HomeMy WebLinkAbout110520 TRAFFIC SIGNAL CONTROLS - INSURANCE CERTIFICATE (5)02/092010 15:27 303-776-2940 Gigi Case Page 2/2
CERTIFICATE OF LIABILITY INSURANCE
American Family Insurance Company ❑
American Family Mutual Insurance Company if selection box is not checked.
6000 American Pky Madison, Wisconsin 53783-0001
Insured's Name and Address Agent's Name, Address and Phone Number (Agt./Dist.)
Traffic Signal Controls Inc
255 Weaver Park Rd
Longmont, CO 80504
Cindi A Johnson -Armitage (303) 776-9870
923 Main Street
Longmont, CO 80501 (192/309)
This certificate is issued as a matter of information only and confers no rights upon the Certificate Holder.
This certificate does not amend, extend or alter the coverage afforded by the policies listed below.
_... ....
COVE. RAGES
This is to certify that 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 respell to which this certificate may be issued a may pertain, the insurance afforded by the polices described herein is subject to all the terms, exdusions, and conditions of such policies.
TYPE OF INSURANCE
POLICY NUMBER
LIMITS OF LIABILITY
EFFECTIVE EXPIRATION
(Mo. Day, Yr) (Mo Day, Yr
Homeowners!
Bodily Injury and Properly Damage
Mobilehomeowners Liability
Each Occurrence $ 000
Boatowners Liability
Bodily Injury and Property Damage
Each Occurrence $ '000
Personal Umbrella Liability
Bodily Injury and Property Damage
Each Occurrent $ '000
Farm Liability & Personal Liablily
Farm/Ranch Liability
Each Occurrence $ '000
Farm Employer's Liability
Each Occurrence $ 000
Workers Compensation and
Statutory
Each Accident $ 000
Employers Liability t
Disease - Each Employee $ '000
Disease -Policy Limit $ '000
General Liability
General Aggregate $ 2,000 000
Products - Completed Operations Aggregate $ 000
(M Commercial General
Liability (occurrence)
❑
05-X46565-02-00
6/24/2009
6124/2010
Personal and Advertising Injury $ 1,000 000
Each Occurrence $ 1,000 ,000
❑
Damage to Premises Rented to You $ 100 000
Medical Expense (Any One Person) $ 5 000
Businessowners Liability
Each Occurrencet t $ '000
Aggregatett $ '000
Liquor Liability
Common Cause Limit $ '000
Aggregate Limit $ '000
Automobile Liability
Bodily Injury - Each Person $ '000
❑ Any Auto
❑ All Owned Autos
Bodily Injury - Each Accident $ 000
❑ Scheduled Autos
❑ Hired Auto
Property Damage $ 000
❑ Nonowned Autos
❑
Bodily Injury and Properly Damage Combined $ 000
Excess Liability
❑ Commercial Blanket Excess
Each Occurreno /Aggregate $ 000
❑
Other (Miscellaneous Coveral l
The City of Fort Collins will be named as additional insured.
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES RESTRICTIONS ! SPECIAL ITEMS t The incLadual a patners shovm as insured ❑Nava ❑Have not
Contracts # 6033 & # 5955 electedtobe coveredas employees under this policy.
ttProdrets-Connoeted Operations aggregate is equal to each
occurrence hint and is included in policy aggregate.
CERTkFICATEHOLDERSNAMEANDADDRESS-
CANCELLATION
_..._. _
• The City of Fort Collins
Y
Should any of the above described policies be cancelled before the
•(
expiration date thereof, the company will endeavor to mail 30 days)
Purchasing Division
written notice to the Certificate Holder named, but failure to mail such
P.O. Box 580
notice shall impose no obligation or liability of any kind upon the
'TO
company, its agents or representatives. days unless different
Fort Collins, Co 80522
number of days shown.
❑ This certifies coverage on the date of issue only. The above
Fax: 970-221-6707
described policies are subject to cancellation in conformity with their
terms and by the laws of the state of issue.
DATEISSUED
AUTHORIZED REPRESENTATIVE
2/9/2010
Cindi A. Johnson
U-201 Ed. 5/00 Stock No. 06668 Rev. 7/02