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HomeMy WebLinkAbout119979 QUALITY TRAFFIC CONTROL - INSURANCE CERTIFICATE (13)acoRD CERTIFICATE OF LIABILITY INSURANCE OP ID BA DATE (MM/DD/YYYY) UAL-6 03 24 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LBN Insurance Agcy-Johnstown HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4848 Thompson Pkwy, Ste 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Johnstown. -CO 80534 m Phone:970-635-9400 Fax:970-635-9401 INSURERS AFFORDING COVERAGE- NAIL# INSURED INSURER A: Mountain States; :Insurance INSURER a Pinnacol Insurance 41190 Quality Traffic Control, Inc. INSURERI Mike Obester" ..216 Racquette Drive #5 —"" Fort. Collins CO 80524 INSURER D: 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.POLIC - LTR NSR TYPE OF INSURANCE POLICY NUMBER DATEYMMIDD/YY E PDATEY MMIDD/YYON LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 500,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE I-X-1 OCCUR CPP 009571406 07/27/08 07/27/09 PREMISES(Eaoccurence) $100,000 MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $ 1,000,000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS - - BODILY INJURY (Per person) - $ , 'HIRED AUTOS .. •.... ... .. - . - . . - - -_ .. -. _ ' _ - INJURY NON -OWNED AUTOS - --'-"' -- - _BODILY (Per accident) .x. �. PROPERTY DAMAGE (Per accident) GARAGE LIABILITY •' '• "' AUTO ONLY -EA ACCIDENT $ ... ANY -AUTO-._...._ -_._ _ .. ..... _.. . _. .._ - _ .. ._ --- .. _. OTHER THAN EA ACC $ $ AUTO ONLY: AGG ' EXCESS/UMBRELLA LIABILITY . • EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE $ $ ' DEDUCTIBLE - - - - RETENTION $ $ B WORKERS COMPENSATION ANDWC EMPLOYERS' ANY PROPRIETORIPARTNER/EXECUTIVE 3087822 04 /01 /09 04/01/10 TORY LIMITS ER E.L. EACH ACCIDENT Is lOOOOO OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYEE $ 100000 E.L. DISEASE - POLICY LIMIT I $ 500000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS All Locations / Traffic Control Operations CERTIFICATE HOLDER CANCELLATION 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 SO 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 1 AUTdAlgPAIEVRESEWTIVE. _ I-- `" 1--.1 ©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.