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HomeMy WebLinkAbout119979 QUALITY TRAFFIC CONTROL INC - INSURANCE CERTIFICATE (6)QUALI-6 OP ID: BA �6. iz CERTIFICATE OF LIABILITY INSURANCE D03/11/201ATE VVI 03/1112013 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 Iiewof such endorsements . PRODUCER • °. 1 ..-D'"L, 970-635-9400 ACT CONTPhone: NAME: PFSlnsuraDceGrOup -JT 4848 Thompson Pkwy, Ste 200 Fax: 970-635-9401 Johnstown; CO.80534.. ___ _. - - __._ _ -I _. )_ Johnstown Select Accounts PHONEFAX Eat: _INC,No AIL RDDBEss: _ `ll INSURER 5 AFFORDING COVERAGE NAIC # INSURER A: Mountain States Insurance Carp INSURED Ouallty Traffic Control, Inc. Mike Obester 209 Racquette Drive #5 INSURERS: Plnnacol Assurance Co INSURER C: 141190 Fort Collins, CO80524 INSURERD: 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 rypE OF INSURANCE AD UR POLICYNUMBER POLICY EFF MMIDDIYYYY) POLICY EXP (MMIDONYYYI LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR CPPOO95714 07/27/2012 07/27/2013 EACH OCCURRENCE $ 500,000 PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 10,00 PERSONAL B ADV INJURY $ 500,00 GENERAL AGGREGATE S 1,000,000 GEN' L AGGREGATE LIMITJECT APPLIESPER. POLICY X PRO- LOC PRODUCTS-COMPIOP AGO $ 1,000,000 $ . ...I 'AUTOMOBILE ............. LIABILITY :. .: .. ANY AUTO -"''-'_'••- ALL OWNED SCHEDULED AUTOS '-. AUTOS HIRED AUTOS NON -OWNED _ AUTOS I -' ...... , .. - . " -` 1 ""I' �.�.:•'-. .. (, '. f.' -. _. _... COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY(Per person) $ •• ' BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE - EACH OCCURRENCE $ AGGREGATE Is DEG RETENTION $ $ B WORKERS COMPENSATION _ _ AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE Y/N OFFICERIMEMBER EXCLUDED? (Mandatory in NH) R yes, desvnbe under DESCRIPTION OF OPERATIONS below N / A 4130969 _ 04/01/2013 04/01/2014 X WC STATU- OTH- TORY LIMITS E.L.EACH ACCIDENT $ 100,00 E.L DISEASE -EA EMPLOYEE $ 100,00 E.L. DISEASE - POLICY LIMIT $ SDD,DD DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101• Additional Remarks Schedule, If more space Is required) All 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