HomeMy WebLinkAbout375464 DAVINCI SIGN SYSTEMS - INSURANCE CERTIFICATE (3)ACORDTM CERTIFICATE
OF LIABILITY INSURANCE
1DATE 2/15/05Dnvvv)
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Insurance Inc
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
4821 Wheaton Drive
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P O Box 270370
Fort Collins, CO 80527
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
INSURER A: Continental Western Group
DaVinci Sign Systems, Inc.
INSURER B: Pinnacol Assurance
132 Commerce Drive
INSURER C:
Fort Collins, CO 80524
INSURER D:
INSURER E
COVFRAGFS -
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
PDATEYMMIDDnVE
POLICY
DATE EXPIRATION
LIMITS
A
GENERAL LIABILITY
CWP256262221
04/01/05
04/01/06
EACH OCCURRENCE
$j 000000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE O OCCUR
PREMGE TO (Ean
$100 000
MED EXP (Any one person)
$5 000
PERSONAL 8 ADV INJURY
$1 000 000
X PD Ded:500
GENERAL AGGREGATE
s2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
s2,000,000
X POLICY MPRI El LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
CWP256262221
04/01/05
04/01/06
COMBINED SINGLE LIMIT
(Ea accident)
$1 000 ,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULEDAUTOS
X
BODILY INJURY
(Per accident)
$
HIREDAUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
EXCESS/UMBRELLA LIABILITY
CU256964520
04/01/05
04/01/06
EACH OCCURRENCE
$2000000
X1 OCCUR CLAIMS MADE
AGGREGATE
s2,000,000
$
DEDUCTIBLE
$
RETENTION $ O
B
WORKERS COMPENSATION AND
4081336
05/01/05
05/01/06
X WC STATU- OTH-
ITO LIMITS ER
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$100,000
E.L. DISEASE - EA EMPLOYEd
$100,000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
I $500,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
RE: Lincoln Center Box Office Marquee
Certificate Holder is listed as an Additional Insured as their interest
may appear as respects General Liability.
City of Fort Collins
Purchasing Dept.
Attn: John Stephen
PO Box 580
Fort Collins, CO 80522
LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 'I0_ DAYS WRITTEN
E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08) 1 of 2 #S332997/M331719 JZS o 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.
ACORD 25-S (2001/08) 2 of 2 #S332997/M331719