HomeMy WebLinkAbout375464 DAVINCI SIGN SYSTEMS INC - INSURANCE CERTIFICATEOP ID: KH
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�� CERTIFICATE OF LIABILITY INSURANC.E........
DATE (MWDDIYYVV)
, . 06/13/11
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 endorsements .
PRODUCER 970-635-9400
CONTACT
NAME
PFS Insurance Group -JT 970-635-9401
4848 Thompson Pkwy, Ste 200
Johnstown, CO 80534
John Hintzman
PHONE FA%
AIC No Ea[ : AIC No):
EMAIL
ADDRESS:PRODUCER
CUSTOMER ID N: DAVIN-1
INSURERS AFFORDING COVERAGE
NAICN
INSURED DaVinci Sign Systems, Inc.
INSURER A: Pinnacol Assurance
41190
INSURER B:
4496 Bents Drive
Windsor, CO 80550
INSURER C:
INSURER D
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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.
INSR
LTRINSR
TYPE OF INSURANCE
ADD L
SUB
Won
POLICY NUMBER
MOWLAC EFF
POLICYEXP
IYYYY
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 7 OCCUR
N/A
EACH OCCURRENCE
$
RE ETSRE
PREMISES Ea occurrence)
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO LOG
IFDT
PRODUCTS - COMPIOP AGG
$
S
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNEDAUTOS
NIA
COMBINED SINGLE LIMIT
(Ea accident
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAR
EXCESS LIAR
OCCUR
CLAIMSI.AADE
N/A
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
S
_ _
A
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY _ YIN_
ANY PROPRIETORiPARTNERIE%ECUTIW
MF ntla oiry In NH) EXCLUDED?
If yes describe under
DESCRIPTION OF OPERATIONS below
_
N / A
_ _
14081336
_
BLANKT MR OF SUBROGATION
_ _
07/01/11
07/01/11
07/01/12
07101112
X WCS ATU- X OTRH-
E.L. EACH ACCIDENT
$ 1,000,00
E.L. DISEASE - EA EMPLOYEE
$ 1,000,00
E.L. DISEASE -POLICY LIMIT
$ 1,000,00
N/A
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
Project: 7062 Council Tree Exterior Signage
CITYFTC
City of Ft. Collins
Financial Services/Purchasing
Division
P.O. Box 580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
41a�
U 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD