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HomeMy WebLinkAbout119979 QUALITY TRAFFIC CONTROL INC - INSURANCE CERTIFICATE (4)UUALI-b UP IU: BA '``E � R� CERTIFICATE OF LIABILITY INSURANCE (MMlDD/YYYY) opT07/10/12 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 4848 Thompson Pkwy, Ste 200 970-635-9401 PHONE FAX AIC No Ex[ : A/C, No): Johnstown, CO 80534 Johnstown Select Accounts EMAIL ADDRESS: AFFRDING NAICp Rain States es Insurance Grp INSURERA; Mountain States Insurance Grp INSURED Ouality Tra IC Control, Inc. INSURER B: Pinnacol Assurance Co 141190 Mike Obester 209 Racquette Drive #5 INSURER C Fort Collins, CO 80524 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 ADDLISUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I POLICY NUMBER MWDDIYYYY MWDDIYYYY LIMITS A GENERAL LIABILITY tXCOMMERCIAL GENERAL LIABILITY -MADE � OCCUR CPP0095714 07/27/12 07/27/13 EACH OCCURRENCE DAMAGE TORENTED PREMISES (Ecurrence)_ MED EXP (Any one person) $ 500,000 100,000 $CLAIMS $ 10,000 PERSONAL BADV INJURY I $ 500,000 GENERAL AGGREGATE I$ 1,000,000 GEN'L AGGRE�PRaT APPnS PER. POLICY LOC EI& PRODUCTS-GOMPIOP AGG $ 1,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON-OHIRED AUTOS AUUTOSWNED U COMBINED SINGLE LIMIT -(Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accidenU $ Per accident) AMAGE I $ Is UMBRELLA LIAB EXCESS LIA OCCUR CLAIMSTv1ADE EACH OCCURRENCE I $ AGGREGATE Is DIED I I RETENTION$ $ B WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) p yes, describe on, DESCRIPTION OF OPERATIONS below NIA 4130969 04/01/12 04/01113 WCSTATU- I OTH- X TORV_ LIM TS._1_ER EL. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE$ 100,00 E.L. DISEASE -POLICY LIMIT I$ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) 11 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 4 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD