Loading...
HomeMy WebLinkAbout119979 QUALITY TRAFFIC CONTROL INC - INSURANCE CERTIFICATE (9)�1 QUALI-6 OP ID: VM ACORO CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/DDIYYYY) 11111/ 04/10/2015 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). CONTAPRODUCER NAME: Johnstown Select Accounts _ PFS Insurance Group - JT PHONE FAX 4848 Thompson Pkwy, Ste 200 A/c No. ExD:970-635-9400 Arc Rti 970 635-9401 Johnstown, CO 80534 E-MAIL Johnstown Select Accounts ADDRESS: INSURED Ouality Traffic Control, Inc. Mike Obester 209 Racquette Drive #5 Fort Collins, CO 80524 COVERAGES CERTIFICATE NUMBER: INSURER A: Mountain States Insurance Grp _ �— INSURERS: Pinnacol Assurance Co 411 INSURER C: INSURER D : 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 TYPE OF INSURANCE L U I POLICY EFF POLICY EX P LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYri A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FKOCCUR CPP0261869 07/27/2014 07/27/2015 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurcence S 100,00 MED EXP (Any one person) S 10,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY E EST LOC OTHER GENERAL AGGREGATE $ 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 SAP0252237 07/27/2014 07/27/2015 COMBINED ISINGLE LIMB $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Peraccident _ $ _ $ A X UMBRELLA LIAO EXCESS LIAR X OCCUR CLAIMS -MADE UMB0260811 07/27/2014 07/27/2015 EACH OCCURRENCE $ 1,000,00 $ _ $ AGGREGATE DIED RETENTION$ _ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY OFFICER/MEMBER/EXCLUDED?ECUTIVE Y� (Mandatory In NH) If yes. describe under DESCRIPTION OF OPERATIONS below N/A 130969 04/01/2015 04/01/2016 PER O - STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE -POLICY LNdIT $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Traffic Control CITYFOR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. 300 LaPorte Ave Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE 4� © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD