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HomeMy WebLinkAbout119979 QUALITY TRAFFIC CONTROL INC - INSURANCE CERTIFICATE (3)LIUALI-6 UP ID: BA ACORO` CERTIFICATE OF LIABILITY INSURANCE `-� DAT07/10D/YYYY) 7n m12 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 970-635-9401 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 Johnstown Select Accounts PHONE FAX AIC No Ext : (AIC, No): E-MAIL ADDRESS: ` 1 ID INSURER@) AFFORDING COVERAGE NAIC # INSURER A: Mountain States Insurance Grp 1 INSURED Ouality Traffic Control, Inc. INSURER B: Pinnacol Assurance Co 41190 Mike Obester 209 Racquette Drive #5 INSURERC: Fort Collins, CO 80524 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER- RFVI..glnN NI IMRFP- 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. ILTR TYPE OF INSURANCE NSRADDLISUBRI POLICY NUMBER MM/DDIPOL'CYYYV MM/DOEFF Y EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 500,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX1 OCCUR CPP0095714 07/27/12 07/27/13 DAMAGE To RENTED PREMISES Ea occurrence) $ 100,000 MED EXP (Any one person) $ 10,000 PERSONALS ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOPAGG $ 1,000,000 POLICY X PRO F LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident is BODILY INJURY (Per person) $ ANY AUTO AUTOS OS AUTOS SCHEDULED AU BODILY INJURY (Per accident) $ HIREDAUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMSWADE DED I I RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? NIA 4130969 04/01/12 04/01/13 X WC STATU- IOTH- TORY LIMITS�LER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) 1 Locations / Traffic Control Operations CITYOF3 City of Fort Collins Attn: Purchasing Division 215 North Mason Street, 2nd FI PO 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 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD