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Home My WebLink About375464 DAVINCI SIGN SYSTEMS INC - INSURANCE CERTIFICATE (5)OP ID: KH AC"R"" CERTIFICATE OF LIABILITY INSURANCE `—� DATE 01201VV) O6/30/2014 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 PFS Insurance Group -JT 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 John Hintzman CONTACT NAME: PHONE FAX ac No EJ: lac No): EMAIL ADDRESS:PRODUCER CUSTOMER ID d: DAVIN-1 INSURERS AFFORDING COVERAGE NAIC d INSURED DaVinci Sign Systems, Inc. INSURER A: Pinnacol Assurance 41190 4496 Bents Drive Windsor, CO 80550 INSURER B: Continental Western Group INSURER C 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, IN$R LTR TYPE OF INSURANCE AO U POLICY NUMBER (MMIDO YYYY MWODNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 B X COMMERCIAL GENERAL LIABILITY CI -AIMS -MADE OCCUR CPA3050394 07/01/2014 07/01/2015 A� E T RENTED PREMISES RENToccurrence)$ 100,00 NED EXP(Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 X Blkt At WOS GENERAL AGGREGATE $ 2,000,00 EGATE G 1AGGRLIMITAPPLIESPER: POLICY PRO- n LOC PRODUCTS-COMP/OPAGG $ 2,000,00 $ B AUTOMOBILE LIABILITY ANY AUTO CPA3050394 07/01/2014 07/01/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (PER ACCIDENT) $ X X $ NON-OWNEDAUTO$ X Blkt Al $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,00 B EXCESS LIAB CLAIMS -MADE CPA3050394 07101I2014 07101/2015 DEDUCTIBLE g X $ RETENTION $ 0 A A KERS CcAND EMPLOYERS' LIABILNSATIOITY ANYPROPRIETORIPARTNER/E%ECUTIVE V/N OFFICER (Mandatory, in N R EXCLUDED? NH) (f yes, describe Dyes, describe OFuncleC OPERATIONS DESCRIPTION OF below N I A 4081336 BLKT WOS 07/01/2014 07/01/2016 X T�RV IMIT DER E.L. EACH Acc1DENT $ 1,000,00 E.L. DISEASE -EA EMPLOYEE.$ 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1,000,00 g Installation Float CPA3050394 07"'12014 07/01/2015 Limit 70,00 B Cargo CPA3050394 07/01/2014 07/01/2015 Limit 70,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AEdMonal Remarks Schedule, If mom space Is rsqulred) RE: Old Town Garage - If required by written contract or written agreement the following provisions apply subject to the policy terms conditions, limitations and exclusions: The Certificate Holder, is included as as Additional Insured for ongoing operations under General Liability and Designated Insured under Automobile Liability (except Hired and Non -Owned CITYFCI City of Fort Collins Purchasing P.O. Box 580 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 R (J 1983-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD No Text OP ID: KH ACORO" CERTIFICATE OF LIABILITY INSURANCE `-� D06/30/201ATE YY) 06/30/2014 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 PFS insurance Group -JT 4848 Thompson Pkwy, Ste 200INC,No CONTACT PHONE FA% Est), uc No): Johnstown, CO 80534 John Hintzman EMAIL ADDRESS: PRODUCER DAVIN-1 CUSTOMER ID N: INSURERS AFFORDING COVERAGE NAIC Is INSURED DaVinci Sign Systems, Inc. 4496 Bents Drive Windsor, CO 80550 INSURER A: Pinnacol Assurance 41190 INSURERS: Continental Western Group INSURER C 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 rypE OF INSURANCE A DL UB POLICY NUMBER POLICY EFF MMIDDNYYY) POLICY EXP JNIM?DDIYYYY1 LIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_1 OCCUR X BIkt AIWOS CPA3050394 07/01/2014 07/01/2015 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RE T PREMISES IFa occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- n LOG IFCT PRODUCTS - COMP/OP AGO $ 2,000,00 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Blkt Al CPA3050394 07/01/2014 07/01/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 ij X BODILY INJURY (Per person) $ BODILY INJURY (Per awdent) $ PROPERTY DAMAGE (PER ACCIDENT) $ X X $ X $ B X UMBRELLA LIAB IAB EXCESS L X OCCUR CLAIMS-MADE CPA3050394 07/01/2014 07I01I2015 EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,00 DEDUCTIBLE RETENTION $ 0 $ X $ A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER (Mandatory in NH) EXCLUDED? Dyes, describe under DESCRIPTION OF OPERATIONS below NIA 4081336 BLKT WOS 07/01/2014 07/01/2015 WC STATU- OTH- X T RY MI S ER E.L. EACH ACCIDENT $ 1,000,00 E. L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1,000,00 B Installation Float Cargo CPA3050394 07/01/2014I 07/01/2015 Limit 70,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANach ACORD 101, Additional Remarks Schedule, if mom space is required) Project: 7062 Council Tree Exterior Signage City of Ft. Collins Financial Services/Purchasing Division P.O. Box 580 CITYFTC 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�aQA_1101 ACORD 25 (2009109) (91955-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD