HomeMy WebLinkAbout105396 TRAFFIC MASTERS - INSURANCE CERTIFICATE (5)ACORD- CERTIFICATE OF LIABILITY INSURANCE 08/0DATE
/07D/YYYY)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood 81 Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
4821 Wheaton Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P O Box 270370 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fort Collins, CO 80527 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURERA: National Fire & Marine Insurance Co.
Traffic Masters, Inc. INSURERS: Illinois Union
1304 Duff Drive #14 INSURERC: Pinnacol Assurance
Ft. Collins, CO 80524 INSURER D: Travelers Insurance Companv
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DDIYY
POLICY EXPIRATION
DATE MMIDD/YY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
72LPS006107
08/03/07
08/03/08
EACH OCCURRENCE
$1 000 000
DAMAGE TO RMISES (E.ENTED
$100 000
MED EXP (Any one person)
$5 000
PERSONAL & ADV INJURY
$1 000 000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO LOC
POLICY 7 JECT
PRODUCTS - COMP/OP AGG
s2,000,000
D
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
BA6547C34107EL
07/14/07
07/14/08
COMBINED SINGLE LIMIT
(Ea accident)
$1000 r00 0
X
BODILY INJURY
(Per person)
$
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
I
GARAGE LIABILITY
EANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
_
$
$
B
EXCESS/UMBRELLA LIABILITY
X1 OCCUR CLAIMS MADE
DEDUCTIBLE
X RETENTION $ 10000
N04276450
08/03/07
08/03/08
EACH OCCURRENCE
$1 000 000
AGGREGATE
$1 00O 000
$
$
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
4058170
06/01/07
06/01/08
oTH-
X WC STATU- I ER
E.L. EACH ACCIDENT
$500,000
E.L. DISEASE - EA EMPLOYE1
$500,000
E.L. DISEASE - POLICY LIMIT
$500 000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
City of Ft. Collins is listed as Additional Insured where their interest
may appear.
�� �.rA19l.CLLA 11Vry
City of Fort Collins
ATTN: Purchasing
PO Box 580
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL '-In DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZE0 REPRESENTATIVE
mq,vmu co (cuullua) 1 of 2 #M389477 KLB 0 ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
--W-U zu-'J JLVV 1/Vol Z of Z OM339477
SHELTER INSURANCE, COMPANIES
1817 WEST BROADWAY
COLUMBIA, MISSOURI 65218-0001
® 1-800-SHELTER
002299 ODECO73107 =
#003561297
CITY OF FORT COLLINS
PO BOX 580
FORT COLLINS CO 80522-0580
POLICY NUMBER: 05-31-003561297-0003
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