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E� fr���M�����'��V CERTIFICATE NUMBER
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PRODUCER
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Marsh USA Inc.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
The Financial Center
NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
1215 Fourth Avenue, SUlte Z3OO
POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
Seattle, WA 98161 -1095
AFFORDED BY THE POLICIES DESCRIBED HEREIN.
Attn: Kathy Hariri 206 613 -2625 Fax: 206 613 -2516
COMPANIES AFFORDING COVERAGE
COMPANY
A NATIONAL UNION FIRE INS CO OF PA
rv�0 - QCC- GAW -07 -08 cont KBH bai
INSURED
QWEST COMMUNICATIONS CORPORATION
COMPANY
1801 CALIFORNIA STREET, SUITE 1150
B INSURANCE COMPANY OF THE STATE OF PA
DENVER, CO 80202
COMPANY
C AMERICAN HOME ASSURANCE COMPANY
COMPANY
D
OVRAGF� �o-
i .... ti This certlfi ate',supersedesand repilC2 any pf2Uious)y issued c'`i�Wata r ite.p..,: r
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE
NOTWITHSTANDING
x _.
BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT
PERTAIN,
OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR
MAY
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE
LIMITS
SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
DATE (MM/DDNY)
DATE (MM /DDNY)
LIMITS
A
GENERAL
LIABILITY
GL1595519
10/01/07
10/01/08
COMMERCIAL GENERAL LIABILITY
GENERAL AGGREGATE
$ 2,000,000
X
PRODUCTS - COMP/OP AGG
$ 2,000,000
CLAIMS MADE
PERSONAL & ADV INJURY
$ 1,000,000
OCCUR
OWNER'S & CONTRACTOR'S PROT
EACH OCCURRENCE
$ 1,000,000
FIRE DAMAGE (Any one fire)
$ 1,000,000
MED EXP (Any one person)
$ 10,000
A
AUTOMOBILE LIABILITY
CA1607086 (AOS)
10/01/07
10/01/08
A
X ANY AUTO
CA1607087 (CT, LA)
10/01/07
10/01/08
COMBINED SINGLE LIMIT
$ 2,000,000
C
ALL OWNED AUTOS
CA1607088(MA)
10/01/07
10/01/08
A
SCHEDULED AUTOS
CA 1607089 (VA)
10/01/07
10/01/08
BODILY INJURY
(Per person)
$
HIRED AUTOS
BODILY INJURY
$
NON -OWNED AUTOS
(Per accident)
X SELF - INSURED FOR
PROPERTY DAMAGE
$
UTO PHYSICAL DAMAGE
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN AUTO ONLY:
z
EACH ACCIDENT
$
AGGREGATE
$
EXCESS LIABILITY
EACH OCCURRENCE
$
UMBRELLA FORM
AGGREGATE
$
OTHER THAN UMBRELLA FORM
$
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABWTY
WC5455528 (AOS)
10/01/07
10/01/08
X W A
TORY LIMITS ER
$�E Fiji \r ,.,.
B
WC5455529 (CA)
10/01/07
10/01 /08
EL EACH ACCIDENT
$ 1,000,000
B
THE PROPRIETOR/ INCL
PARTNERS/EXECUTIVE
WC5455530 (FL)
10/01/07
10/01/08
EL DISEASE-POLICY LIMIT
$ 1,000,000
A
OFFICERS ARE: EXCL
WC5455531 (OR)
10/01/07
10/01/08
EL DISEASE
$
OTHER
-EACH EMPLOYEE
1,000,000
B Workers' Compensation WC5455532 (TX)
10/01/07 10/01/08 Each AccidenUEmployee $1,000,000
A Workers' Compensation WC5455533 (WI ND OH WV WY)
10/01/07 10/01/08 Each AccidenUEmployee $1,000,000
C Excess Workers' Compensation IXWC5455534 (WA)
10/01/07 10/01/08 Excess of SIR Shown Above $1,000,000
DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /SPECIAL ITEMS
THE CITY OF COPPELL, TEXAS IS AN ADDITIONAL INSURED AS RESPECTS
THEIR INTEREST IN THE OPERATIONS
OF THE NAMED INSURED AS
REQUIRED BY WRITTEN REGARDING GENERAL LIABILITY COVERAGE.
CERTIFICATE I10LDEFtE €F5 CANCELLATION;,.
....E , z'71 ,•. .. •:• y €F. .?'. / 'f
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..:aF<3r. ..,,.. ...E .�, n. .;E,s< a,E.,FEu,�,. ..
Et: ''9e .'?'
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
CITY OF COPPELL
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL _3D DAYS WRITTEN NOTICE TO THE
ENGINEERING DEPARTMENT
CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
255 PARKWAY BOULEVARD
COPPELL, TX 75019
LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES, OR THE
ISSUER OF THIS CERTIFICATE.
MARSH USA INC.
By Cheryll L Koch 7/`r �_ "'15 {/O
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a �j E d fey �€ — at J
1,� E�( E --/ E" MN11 3 /I? ` VALID AS OF .09/28/07
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