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GTE-CS090720ACORD CERTIFICATE OF LIABILITY INSURANCE DATE PRODUCER (501) 376 -0716 FAX: (501)376-2118 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION e Cashion Company, Inc. J Box 550 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Little Rock AR 72203 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: National Fire Ins. Co. of 20478 Klaasmeyer Const. Co., Inc. INSURER B: National Union Fire Ins 19445 PO Box 847 INSURER a Valley Forge 20508 INSURER D: Conway AR 72033 INSURER E: OVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM /DD/YY POLICY EXPIRATION DATE MM /DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR 2091374110 8/1/2009 8/1/2010 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MEDEXP (Any one person) $ 5,000 PERSONAL& ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JECT LOC PRODUCTS - COMP /OP AGG $ 2,000,000 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ 1,000,000 X A ALL OWNED AUTOS SCHEDULED AUTOS 2091374155 8/1/2009 8/1/2010 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS/UMBRELLALIABILITY X OCCUR FI CLAIMS MADE EACH OCCURRENCE $ 15,000,000 AGGREGATE $ 15, 000, 000 B DEDUCTIBLE BE7227380 8/1/2009 8/1/2010 $ X RETENTION 10 000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY X TORY L MITS ER E.L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? If yes, describe under 2091374205 8/1/2009 8/1/2010 E.L. DISEASE - EA EMPLOYEE$ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION City of Copple Texas Attn: Keith Marvin 255 Parkway Blvd Copple, TX 75019 ACORD 25 (2001/08) INS025 (0108).08a SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ,r 7im Allbritton /MJC001 © ACORD CORPORATION 1988 Page 1 of 2 COMMENTS /REMARKS IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements(s). 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). DISCLAIMER The Certificate of Insurance attached to this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. Policy terms and conditions mandate 10 day notice of cancellation for nonpayment of premium. ' OFREMARK COPYRIGHT 2000, AMS SERVICES INC.