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HomeMy WebLinkAbout110520 TRAFFIC SIGNAL CONTROLS INC - INSURANCE CERTIFICATE (3)`' b® CERTIFICATE OF LIABILITY INSURANCE 1 6/19/2012 ) 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 First Mainstreet Insurance, LLC 275 S. Main Street, Suite 100 P.O. BOX 847 Longmont CO B0502 CONTACT Debbie Brickhara NAME: PHONE F. (303) 776-5122 FAX . (303)776-5495 E'N'AIL ADDRESS. dbrickham@Firs tMainStreet. tom INSURERS AFFORDING COVERAGE NAIC# INSURERAMtn. States Mutual Casualty Co INSURED Traffic Signal Controls, Inc. 255 Weaver Park Road, #100 Longmont CO 80504 INSURER B : INSURERC: INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER:12-13 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 LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM DDY EFF PMDCY EXP LIMITS GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO NTED PREMISES EaEcccu ante $ 100,000 A CLAIMS-MADEOCCUR PP013091802 /24/2012 /24/2013 MED EXP fAny one person $ 10,000 PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ X POLICY PRO- LOC LIABILITY EOMBINdEEDt SINGLE OMIT 1,000,000 BODILY INJURY(Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 013091802 /24/2012 /24/2013 POMOBILE BODILY INJURY(Per accident) S PPROPERTYDAMAGEacciden $ MIRED AUTOS X ANOONoWNED TOS Medical pm,ru.ts S 5,00 X UMBRELLA LIAR 1 X I OCCUR EACH OCCURRENCE $ 1,000,000 rl AGGREGATE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $ 013091802 6/24/2012 6/24/2013 WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? NIA E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) _ _ --- _ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) (970)221-6707 City of Fort Collins PO Box 580 Fort Collins, CO 80522-0580 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 REPRESENTATVE ACORD 25 (2010105) Brickham/DBRICK ©1988.2010 ACORD CORPORATION. All rights reserved. INS025 (201005).ot The ACORD name and logo are registered marks of ACORD