/1/2018 EACH OCCURRENCE $2,000,000 AGGREGATE $2.000,000 DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4032913 9/1/2016 9/1/2017 X OTH- STATUTE ER E.L. EACH ACCIDENT $100000 E.L. DISEASE - EA EMPLOYE — $100000 E.L. DISEASE - POLICY LIMIT $500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is named as an Additional Insured. CER 1IFIGAI E HULUER GANGELLAI IUN 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 R © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD