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HomeMy WebLinkAbout119979 QUALITY TRAFFIC CONTROL - INSURANCE CERTIFICATE (4)ACORD. CERTIFICATE OF LIABILITY INSURANCE OPJIDD BA DATE (MO1rc08) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LBN Insurance Agency 4848 Thompson Pkwy HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Johnstown CO 80534 Phone: 970-635-9400 Fax:970-635-9401 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA'. Mountain States Insurance Grp INSURERB: Pinnacol Assurance realityy Traffic Control, Inc. ike Obester 216 Racquette Drive #5 Fort Collins CO 80524 INSURER G. _ _. 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. INSR 0--'— ___. __._.__. _—_.._ ---- -"_-- POLICY EFFECTIVE- PO- LICY E%PIRATION "'-_... .____...._.._ LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MMIDDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE s500,000 A X COMMERCIAL GENERAL LIABILITY CPP 0095714-05 07/27/07 07/27/08 -DAMAGE RENT PREMSESO(Ea occuence) S100,000 CLAIMS MADE X OCCUR MED EXP (Any one person) S 10 , 000 PERSONAL B ADV INJURY s500,000 GENERAL AGGREGATE S1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS - COMPIOP AGG 51,000,000 POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accitlen) ALL OWNED AUTOS BODILY INJURY I SCHEDULED AUTOS (Per person) S HIREDAUTOS BODILY NON OWNED AUTOS accident) (Per accitlenQ S PROPERTY DAMAGE $ (Peraccidenl) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACHOCCURRENCE S OCCUR n CLAIMS MADE AGGREGATE S S DEDUCTIBLE- S RETENTION S S WORKERS COMPENSATION AND TORY LIMITS X EMPLOYERS' LIABILITY 3087822 04/01/08 04/01/09 __,I_,ER E.A.ACHACCIDENT S100000 ANY PROPRIETOR/PARTNER/EXECUTIVE ..._.---- __._ OFFICERIMEMBER EXCLUDEW E.L. DISEASE - EA EMPLOYEE S100000 It yes, describeunder ---'--"------'—'-- ---- - SPECIALPROVISIONSbel. EL DISEASE POLICY LIMIT S 500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS) VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS All Locations / Traffic Control Operations CERTIFICATE HOLDER CANCELLATION CITYOF3 SHOD LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN City of Fort Collins Attn: Purchasing Division 215 North Mason Street, 2nd F1 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 PO BOX 580 REPRESENTATIVES. Fort Collins, CO 80522 AUT I?d'DjLEdRESE ATIV u� ACORD 25 (200V08) © ACORD CORPORATION 1 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.