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HomeMy WebLinkAbout119979 QUALITY TRAFFIC CONTROL - INSURANCE CERTIFICATE (26)QUALTRA-02 VMATHIASON CERTIFICATE OF LIABILITY INSURANCE FDAT32/2 DYYYY) 1212016 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 PHONE 970 635-9400 FAX 4848 Thompson Parkway Suite 200 A/c No Ex,: ( ) A/C No): (970) 635-9401 Johnstown, CO 80534 E-MAIL ADDRESS. valeriern0mv0sinsurance.com INSURED Quality Traffic Control, Inc. Mike Obester 209 Racquette Drive #5 Fort Collins, CO 80524 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Admiral Insurance Company 24856 INSURER B : Pinnacol Assurance Co 41190 INSURER C: INSURER D : INSURERE: INSURER F : COVERAGES CERTIFICATF N1IMRFR• RFVICInM Kit I11i 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 POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/Y LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR CA000022348-01 08/27/2015 08/27/2016 AGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- ❑ ❑ JECT LOC PRODUCTS - COMP/OPAGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY P JU(Per accident) $ NON -OWNED HIRED AUTOS AUTOS $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE EXCESS LIAB CLAIMS -MADE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- B AND EMPLOYERS' LIABILITY ANY PROP RIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? N / A 4130969 04/01/2016 04/01/2017 STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE -EA EMPLOYEO $ 1,000,00 (Mandatorym NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Traffic Control CERTIFICATE HOLDER CANCELLATION 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 904,A 0. 1/W © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD