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HomeMy WebLinkAbout375464 DAVINCI SIGN SYSTEMS INC - INSURANCE CERTIFICATE (6)OP ID: BA ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (30/20YYYY) `-� 061/15 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 CONTACT NAME: PFS Insurance Group - JT PHONE FAX 4848 Thompson Pkwy, Ste 200 (A/C. No, E:c):_ A/C, /c No): Johnstown, CO 80534 E-MAIL John HintZman-ADDRESS: PRODUCER CUSTOMER In u. DAVIN-1 INSURERS AFFORDING COVERAGE NAIC # INSURED DaVinci Sign Systems, Inc. INSURER A: Pinnacol Assurance 41190 4496 Bents Drive INSURER B: Continental Western Group 10804 Windsor, CO 80550 INSURER C INSURER D : INSURER E INSURER F nnVFRAr%FS rFRTIFIrATF NI IMRFR• 09=%/ICIAIU k11 IMRCD• 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 TYPE OF INSURANCE ADDL UB POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx-] OCCUR X Blkt Al WOS CPA3050394 07/01/2015 07/01/2016 EACH OCCURRENCE $ 1,000,00 DAMA E�TED PREMISES Ea occurrence $ 1OO OO MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Blkt Al CPA3050394 07/01/2015 07/01/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ - $ PROPERTY DAMAGE (PER ACCIDENT) X X — $ X $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CPA3050394 07/01/2015 07/01/2016 EACH OCCURRENCE $ 5,000,00 AGGREGATE_ $ 5,000,00 DEDUCTIBLE RETENTION $ 0 $ X $ A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below ­7 N/A 4081336 BLKT WOS 07/01/2015 07/01/2016 X WC STATU- OTH- Y LIMIT E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,00 B B Installation Float Cargo CPA3050394 07/01/2016 CPA3050394 07/01/2015 07/01/2016 07/01/2016 Limit 70,00 Limit 70,0010 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) RE: Old Town Garage - If required by written contract or written agreement the following provisions appplyy subject to the policy terms, conditions, limitations and exclusions: Y e Certificate Holder is included as as Additional Insured for on oin operations under beneral Liability and Designated Insured uncle gAu omobile Liability (except Hired and Non -Owned CITYFC1 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. Purchasing AUTHORIZED REPRESENTATIVE P.O. Box 580 Fort Collins, CO 80522 © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD NOTEPAD. HOLDER CODE CITYFC1 DAVIN-1 INSURED'S NAME DaVinci Sign Systems, Inc. OP ID: BA PAGE 2 Date 06/30/2015 tomobile). A Waiver of Subrogation applies to those named above for rkers' Compensation. e issuing Insurer will endeavor to mail 30 days written notice to the rtificate holder, but failure to do so shall impose no obligation or ability of any kind upon the insurer, its agents or representative. 10 ys notice for non-payment