HomeMy WebLinkAbout119979 QUALITY TRAFFIC CONTROL INC - INSURANCE CERTIFICATE (2)UP IU: t3A
CERTIFICATE OF LIABILITY INSURANCE
DAT03/13112 )
F
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
PFS Insurance Group - JT
4848 Thompson Pkwy, Ste 200 970-635-9401
Johnstown, CO 80534
Johnstown Select Accounts
I Lj
PHONE FAX
A/C, No, Ex[): (AIC, No):
E-MAIL
ADDRESS:
PRODUCER
_CUSTOMERJD.a:QVALI-6
INSURER(S) AFFORDING COVERAGE
NAIC0
INSURED Quality Traffic Control, In I
INSURERA:Mountain States Insurance
Mike Obester
216 Racquette Drive #5
Fort Collins, CO 80524
INSURER B: Pinnacol Insurance
524210
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 ADDL'SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE I 1 POLICY NUMBER MMIDDIYYYV MMIODIYYYY LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS-v1A0E OCCUR
CPP 009571408
07127/11
07127/12
EACH OCCURRENCE
DAMAGE TOED
PREMISES {Ea occurrence)
MED EXP (Any one person)
$ 500,00
$ 100,00
$ 10,00
PERSONAL&ADV INJURY
$ 500,00
GENERAL AGGREGATE
$ 1,000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY IPRO-PrT F LOC
PRODUCTS - COMPIOP AGO
S 1,000,00
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accitlenl)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY
(Per acad rDAMAGE
$
—
$
$
UMBRELLA LIAB OCCUR
EXCESS LIAB CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
$
B
WORKERS COMPENSATION
AND EMPLOYERS 'LIABILITY
ANY PROPRIETOR/PARTN.1MXECUTIVE VIN
OFFICERIMEMBER EXCLUDE09
(Mandai In NH)
DESCRIPTION OF OPERATIONS belay
N / A
-
4130969
G4/ot/12
G4/Gi/13
WC STATU- I IOTH-I
X TORV-LIMITS.L�ER
E.L. EACH ACCIDENT
$ 1DD,DD
EL DISEASE - EA EMPLOYEE
$ 100,00
E.L. DISEASE -POLICY LIMIT $ 500,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addhlenal Remarks Schedule, If more space Is required)
1 Locations / Traffic Control Operations
CITYFOR
City of Fort Collins
300 LaPorte Ave
Fort Collins, CO 80522
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
U 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD