Loading...
HomeMy WebLinkAbout119979 QUALITY TRAFFIC CONTROL - INSURANCE CERTIFICATE (14)ACOR_D_„ CERTIFICATE OF LIABILITY INSURANCE OP ID BA UALI-6 DATE(MMIDDIYYYY) 04/13/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LEN 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 Phone:970-635-9400 Fax:970-635-9401 INSURERS AFFORDING COVERAGE NAIC# .._._..._.._ --._.._. INSURED ._._._ -- -__._ In INSURER A'. MOUntain StatesInsurance INSURERS Pinnacol Insurance 41190 pualityy Traffic Control, Inc. --- -� �--- — ---- --- ------ t31ke Obester INSURERC: 216 Racquette Drive #5 INSURER Fort Collins CO 80524 --- --- -.-- ----- INS INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUNEMENT, 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. INS _______ _ _-- POLICY EF'1; E�RyVE POLICY EXPIRAffOIT LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MMIDDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $500,000 A $ COMMERCIAL GENERAL LIABILITY cPP 00e5714 oe ce�I.en 07/27/08 04/07/09 PREMISES(Eaoccurence) $lOO,000 CLAIMS MADE _X OCCUR MED EXP (Any one person) $ 10 , 000 PERSONAL B ADV INJURY s500,000 GENERAL AGGREGATE $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMPIOP AGG S 1 , 000, 000 POLICY PRO- ECT D LOC AUTOMOBILE LIABILITY -- COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWN ED AUTOS BODILY INJURY _ SCHEDULED AUTOS (Per person) $ .._._. HIRED AUTOS BODILY INJURY NON OWNED AUTOS (Per accident) ___ S PROPERTY DAMAGE S (Peraccident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO — THAN EA ACC S AUTO O AUTO ONLY: AGG $�— EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ _ $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER_-_ B EMPLOYERS' LIABILITY 3087822 CANCELLED 04/01/09 04/01/09 EL EACH ACCIDENT $ 100000 ANY PROPRIETORIPARTNERIEXECUTIVE .....__. _..__-. OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE S 100000 If yes, describe under E.L. DISEASE POLICY LIMIT I S 500000 SPECIAL PROVISIONS below OTHER E-1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS All Locations / Traffic Control Operations CERTIFICATE HOLDER CANCELLATION CITYOF3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO! DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN City Of Fort Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL Attn: Purchasing Division IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 215 North Mason Street, 2nd F1 PO BOX 580 REPRESENTATIVES. Fort Collins, CO 80522 1 AUT RIK)IIEPRESE00fATIVE' nn .n is ��aitie.i Ili► 0611-41FAM 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. AMD. CERTIFICATE OF LIABILITY INSURANCE OP ID BA DATE (MMIDD/YYYY) PRODUCER UALI-6 09/13/09 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION LBN Insurance Agcy-Johnstown ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4848 Thompson Pkwy, Ste 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Johnstown CO 80534 Phone:970-635-9400 Fax:970 635-9401 INSURERS AFFORDING COVERAGE NAIC# INSURER A. Mountain States Insurance ualit Traffic Control, Inc. ike INSER8 Pinnacol Insu URrance --- -- --- ---- gljgp O ester 216 RacQuette Drive #5 INSURERC __-- ------ ---- ---- ------------ Fort Collins CO 80524 INSURER INSURER CnVFRAGCC _... 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- DD' --POLICTI EFFECTIVE POLICY EXPIRgT10 - —"'---_--"'- --'------'------ LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MMIDOIYV LIMITS GENERAL LIABILITY - EACH OCCURRENCE $500,000 A X COMMERCIAL GENERAL LIABILITY CPP 009571406 CANCeLLED 07/27/08 04/07/09 _ DrAMAGESO(Eaolcouence)—_$lOO, 000 CLAIMS MADE OCCUR MED EXP (Any one person) $ 10,000 -] PERSONAL B ADV INJURY $500,000 --------.