WA9401-CS 941213GENERAL CC}NTRACTQR:S '
30i3 wES'T'
F.C, RTWQ RT,'-I,, T'X 7'~
817'-~.~-4-~7' FAX
tO: City o~ Coppell Z:)~,e: Z2-:13-94
P,O, Box 4?8 Af,~,n: Kenneth 'Z~, Gri~in~
Coppe11~ Texas 7[~01_9 ~e: hst Beztzine Road ~ater T,ine Pro.i
WE ARE SENDING YOU X A==ached Under gaperate cover via t, he
following
Shop Drawings __ Prints Samples ., Specifications
Cop~ '02 Let=e_- __ Change Order Brochures ....
] COPIES % DATE % DESCRIPTIOn__
3 12-13-94 Insurance certificates
1 12-13-94 Insurance Binder
I 12-13-94 CODieS Of Insurance Certificates sent ~o DART
'for yo~3r file .
THESE 2LRE TRANSMITTED as checked below:
For Approval App=oved as S~:mi~:ed __ Resuhmit__ copies for Approval
X. For your Use , Approved u Note~ SuJmaj,~. .~p~-~ =~r Dis~ribution
As Rec~es~ed Returned for Cor=,e~cions Retur~ Cotfeted Prints
For Review & Ccmmen=
REMARKS & PaQQ;STS:
COPY TO = ARCHITECTURAL UTILITIES, INC,
By Betty J, Sanders
· a ':. I 1 [ I'
CERTiFiCATTJ/
AI,"IIIIll,, OF INSURANCE
mm ~lS CER~RCA~ IS IS~U~ AS A ~R OF INFORm~N
ONLY AND CON~RS NO RIGH~ U~N ~E CE~A~
Southwest Assurance Groupt Inc HOLDER. ~IS CER~RCA~ DOES NOT AMEND, ~ND
9400 N. Central E~,, f1550 AL~R ~E COVERAGE AFFORDED BY ~E ~UCIES BEL~.
Dallas, TX 75231-5044 COMPANIES AFF~mNG COVE~GE
(214) 691-5721 F~ 691-4961
A T~BPORTXTION INB~CE CO.
~CHITECT~ UTILITIES, INC. B V~LEY FORGE CO~P~
P. O, BOX 11586 C CO~INE~ CXBU~TY CO~
FT · WORTH TX 76110
O GRDT ~ERIC~ LLO~8
COVERAGES .' "*' .... . "' '
.'. .. '. ...~. '...T ~.' ....; ....
~S ~S TO C~R ~T ~E ~C~B ~ ~NSU~CE US~ ~ HA~ ~N mum TO ~E ~NSUS N~
INDICA~, NO~DING ~ ~I~ME~, ~ ~ C~DI~ ~ ~Y C~T ~ O~B ~UM~ ~ ~ ~ ~ICH ~lS
CE~FICA~ MAY ~ I~UED ~ MAY E~NN, ~E INSU~CE ~ BY ~E ~CIES D~CRIB~ HEWN IS SU~ECT TO ~ ~E ~S,
~C~SI~S ~D C~DI~S ~ SUCH P~CI~. UMI~ SH~N MAY HAVE BE~ ~UC~ BY PND C~MS.
cO ~V ~
Lm ~ ~ m~ ~v ~ DA~ ~ DA~
A ~ ~~~ s~ 2~ 05/0~4 05/0~5 ~-~~
X CG25-03
~D ~ (~ ~ ~r~) I 5,~
A~ ~
a X ~o BUAS~mm 05/0Z~4 05/0Z~5 ~~LN~ $~,m
~ ~D ~ ~LY
X H~D ~ ~DLY
GAUGE ~ ~0 ~Y -
C X ~ ~ ~ PLUS ~m~ 0 5/0 Z ~ l 0
o~ ~ ~ ~ R~AINED
P~~
D BUILDER8 RISK nM 8~74 05/01~4 05/01~5 ~ ONE LOC ~,~
~L RISK FLOOD/QUgE $ ~,~
PROJECT= EAST BELTLINE RO~ WATER LINE INST~LATION WA 94-01
$HOULD ANY OF THE ABOVE DE3CRI8) FOUCB IE
EXIqRAllON DATE THEREOF, THE IIIJING COIl*aNY MLL BIDEAYOR TO MNL
3 0 DAY8 ~ NOllCE TO THE CEITWllqGATE HOLDER II/talED TO 11E LEFT,
CITY OF COPPELL BUT FALURE TO lea. euc. NONCE e4aLL WOe NO oeu~me
ATTN= KENNETH M. GRIFFIN, P.E. OF a~v xa~ ~ cce~u., ~ A~fm
PO BOX 4 7 8 A~.~ ~ ~.~,~~
co.,EL%. TX 75019
..... · ...'. . ..... X ............
