HomeMy WebLinkAbout119979 QUALITY TRAFFIC CONTROL - INSURANCE CERTIFICATE (10)�Rh® CERTIFICATE OF LIABILITY INSURANCE OP ID BA
DATE(MM/DD/YYYY)
07/20/10
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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).
PRODUCER
NAME:
LEIN Insurance Agcy-Johnstown
PHONE FAX
(AIC, No, Ext): (A/C, No):
ADDRESS:
4848 Thompson Pkwy, Ste 200
Johnstown CO 80534
Phone:970-635-9400 Fax:970-635-9401
PRODUCER
CUSTOMERID#: QUALI-6
INSURER(S) AFFORDING COVERAGE
NAIC#
INSURED
INSURERA: Mountain States Insurance
QQualityy Traffic Control, Inc.
Mike Obester
216 Racqquuette Drive #5
Fort Collins CO 80524
INSURERB: Pinnacol Insurance
41190
INSURERC:
INSURER D :
INSURER E :
INSURER F :
ItMV CJ I Mm I Ir lil 1 t mulwltltK' RF\/ICInN rJ11MQCC•
THIS IS TO CERTIFY THAT 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, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
INSR
WVD
POLICY NUMBER
(MM/DD/YYYY)
(MMIDDIYYYY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 500 , 000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE a OCCUR
CPP 009571408
07/27/10
07/27/11
PREMISES(Ea occurrence)
$ 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/OP AGG
$ 1 , 000 , 000
POLICY PROECT LOC
J
$
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident) '
$
ALL OWNED AUTOS
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
SCHEDULEDAUTOS
HIRED AUTOS
PROPERTY DAMAGE
(Per accident)
$
NON -OWNED AUTOS
$
$
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
$
EXCESS LIAR
CLAIMS -MADE
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVID
OFFICER/MEMBER EXCLUDED?
/A
4130969
04/01/10
04/01/11
WC SiAiU-
TORY LIMITS ER
E.L. EACH ACCIDENT
$ 100000
E.L. DISEASE - EA EMPLOYEE
$ 100000
(Mandatory in NH)
If yes, describe under
-
E.L. DISEASE - POLICY LIMIT
$ 500000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
All Locations / Traffic Control Operations
-.nI lvjVmIc r1VL.ur_r% CANCELLATION
City of Fort Collins
Attn: Purchasing Division
215 North Mason Street, 2nd Fl
PO Box 580
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITYOF3 I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
TIVE
91988-2009 ACORD CORPORATION. All rights reserved.
ACORD 26 (2009109) The ACORD name and logo are registered marks of ACORD