HomeMy WebLinkAboutJ A SAFETY SIGN INC - INSURANCE CERTIFICATEClient#- 27625
T12AIUA
ACORD.M CERTIFICATE OF LIABILITY INSURANCE
DATE
,,,8/0/DD/VYYY)
05/28l04
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Insurance Inc
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
9351 Grant Street, Suite 600
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Thornton, CO 80229
720 977-7110
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
INSURERA: EMC Insurance Company
J & Safety &Sign, Inc.
INSURERB: Pinnacol Assurance
dba: Traffic Masters, Inc.
1304 Duff Drive #14
INSURER C:
INSURER D:
Ft. Collins, CO 80524
INSURER E:
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
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MWDD/YY
POLICY EXPIRATION
ATE MM/D
LIMITS
A
GENERAL LIABILITY
2D70977
05/30/04
05/30/05
EACH OCCURRENCE
$1 000 000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
DAMAGE TO RENTED
a10D Ot)t)
MED EXP (Any one person)
$5 D00
PERSONAL & ADV INJURY
$1 000 000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
—IJPOLICY
PRODUCTS - COMP/OP AGG
$2 000 000
PEa LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
2E70977
05130/04
05/30/05
COMBINED SINGLE LIMIT
(Ea accident)
$1,OOD,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
HIREDAUTOS
NON -OWNED AUTOS
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
EXCESS/UMBRELLA LIABILITY
X OCCUR CLAIMS MADE
2J70977
05/30/04
05/30/05
EACH OCCURRENCE
$1 000 000
AGGREGATE
$1 000 D00
a
DEDUCTIBLE
X RETENTION $ 10000
$
B
WORKERS COMPENSATION AND
4058170
06/01104
06101/05
MITWC STATU- I OTH-
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$100000
ANY PROPRIETORtPARTNEILEXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
E.L. DISEASE - EA EMPLOYEE
$100 000
E.L. DISEASE - POLICY LIMIT
$500,000
SPECIAL PROVISIONS below
A
OTHER Commercial P
2A70977
05/30/04
05/30/05
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.
CITY OF FT. COLLINS
PURCHASING DEPARTMENT
ATTN: JOHN STEPHEN
PO BOX 580
FT. 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
AUTHORIZED REPRESENTATIVE
. i.... M.
r Ur c /HInLBJ 1 ov MXB 0 ACORD CORPORATION 1988