HomeMy WebLinkAbout110520 TRAFFIC SIGNAL CONTROLS INC - INSURANCE CERTIFICATE (2)303-776-4670 To:1-970-221-6707 City of Fort Collins(1 of 1) 06-29-2011 09:06 AM -0600
''� �® CERTIFICATE OF LIABILITY INSURANCE
6/29/2011Y1
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(les) 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
First 14ainstreet Insurance, LLC
512 9th Avenue
P.O. Box 847
Longmont CO 80502
CONTACT NAME: Debbie Brickhard
acNE Eat: (303) 776-5122 NC No; (303)776-549$
EWAIL
ADDRESS dbrickhard@ Firs tMainS treet. cord
ADDRE
PRODOUMCCR
COST 00015089
INSURERIS) AFFORDING COVERAGE
NAIC0
INSURED
Traffic Signal Controls, Inc.
255 Weaver Park Road Suite 100
Longmont CO 80501
INSURER 14onntain States Insurance Grp
INSURER B
INSURERC:
INSURER O:
INSURER E
INSURER
COVERAGES CERTIFICATE NUMRFR-11-12 Liab. Master REVISION NIIMRFR-
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. LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTSRN
TYPE OF INSURANCE
DS
POLICY NUMBER
MMIODITYYY EFF
MMIDOIYYYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GEN ERAL UABIUTY
I CLAMS.6IADE FX-1OCCU0.
PP013091801
6/24/2011
/24/2012
EACH OCCURRENCE
S 1,000,000
PREMISES Eaoccarrence
S 100, 000
MED EXP IAPycne Person)
$ 10,000
PERSONAL&ADVINJURY
S 1,000,000
GENERALAGGREGATE
S 2,goo,000
GEN'LAGGREGATE UMIT APPUES PER:
X POLICY JFC LOC
PRODUCTS-COMPIOP AGO
$ 2,000,000
$
A
AUTOMOBILE
X
I-men-ITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NOR OWNED AUTOS
013091801
6/24 /2011
6/29/2032
COMBINED SINGLE UNIT
(Ea acodem)
S 1,000,g0o
BODILY 'OR!(Per Person)
E
BODILY INJURY (Per acciden0
S
PROPERTY DAMAGE
(Per acodeni
S
MedicaIpaymenls
S 5,000
Uninsured mW.,,sl Bl-single
$ 1,000,000
A
X
UMBRELLA LIAR
EXCESS LAB
OCCUR
CLAIMS MADE
M013091801
6/24/2011
1124,2012
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
S 1,000,000
X
DEDUCTIBLE
RETENTION $ 0
S
S
WORBERSCOMPENSATION
AND EMPLOYER9'UABIUW YIN
ANY PROPRETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED'
(MsnditM In NH)
li Yes descnbemde!
DESCRIPTION OF OPERATIONS belay
NIA
WC STATU_- OTH-
EL EACH ACCIDENT
$
JJ
EL DISEASE - EA EtdPLOYEq
S
E.L DISEASE -POUCY LIMIT I
$
BE SCRI PRO OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AddiU one Remarks Schedule, If more apace is required)
(970)221-6707
City of Fort Collins
PO Box 580
Fort Collins, CO 80522-0580
R[d�]:UYbiiLLI7GFP
LNNI.CLLN I I V N
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZEDREPRESENTATNE
Brickhard/DBRICR
n EBRR_90nR Arn Rn rn RRn RaTInki and i,dsa rnan..,n,1
INS025 (200909) The ACORD name and logo are registered marks of ACORD