HomeMy WebLinkAbout119979 QUALITY TRAFFIC CONTROL - INSURANCE CERTIFICATE (11)Rv 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:
LBN Insurance A Johnstown
PAX
(A/C NNo, Ext:
ADDRESS:
4848 Thompson Pkwy, Ste 200
Johnstown CO 80534
Phone:970-635-9400 Fax:970-635-9401
CUSTOMERIDM QUALI-6
INSURER(S) AFFORDING COVERAGE
NAIC#
INSURED
Qualityy Traffic Control, Inc.
Mike Obester
216 Racqquuette Drive #5
Fort Collins CO 80524
INSURER A : Mountain States Insurance
INSURERB: Pinnacol Insurance
41190
INSURERC:
INSURER D :
INSURER E : '
INSURER F :
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD •• `• `
C
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/DDIYYYY)
(MM/DD/YYYY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 500 , 000
A
X COMMERCIAL GENERAL LIABILITY
CPP 009571408
07/27/10
07/27/11
UAMAUL
PREMISES[ EL(aocccurrence)
$100,000
FX
MED EXP (Any one person)
$ 10,000
CLAIMS -MADE OCCUR
PERSONAL & ADV INJURY
s500,000
GENERAL AGGREGATE
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 1,000,000
POLICY jE LOC
$
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO
(Ea accident)
$
ALL OWNED AUTOS
BODILY INJURY (Per person)
$
SCHEDULED AUTOS
,
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
$
HIRED AUTOS
(Per accident)
NON -OWNED AUTOS
$
$
UMBRELLA LIAB
HCLAIMS-MADE
OCCUR
EACH OCCURRENCE
$
EXCESS LIAB
AGGREGATE
$
DEDUCTIBLE
$
RETENTION $
$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
41309.69 _
04/01/10
04/01/11
WC
-r
Y / N
LIMITS ER
ANY PROPRIETOR/PARTNER/EXECUTIV
OFFICER/MEMBER EXCLUDED?
/A
E.L. EACH ACCIDENT
$ 100000
(Mandatory in
If yes, describe under
und
E.L. DISEASE - EA EMPLOYEE
$ 100000
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
ERTIFICATE HOLDER CeMr`FI I ATInIJ
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITYFOR I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Fort Collins AUTHORIZED REPRESENTATIVE
300 LaPorte Ave �-
Fort Collins CO 80522�
v I VOG-cuUU AUUKU cUKrUItATIUN. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD