HomeMy WebLinkAbout119979 QUALITY TRAFFIC CONTROL - INSURANCE CERTIFICATE (5)ACORV, CERTIFICATE OF LIABILITY INSURANCE OPID BA DATE (MMIDDI
UALI-6 04 O1 08 08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO
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 A: Mountain States Insurance Grp
INSURER B: Pinnacol Assurance
QQuality Traffic Control, Inc. INSURER b3Ike Obester
216 Racquette Drive #5 INSURER
Fort Collins CO 80524 --- -- -- ---- -
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.
BIER DD'----"--_-_--" --"-"-'"" '---"—"--"'"'----- POLICY EFFECTIVE POLICY EXPIRATION ------__-_-- --....-. --
LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MMIDDIVV LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
S500,000
A
.__.
$ COMMERCIAL GENERAL LIABILITY
CPP 0095714-05
07/27/07
07/27/08
DAMAGE DEEMED---
PREMISES (Ea oeourence)
- —----_--_--.____
5100,000
-J CLAIMS MADE $� OCCUR
MED ESP (Any one person)
S 10,000
PERSONAL B ADV INJURY
$500,000
GENERAL AGGREGATE
$1,000, 000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGO
S1, 000, 000
POLICY PRJFCTO LOG
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO
(Ea accident)
S
--
ALL OWNED AUTOS
BODILY
SCHEDULED AUTOS
(Per
(Per person)
person)
5
—
HIRED AUTOS
BODILY
NON -OWNED AUTOS
(Per aceitlenl)
(Per
S
PROPERTY DAMAGE
$
(Per acbrouB
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
—
THEA ACC
OTHER
5
AUTO ONLY.
AUTO ONLY: AGG
5
ESSIUMBRELLA LIABILITY
EACH OCCURRENCE
S
CLAIMS MADE
7_1
__—.-..._..00CUR
AGGREGATE
S
DEDUCTIBLE
S
RETENTION S
- _ -_-� -� -
S
WORKERS COMPENSATION AND
TORYU ERR
X
EMPLOYERS' LIABILITY
3087822
04/01/08
04/01/09
FI EACH ACCIDENT
-- ------
ANY PROPRIMBERIP IEXECUI'IVIi
$100000
EXCLUDED'
/MEenR E%CLUDED4
Oyes,
A --�
C L DISEASE EA EMPLOYE
_
-- -
S 100000
de
If Yes, describe under
-
SPECIAL PROVISIONS below
EL DISEASE -POLICY LIMIT
1 $500000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
All Locations / Traffic Control Operations
CITYFOR
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL
City Of Fort Collins
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
300 LaPorte Ave
REPRESENTATIVES.
Fort Collins CO 80522
AUT II1�ylE�RESE ATIV.
—,""". v 1 (D ACURD 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.