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HomeMy WebLinkAbout119979 QUALITY TRAFFIC CONTROL INC - INSURANCE CERTIFICATE (5)QUALI-6 OP ID: BA ATE '% f- CERTIFICATE OF LIABILITY INSURANCE JMMIDDNYYY) . 03/11/2013 03/11/2013 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 Phone: 970-635-9400 PFSlnsurance GroupJT ' 4848 Thompson Pkwy, Ste 200f—r7r--- �- - ---. ---Fax: 970-635-9401 Johnstown; CO 80534 Johnstown Select Accounts CONTACT NAME: PHONE FAX --- - AIc No Eat: - - ac No: E-MAIL ADDRESS: ,. INSURERS AFFORDING COVERAGE ,NAIC # ,t INSURER A: Mountain .States Insurance Grp INSURED Ouality Traffic Control, Inc. Mike Obester INSURER B: Pinnacol Assurance Co 41190 209 Racquette Drive #5 NSURER 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 LTR TYPE OF INSURANCE B POLICY NUMBER POLICY EFF MWDD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 500,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR CPP0095714 07/27/2012 07/27/2013 PREMISES Ea ocwrrence $ 100,000 MED EXP(Any one person) $ 10,00 PERSONAL B ADV INJURY $ 500,00 GENERAL AGGREGATE $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X- PRO- IFCT_ n LOC PRODUCTS COMP/OP AGG $ 1,000,00 - - 8 - -- AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT - BODILY INJURY (Per person)-$ - .. ... . • ANY AUTO.._ ..-._ _ .. •',.. .:...._- -.'.." .. - ALL OWNED. .'•SCHEDULED' AUTOS AUTOS BODILY INJURY (Par accitlenl) $ HIRED AUTOS NON -OWNED' AUTOS PROPERTY DAMAGE Per accitlenl $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE OEO I IRETENTIONS $ B WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE V / N OFFICER/MEMBER EXCLUDED? ❑ NIA 4130969 04/01/2013 04/01/2014 WC STATU- OTH- X TTER E.L. EACH ACCIDENT $ 100,000 E. L. DISEASE - EA EMPLOYEE $ 100,000 (Mandatory in NH) It yes, describe antler DESCRIPTION OF OPERATIONS below E.L. D15EASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace is required) All 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