ACORO ~ (S~ .. . . · ....· , =' ". '...: .~:/. n .. ,:' ¢0~
Al;Olllk CERTIFICATe. OF INSURANCE
12/8/1._9.94
monucm THIS CERTIFICATE IS ISSUED AS A MATI'ER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Southwest Assurance Group, lnc HOLDER. THIS CERllF1CATE DOES NOT AMEND, EXTEND OR
9400 N, Central Expv]~., #1550 ALTER THE COVERAGE AFFORDED BY THE POUCqES BELOW.
Dallas, TX 75231-5044 COMPARES AFFORDING COVERAGE
(214) 691-5721 F3X 691-4961
A TRANSPORTATION INS. CO.
NIURED
CITY OF COPPELL S
P. O. BOX 478 C
COPPELL TX 75019
D
COVERAGES.
1.1~ ,.~ I0 C[ltTIrv IhAI I.'L I~,)[ICI.s S ('r' INSJ|~CL LJSli'-'~ H|. LOW HA,'~ BH~ .'.~StL~ TO 1.eE I~c~14i:J NAM.rD N~V|.. ~OH |.'IF IYJLJCY P~RI'~
INDICATED, NOT~qTHSTANDING ANY REQUIREMENT, TERM OR COND~ION OF ANY CONTRACT OR OTHER DOCUMENT W~H RESPECT TO WHICH TH~
CERRFICATE MAY RE LSSUED OR MAY PERTAJN, THE INSURANCE AFFORDED BY THE POUCIES DESCF~RED HERBN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDIllONS OF SUCH POUCIES. UMrTS SHOWN MAY HAVE BEEN REDUCED BY PAJD CL/dMS.
co IsoucY BqslC1wl IsOUCY IXPIRA110N
OENERAL UAmUTY GENEraL AGeREGAlE $1
CCxW.~RCLN. eS, ERN. LUUn.~ 10~1954012 12/15/94 04/01/95 PRODUC~-COMP/CP.,.ee
X oees & cu~n~'Kxrs F,,of F. AC, ~ sl,ooo, Ooo
__ FRED.4MAGE()~/Oner, m) $
MEDBa'(~nyonepeeon) $
.aNy AUTO CQIdBI4ED SNQLE LIdIT $
ALL OWI,~D AUTOS
-- BODLYII~URY
HeED
NCN-CWVNED AUTOS (Per ~
PROPEmY~ $
__ ANY AUTO O'THO~ ~ NJTO CNLY:
__ EACH ~DENT
'lUMBRlalA FORM AGGREGA'IE
!lll~IB, tl' L.e,!lJtY
PAR~CUTNE
PRO;ECT: EAST BELTLINE ROAD WATER LINE WA94-01
DESIGNATED CONTRACTOR: ARCHITECTURAL UTILITIES, INC.
PO BOX 11586
FORT WORTH, TX 76110
CERTIRCATE HOtDER CANCELLATION . ~.:'
3 0 DAYS W!!IT'ITN NO11CE 10 THE CBI11RCAll M NAILED 10 1HE LEFT,
CITY OF COPPELL m~ ,aumE 10 ass. ~uc. Nonca SHALL .s'Oe NO om. mA'nofi oR u~mun,
COPPEL~ TX 75019
ACO~D 2~S (~) ~ .....
I '! III i ] ~T TT'
THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORIL
FROOUCER I IK)~E OOUPANY ~ BICBI ·
(AJC. NO. Ex~:
Southwest/~ssuzance Gzoup, lnc TRKNBPORTATION INS. CO. 001976
9400 N. Central Expwy., ~1550 DA~ me m~
Dallas, TX 75231-5044 12/15/94 12:01
(214) 691-5721 FI~X 691-4961
coo~ 074706040
AQENC~
CUITOMER m:.