---_—__—_._.._. GENERAL AGGREGATE S11000,000 ----------- -- GEN'L AGGREGATE LIMIT APPLIES PER PRO- PRODUCTS-COMPIOP AGG $1, 000, 000 POLICY JECT —_--- AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea aDCidenl) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON-OWNEDAUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Par accident) GARAGE LIABILITY AUTOONLY EAACCIDENT 5 ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO S EXCESSIUMBRELLA LIABILITY OCCUR [� CLAIMS MADE EACH OCCURRENCE $ - AGGREGATE $ 5 — DEDUCTIBLE 5 RETENTION S WORKERS COMPENSATION AND B EMPLOYERS' LIABILITY „-,_ TORY UMITS ER_— -- ANYPROPRIETORIPARTNER/EXECUTIVE 3087822 CANCELLED 04/01/09 04/01/09 E.L. EACHACCIDENT $100000 OFFICER/MEMBER EXCLUDED?--"'----------------- E.L. DISEASE - EA EMPLOYEE $j00000 I(yes,describeands, SPECIAL PROVISIONS below EL. DISEASE - POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS All Locations / Traffic Control Operations rcoTlnrnTC u11 n _ City of Fort Collins Purchasing Division P.O. Box 580 Fort Collins CO 80522 FTCOLLP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 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 REPRESENTATIVES. ACORD 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. CERTIFICATE OF LIABILITY INSURANCE OPUAIDL1-6 DATE(09/13/0913/09 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 Phone:970-635-9400 Fax:970-635-9401 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER Mountain States Insurance INSURER B: P.innacol Insurance 41190 _ puality Traffic Control, Inc. tNSURERC Mike Obester 216 RaogDiette Drive #5 INSURER _ _-- Fort Collins CO 80524 -- -- -__-- "-"- ----"----- ,.w crv.vw THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOT HE INSURED NAMED ABOVE FORT HE 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 D' -- POLICY EFFECTIVE- POLICY E7iPIRATION LIMITS LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MMIDDIYY EACH OCCURRENCE S500,000 GENERAL LIABILITY PREMISES (Eaoccurence) $-100,000 A X. COMMERCIAL GENERAL LIABILITY CPP 009571406 cANCELLso D7/27/DB O4/07/09 MED EXP (Any one person) $ 10,000 CLAIMS MADE L"J OCCUR -.� PERSONAL &ADV INJURY 55OO, ODD _ GENERAL AGGREGATE S1,000,000 GEN-L AGGREGATE LIM IT APPLIES PE R: PRODUCTS COMPIOP AGO S1,,000, 000 POLICY PEROCT LOC J AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALLOWNEDAUTOS BODILY INJURY S - (Per person) SCHEDULED AUTOS --- HIREDAUTOS BODILY INJURY S -- (Per accident) NON OWNED AUTOS _ PROPERTY DAMAGE $ ------ '---- (Per accident) -- GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $ - AUTO ONLY'. AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR Cl CI -AIMS MADE AGGREGATE S S S DEDUCTIBLE I RETENTION S $ WORKERS COMPENSATION AND ___"TORY LIMITS-„__ EMPLOYERS'LIABILITY 3087822 CANCELLED 04/01/09 04/01/09 EL EACH ACCIDENT $100000 B ANY PROPRIETOR/PARTNERIEXECUTIVE -_ EA EMPLOYEE -_ $100000 OFFICER/MEMBER EXCLUDED? E.L. DISEASE � If yes describe under El. DISEASE. POIICY LIMIT S 500000 SPECIAL PROVISONS below — 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 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR City of Fort Collins 300 LaPorte Ave REPRESENTATIVES. Fort Collins CO 80522 AUT4111RI E RESE ACORD 26 (2001108) �,J © ACORD CORPORATION 1988 nIT, Igo] 4rd1kq III � 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.