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HomeMy WebLinkAbout119979 QUALITY TRAFFIC CONTROL INC - INSURANCE CERTIFICATE (8)Ur IU: 1 ,acoRO CERTIFICATE OF LIABILITY INSURANCE O07/30/201(MMIDDYYY) onl sonols 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 Phone: PFS Insurance Group -JT Fax: 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 Johnstown Select Accounts INSURED Mike Obester 216 Racquette Drive #5 Fort Collins, CO 80524 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 190 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 EXP LTR TYPE OF INSURANCE ADDL SUBRI POLICY NUMBER MMIUDDV MM/DFFTPOLIDIYYyY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 'CPP02511161 07/27/2013 0712712014f _EACH OCCURRENCE DAMAGE TO R_oNTED nce) PREMIETORENTEO MED EXP(Any one person) $ 100,00 $ 100,00 $ 10,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER'. X POLICY F PRO- n LOD PRODUCTS-COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS BAP0252237 07/27/2013 07/27/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Peraccidenq $ X X $ A HUMBRELLA LIAB Al OCCUR EXCESS LIAB CLAIMS -MADE CPP0251869 07/27/2013 07/27/2014 EACH OCCURRENCE 1,000,00 (AGGREGATE $ 1,000,00 DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS below NIA I 4130969 04/01/2013 ( 04/01/2014 VJC STATU- I IOTH- X TORV LIMIT51__�ER EL EACH ACCIDENT $ 1,000,000 E. L. DISEASE -EA EMPLOYEE $ 1,000,000 EL.DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Traffic Control 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 A-0'ed — ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD UP IU: PL ,�►coRo CERTIFICATE OF LIABILITY INSURANCE O07/30/DDIV1'YY) 07I3012013 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 endorsementls). PRODUCER PFS Insurance Group - JT 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 Johnstown Select Accounts INSURED Mike Obester 216 Racquette Drive #5 Fort Collins, CO 80524 Inc. Phone: Fax: I INSURER B: PInnacol Insurance 141190 1 E: 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. EXP ILTR TYPE OF INSURANCE INI'R1WVDl UBRI POLICY NUMBER MM//DDROUCY/YYYY MM/DDY/YYVY LIMITS A &GENE�L LIABILITY MMERCIAL GENERAL LIABILITY CLAIMS -MADE O OCCUR CPP02511161 0712712013 0712712014 EACH OCCURRENCE DAMAGE TO RENTED PREMISES IEa occunenceI MED EXP (My one person) $ 100,00 $ 100,00 $ 10,00 PERSONAL BADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY F PRO F LOG PRODUCTS-COMPIOPAGG $ 2,000,00 $ A AUTOMOBILE LIABILITY AAUTO ALLLL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BAP0252237 07127/2013 07I27I2014 COMBINED SINGLE LIMIT (Ea accitlenU S 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) 8 PROPERTY DAMAGE (Per accident) $ X X S Is A LIAR EXCESS LIAB X OCCUR CLAIMS -MADE CPP0251869 0712712013 07127/2014 EACH OCCU RRENCE $ 1,000,000 HUMBRELLA C AGGREGATE $ 1,000,000 DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4130969 04I01/2013 04/01/2014 WC STATU- IOTH- X TORY-LIMITS ER $ 1,000,00 EL. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ 1,000,00 EL DISEASE -POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Traffic Control 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 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD