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HomeMy WebLinkAbout119979 QUALITY TRAFFIC CONTROL INC - INSURANCE CERTIFICATE (11)QUALI-6 OP ID: BA ACORO' CERTIFICATE OF LIABILITY INSURANCE `.� D07/21ATE /2014Y) o7rzvzola 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 200 Johnstown, CO 80534 Johnstown Select Accounts CONTACT NAME: Johnstown Select Accounts PHONE FAX UC Ne Ell, 970-635-9400 A/c No): 970-635-9401 EIAAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC0 INSURER A: Mountain States Insurance Grp INSURED Ouality Traffic Control, Inc. Mike Obester 209 Racquette Drive#5 INSURER B: Pinnacol Assurance Co 41190 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 LTR rypE OF INSURANCE AD )LIS R I POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR CPP0251869 07/27/2014 07/27/2015 EACH OCCURRENCE $ 1,000,00 PREMISES Ea o�rence $ 100,00 MED EXP (Any one person) $ 10,00 PERSONAL$ ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER POLICY ❑PRO- ❑ ECT OC OTHER' GENERALAGGREGATE $ 2,000,00 PRODUCTS-COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X NON -OWNED HIRED AUTOS AUTOS BAP0252237 07/27/2014 07/27/2015 COMBINED SINGLE LIMIT Ea a¢itlent $ 1,000,00 BODILY INJURY (Per person) $ J BODILY INJURY (Per accident)) $ PROPERTY DAMAGE Per accident $ Is A X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE UMB0260811 07/27/2014 07/27/2015 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED' (Mandatory in HIM) If yes, desuibe under DESCRIPTION OF OPERATIONS belay, NIA 4130969 04/01/2014 04/01/2015 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 EL DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,00 1 71 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mom 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 au 4A_-_s © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD