HomeMy WebLinkAbout119979 QUALITY TRAFFIC CONTROL - INSURANCE CERTIFICATE (3)ACORD UALI-CERTIFICATE OF LIABILITY INSURANCE OP ID 6 P DATE( 08 06 07/06/07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
LBN Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4848 Thompson Pkwy ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Johnstown CO 80534
Phone:970-635-9400 Fax:970-635-9401 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER Mountain states insurance Ge,
INSURERS Pinnacol Assurance
Q=alit Traffic Control, Inc. INSURER C
Hike Oybester
216 Racguette Drive N5 INSURER D
Fort Collins CO 80524 ---
[HUTI
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
N3R
TYPE OF INSURANCE
POLICY NUMBER
FEC
DATEYNM/DDMIE
PULICY DATE MNVDD/Y1�NMan
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$500 r 000
A
X COMMERCIAL GENERAL LIABILITY
CPP 0095714-05
07/27/07
07/27/08
PREMISESEaoccurence)
E100,000
CLAIMS MADE � OCCUR
E 10,000
MED EXP (Any one person)
PERSONAL BADV INJURY
E 500 r 000
GENERAL AGGREGATE
$1 r 000 r 000
GENT AGGREGATE LIMIT APPLIES PER
PRODUCTS - COMPIOP AGG
$SrOOOr OOO
POLICY PRO JECTLOG
--
-_ -
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
$
ANY AUTO
(Ea accident)
BODILY INJURY
ALL OWNED AUTOS
SCHEDULED AUTOS
(Per person)
$
BODILY INJURY
HIRED AUTOS
E
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
$
LPer-ecomenp
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
E
OTHER THAN EA ACC
$
ANY AUTO
E
AUTO ONLY AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
E
OCCUR CLAIMS MADE
AGGREGATE
E
E
_
$
DEDUCTIBLE
Is
RETENTION $
WORKERS COMPENSATION ANO
Twc LIMITS ER
X
EMPLOYERS' LIABILITY
3087822
04/01/07
04/01/08
E100000
E.L. EACH ACCIDENT
ANY PROPRIETOR/PARTNER/EXECUTIVE
OISEASE-EA EMPLOYEE
S SOOOOO
OFFICER/MEMBER EXEXCLUDED'EL
Uyes, Descr..be LF
be
--
EL DISEASE -POLICY LIMIT I ESOOOOO
SPECIAL PROVISIOISIONSbelow
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
All Locations f Traffic Control Operations
CERTIFICATE HOLDER CANICFI I ATInN
FTCOLLP
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
City
of Fort Collins
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Purchasing Division
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O.
BOX 580
REPRESENTATIVES.
Fort
Collins CO 80522
AU R REPRE T ^ C
^"�^•� e.. T..... •eel UAUUKU UUKYUKAI IUN 1980
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.