ST8402-CS 881209FORM 3801
NC
~RBON
REQUIRED
RAPID LETTER
:~nd 'Zv'h,te and Pink coD~es
Serder reta,rs Canary copy
TRIPLICATE
SUBJECT
~EPL TO:
l
FOR YOUR
INFORMATION
AP/PROVAL
/ACTION
COMMENTS
PLEASE
FROM:
DATE:
FORWARD
RETURN
SEE ME
FOLLOW UP
3PY
~1~ AMPAD Clingers- 34-351 50 Sbt. P~I
AIHIH'.I . CERTIFICA'¢ -' OF INSURANCE
PRODUCER
COLLIER COBB & ASSOCS
OF DALLAS, INC.
5750 PINELAND DR., STE. 308
DALLAS, TX 75231
PHONE: (214) 739-4991
CODE SUB-CODE
INSURED
ISSUE DATE (MM/DD/YY)
11/29/88
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
COMPANIES AFFORDING COVERAGE
COMPANY A St. Paul Insurance Companies
LETTER
COMPANY
LETTER B
COMPANY
L. H. ~CY C0~P~Y, et al LETTER C
P. O. Box 541297
Dallas· Texas 75354-1297 COMPANYLETTER D
COMPANY
LETTER
E
'COVERAGES
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.
POLICY EFFECTIVE POLICY EXPIRATION
CO TYPE OF INSURANCE POLICY NUMBER
LTR DATE (MM/DDIYY) DATE (MMIDD/YY)
GENERAL LIABILITY
A X COMMERCIAL GENERAL LIABILITY 691NH3415 ** 11/30/88 11/30/89
CLAIMS MADE X OCCUR.
OWNER'S & CONTRACTOR'S PROT. -)(' Aggregate applies
Per Project
AUTOMOBILE LIABILITY
A X ANYAUTO 691NH3415-1 ** 11/30/88 11/30/89
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
EXCESB LIABILITY
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION
ANO
EMPLOYERS'LIABILITY
See Attached
ALL LIMITS IN THOUSANDS
GENERAL AGGREGATE ')(' $ 2,000
PRODUCTS-COMP/OPS AGGREGATE $ 2~, 000
PERSONAL & ADVERTISING INJURY $ l· 000
EACH OCCURRENCE $ 1 · 000
FIRE DAMAGE (Any one fire) $ 50
MEDICAL EXPENSE (Any one person) $ 5
COMBINED
SINGLE $ 1,000
LIMIT
BODILY
INJURY $
(Per person)
BODILY
INJURY $
(Per accident)
PROPERTY
DAMAGE $
EACH AGGREGATE
OCCURRENCE
$ $
STATUTORY
$ (EACH ACCIDENT)
$ ' (DISEASE--POLICY LIMIT)
$ (DISEASE--EACH EMPLOYEI
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIRESTRICTIONSISPECIAL ITEMS
RE: Denton Tap Road Improvements from Sandy Lake Road to Denton Creek
** Additional Insureds, per policy terms and conditions: City of Coppell and Ginn, Inc.
CERTIFICATE HOLDER CANCELLATION
CITY OF COPPELL, TEXAS
P. 0. Box 478
Coppell, Texas 75019
iACORD 25-S (3188)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 30 DAYS WRit'TEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
o.
LIABILI~ A~IND UPON THE COMfy ITS AGE%~ REPRESENTATIVES.
/
AOOItl . CERTIFICA'I OF INSURANCE
PRO~)UCER
COLLIER COBB & ASSOCS
OF DALLAS, INC.
5750 PINELAND DR., STE. 308
DALLAS, TX 75231
PHONE: (214) 739-4991
CODE SUB-CODE
INSURED
ISSUE DATE (MM;DD/YY)
11/29/88
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
COMPANIES AFFORDING COVERAGE
COMPANY
LETTER A St. Paul Insurance Companies
COMPANY
LETTER a
COMPANY
L. H. LACY COMPANY, et al LETTER C
P. O. Box 541297
Dallas, Texas 75354-1297 COMPANYLETTER D
COMPANY
LETTER E
COVERAGES
CO
LTR
A
A
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.