CITY OF COPPELL DESIGNATED CONT: ARCHITECTURAL UTII.I11ES
P. O. BOX 478
~ CAUSES CFL(~S
~ I.iaal.lw GS, EtN. AIa{iPEGAlS Sl,000,0QO
ccMamcw,~mw, u~LnY 1031954012 max~m-~~ s
~:~:~:~:~:~:~:~:~
Z ~s~~ ~ ~ sl,~
~DAE~I ~~~)
~1 ~~ ~ ~ l
PR~ECT: ~ BEL~NE ROAD WA~R ~NE WA~I
. ~..
~CHITECT~ ~ILITIE8, ZNC ·
PO BOX 11586
FORT WORTH TX 76110
/
ACORD ~2 (lZ~3) NO~: IMPORTA~ STA~ INFORMA~ON ON REVERSE
i .....I ' ! '[
CONDITIONS
This Company binds the kind(s) of insurance stipulated on the reverse side. The Insurance is subject to the
terms, conditions and limitations of the polioy(ies) in current use by the Company.
This binder may be cancelled by the Insured by surrender of this binder or by written notice to the Company
stating when cancellation will be effective. This binder may be cancelled by the Company by notice to the
Insured in accordance with the policy conditions. This binder is cancelled when replaced by a policy. If this
binder is not replaced by a policy, the Company is entitled to charge a premium for the binder according to the
Rules and Rates in use by the Company.
Applicable in Califomia
When this form is used to provide insurance in the amount of one million dollars ($1,000,000) or more, the title
of the form is changed from "Insurance Binder" to "Cover Note".
Applicable in Ddaware
The mortgagee or Obligee of any mortgage or other instrument given for the purpose of creating a lien on real
property shall accept as evidence of insurance a wr'~en binder issued by an authorb,.ed insurer or its agent if
the binder includes or is accompanied by: the name and address of the borrower; the name and address of the
lender as loss payee; a description of the insured real property; a provision that the binder may not be canceled
within the term of the binder unless the lender and the insured borrower receive written notice of the cancel-
lation at least ten (10) days prior to the cancellation; except in the case of a renewal of a policy subsequent to
the closing of the loan, a paid receipt of the full amount of the applicable premium, and the mt~unt of
insurance coverage.
Chapter 21 Tie 25 Paragraph 2119
Applicable in Nevada
Any person who refuses to accept a binder which provides coverage of less than $1,000,000.00 when proof is
required: (A) Shall be fined not more than $500.00, and (B) is liable to the party presenting the binder as proof
of insurance for actual damages sustained therefrom.
ACORD 15-S (12193)
. ..me iIIIIIIIIIlu i' 1"' ! ! 'r'
· eOItlh CERTIFICA'i .. OF INSURANCE
· 12/12/1994
e~oucm THIS CERTIFICATE IS ISSUED AS A MAit~R OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Southwest Assurance Group, lnc HOLDEFL THIS CERTIRCATE DOES NOT AMEND, EXTEND OR
9400 N. Central Exl_)w]F., #1550 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Dallas, TX 75231-5044 COMPANIES AFFORDING COVERAGE
(214) 691-5721 YAX 691-4961 COMPANY
A TRJ~TSPORTATION INS. CO.
DKT.,L~S ]~EA RAPID TI~NBIT S
ATTN: JAN BEIDNER co~v
P, O, BOX 660163 C
DALLAS TX 75266-7230
D
THIS IS TO CERT1FY THAT 'IHE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NO11VITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN I$ SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UMIT$ SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR Tn.i OF NIJRANC! FOUCY II DA'II (IINDDPrQ DATE ~
A ~Xaer..UU.C~FUL. LL, a.r~ 103183745~ 12/15/94 04/01/95 ,F~Dt~S-~dW0PA~e
X RAILROAD PROT mE {Wa~E Ck,y o., f,,~
MED EP CMy one pe~n) $
-- COeaSNe)SI~L~Ulm $
' sC,e3taa) AUTOS ~ pe~n) l
HIRED AUTOS BODILY IKA, IRY
NON-OWNED AUTOS (Pe~ accident)
GARAGE UABLITY AUTO ONlY - EA ACCIDS~T S
1HE PROPRIETOR/ ~ INCL DISE.~ - POLICY LIMIT
P~CUTWE
OFRCImS ARe EXCL DISEASE - EACH Eldq_OY~E
ADDITIONAL INSURED - ST. LOUIS SOUTHWESTERN RAILWAY COMPANY
PROJECT: EAST BELTLINE WATER LINE PROJECT WA 94-01 FOR CITY OF COPPELL
30 DAY CANC. ENDT TO DART
.XnnATm. DATE *n~moF, *ne mum coeA.v
3 0 DArl ~ NOTICE 10 114E CER11RCATE HOLDER NAILED 10 THE LEFT,
DART 't _
ATTN: JAN SEIDNER ssrssu'zmmr---
PO BOX 660163 au'moRua~ FEF~aEWrA -
'" '" .. ! I i ]i
- Ai;el;ll. CE TIFICAT,;"r).OF INSUR NC'E' """'""""
. . .................. .......... ,z__2../._..8 / 19 9
PROOUC~R ' THIS CERTIFICATE IS ISSUED AS A MATItR OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Soxlthwest Ass~ttance Grol~p· T]~C HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
9400 No CentraZ Rx~wT. ·//1550 ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
D~llas, t][ 75231-5044 COMPANIES AFFORDING COVERAGE
(214) 691-5721 FAX 691-4961 CCMP~,
A TRAHSPORTAtZON ZNBURILNC~. CO.
