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HomeMy WebLinkAbout119979 QUALITY TRAFFIC CONTROL - INSURANCE CERTIFICATE (19)pa�pdtxU4a $ A L�i'� iTAB TY URS "C PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Pinnacol Assurance AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 7501 E Lowry Blvd CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE DENVER CO 80230-7006 AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE MPANY A Pinnacol Assurance ENSURED COMPANY QUALITY TRAFFIC CONTROL INC B 216 RACQUETTE DRIVE #5 COMPANY FORT COLLINS CO 80524 C MPANY 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 AND CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES MAY BE DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF ESSURANCE POLICY NUMBER POLICY EFPECTNE POLICY EXPIRATION LIMITS LTR DATE ®I DATE m GENERAL LIABILITY GENERAL AGGREGATE COWAERCL . GENERAL LIABILITY PRODUCTS -COMPIOPAOO CLAIMSMADE ❑ OCCUR PERSONAL & ADV EIURY OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE FIRE DAMAGE ( me fue MED EXP . MIM AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LLNTT ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS HIRED AUTOS BODILY EtOAY NON -OWNED AUTOS aaiEm PROPERTY DAMAGE GARAGE LLABEITY AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY ....................................... EACH ACCIDENT AGGREGATE EXCESS LIABILITY EACH OCCURRENCE UMBRELLA PORM AGGREGATE OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND xi WCSTATU- OTHER ':! EMPLOYERS, LIABILITY TORY LIHITS' A 3087822 04/01/2005 04/01/2006 EL EACH ACCIDENT $100, OOO THB PROPRETORIPARTNERSI INCL EL DISEASE - POLICY LIMTT 5500.WO EXECUTNH OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE $100,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNERICLESISPECIAL TTEME SEE BACK OF CERTIFICATE FOR CLASS COVERAGE AND OWNERSHIP COVERAGE DETAIL Ror 824318 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE THE CITY OF FORT COLLINS EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL PURCHASING DEPARTMENT DIVISION 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 215 N MASON STREET BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 2ND FLOOR LIABILITY OF ANY HIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES. FORT COLLINS CO 80524 AUTHORIZED REPRESENTATIVE Charles Doggett Underwriter BULVIRTS CSR S3ppm M"105 W:51:27 508782211,&W: 1211511W 12:00:W M135 CERTIFICATE HOLDER COPY THE CITY OF FORT COLLINS PURCHASING DEPARTMENT DIVISION 215 N MASON STREET 2ND FLOOR FORT COLLINS CO 80524 POLICY NUMBER: 3087822 BUSINESS LOCATION: QUALITY TRAFFIC CONTROL INC CLASSIFICATION OF OPERATION CLASS DESCRIPTION COVERAGE COVERAGE RATING EFFECTIVE EXPIRES TYPE 550605 STREETIROAD CONST: PAVING OR REPAVING & DRIVERS O4101/2005 04/01/2006 EM ACM CERTIFICATE OF LIABILITY INSURANCE OP ID p UA1I-6 DATE(MM/DDNYYY) 08 30 04 PRODUCER Linden/Bartels 6 Noe Agency FC 1614 Oakridge Drive, Unit A Fort Collins CO 80525 Phone : 970-229-9304 Fax : 970-229-1398 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED RQuality Traffic Control, Inc. Flike Obester 216 RaCquette Drive 5 Fort Collins CO 8052 INSURERA: Mountain States Insurance Grp INSURER B: INSURER C: 1 INSURER D: 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 DATE MMIDD/YY RATION DATE MM/DD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE K OCCUR CGL009571402 07/27/04 07/27/05 EACH OCCURRENCE $ 500 , 000 LU PREMISES (Ea ooccrcurence) $100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY s500,000 GENERAL AGGREGATE $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JERC LOC PRODUCTS-COMP/OP AGG $1,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO 1 AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? l yes, describe under SPECIAL PROVISIONS below TORY LIMITS I ER ' E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT I $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS All Locations / Traffic Control Operations CERTIFICATE HOLDER CANCELLATION FTCOLLP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of Fort Collins Purchasing Division IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR P.O. BOX 580 REPRESENTATIVES. AU RIZ REPRES C�+Y-� Fort Collins CO 80522 ACORD 25 (2001108) © ACORD CORPORATION 1988