TYPE OF INSURANCE POLICY NUMBER
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY 691NH3415 CLAIMS MADE X OCCUR.
OWNER'S & CONTRACTOR'S PROT. -~ Aggregage applies
Per Project
AUTOMOBILE LIABILITY
X ANY AUTO 691NH3415-1 **
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
EXCESS LIABILITY
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION
AND
EMPLOYERS' LIABILITY
See Attached
OTHER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DDIYY) DATE (MMIDDIYY)
11/30/88 11/30/89
11/30/88 11/30/89
ALL LIMITS IN THOUSANDS
GENERAL AGGREGATE ~ $ 2,000
PRODUCTS-COMP/CPS AGGREGATE $ 2,000
PERSONAL & ADVERTISING INJURY $ l, 000
EACH OCCURRENCE $ 1 ~ 000
FIRE DAMAGE (Any one fire) $ 50
MEDICAL EXPENSE (Any one person) $ 5
COMBINED
SINGLE
LIMIT
BODILY
INJURY
(Per person)
BODILY
INJURY
(Per accident
PROPERTY
DAMAGE
$ 1,000
EACH
OCCURRENCE
$
AGGREGATE
STATUTORY
(EACH ACCIDENT)
(DISEASE--POLICY LIMIT)
(DISEASE--EACH EMPLOYEE
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS
RE: Denton Tap Road Improvements from Belt Line Road to Sandy Lake Road
** Additional Insureds, per policy terms & conditions: City of Coppell and Ginn, Inc.
CERTIFICATE HOLDER
CITY OF COPPELL, TEXAS
P. O. Box 478
Coppell, Texas 75019
ACORD 25-S (3188)
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 30 DAYS 3~qlTFEN NOTICE TO THE CERTIFICATE ii'OLDER NAMED TO THE
LEFT, BUT/~E TO MAIL SUCH NOISE SHALL ,M~/E NO OBLIGATION OR
LIAB,~ O~Y KIND UPON THE COff~Y, ITS A~OR REPRESENTATIVES.
AUT~RIZED ~PRESE"TATIVE
COBB & ASSOCIATES
OF ....
November 29, 1988
TO WHOM IT MAY CONCERN:
Attached is the renewal certificate of insurance for L. H. Lacy
Company evidencing General Liability and Automobile Liability
coverages for the policy'period 11/30/88 to 11/30/89.
The Workers' Compensation coverage has been bound effective
11/30/88 with the Texas Workers' Compensation Asigned Risk Pool,
and a certificate of insurance evidencing same will be forwarded
to you as soon as possible.
I trust this will be satisfactory for your requirements; howe~er,
if I may be of further assistance, please feel free to contact
me.
Yours truly,
!
Jay Taylor
Administrative Assistant
Att.
L. H. Lacy Company
P. 0. Box 541297
Dallas, Texas 75354-1297
INSURANCE * BONDS , RISK MANAGEMENT * EMPLOYEE BENEFITS
COLLIER COBB & ASSOCIATES
OF DALLAS, iNC.
,. ;, i ,.'.~,...'-~. k' i~L?,~CE, 57'5'2 i'iNELAND I_ t,l\ E, DALL.-~S, TEXAS
November 29, 1988
TO WHOM IT MAY CONCERN:
Attached is the renewal certificate of insurance for L. H. Lacy
Company evidencing General Liability and Automobile Liability
coverages for the policy'period 11/30/88 to 11/30/89.
The Workers' Compensation coverage has been bound effective
11/30/88 with the Texas Workers' Compensation Asigned Risk Pool,
and a certificate of insurance evidencing same will be forwarded
to you as soon as posSible.
I trust this will be satisfactory for your requirements; however,
if I may be of further assistance, please feel free to contact
me.
Yours truly,
Jay Taylor
Administrative Assistant
Att.
L. H. Lacy Company
P. 0. Box 541297
Dallas, Texas 75354-1297