COMPANY
ARC:HZtRCtURAL UtIT.TtZRS· ZNCo S VALT. EIE FORGR COMPILNY
P. O. BOX 11586 C COlfI'TNEN~AI, CASUALTY COMPA.-~
Ft. WORTH tX 7 6 110
D GRFjt, t AN:P. RZCAN T.T.OYDS
~i***:*>:"*:*"*"""':*:<*?"::':*>"'*":*'~"~ii~*;::::::.~*:~' ~**:,'::ai~.~:!;:'~.~" ~:~::ii~!;:.:.;':: z~i~:*~i~if~*`::*`*~:*::*~**:i~:***~*~if;i:::~i:.~**~::***`~:~`:*`~iP``~*i~:~:~.i*:***~*:~*~:.!~E%:~!a~!~.~.~::~.f:~V* '..*.***:~'~':.:'~":%:*~'~.~ ."* '~;'~'~;' ~*:~ **': :a~'~:.i~l: "*" ' ~. ~"' *: .............. ~; ........
THIS IS TO CERTIFY THAT THE POUCIF_~ OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD
INDICATED, NO11VITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUM~IT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAJN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO POLICY EFFECTWE PO~Y EIPIRAll0N
LTR TYPE 0it NSURANCE POLICY NUMmER DAI~ (era DATE (m Urn11
A 'Z' CCMMERC~.a,m.rrf SET 2~08078S 05/01/94 05/01/95 P,O~uCTs-CcH.~AaG s~,000,000
~ & CONIRACTC)R~ PROT · EACH OCCUfg:eiCE $1,000,000
X CG25-03 FFEO,,,~(,~o,,,e,,) $ S0,000
MED EXP (Any e~e peeo~) S, 5,000
AtrTOM0eiL.E LIABILITY
:B __X Nn'AUTO BUA 21080772 05/01/94 05/01/95 COIVSlNEDS,NGLELIMIT S1,000,000
__ALL ON'NED AUTOS BODILY ~
SCHEDUtED N. IT06 (Per pecan)
X HleED AUTOS BOOTY NJ. Rf
Y NON-OWNED NJTOS (Per accident)
-- PROPS~f DAMAGE $
GARAGE UABLffY AUTO ONtY - EA ACCIDefir $
EACHACCIOENT S
"""""'"' ,_,,,, ,,.,.,
ee3_A FCea RETAINED LMT$. 25,000
C em.ovERs'Lum~rv WC 2~o80769 05/01/94 05/01/95 EACHACa0eiT S S00,000
THE PRQPRIEI*0R/ IX[: DISEASE - PCUCY LIMIT S
P/RTN~CUT~
D BUILDERS RISK Tlu 89sss74 05/01/94 05/01/95 ANY ONP- r. OC $s,ooo, ooo
3LT.,I, RISK FT. OOD/QUAK:E S 25o, ooo!
PROJP. Ct: EASt B:Br.tT.IHE ROAD WAFER T. TITB INStAI, LAtION WA 94-01
DART & 8to LOUIS 80UtHREBtERN RAILWAY CO. ARE ADDITIONAL INBUREDB
UNDER AUTO, B~St ADDr. INBURRD ENDORSF, MEN~S ~PPT. ICBI, E ON G]~N,LIAB &
UMBRRT. T.~ T.IAB. RATV~R O1;' BUBROGltIOH OH WORK: COY,.P IN YAVOR OF' DART,
ID(RULllON DATE THEREOf:, THE 188UI4Q COilFANY.}WILL.,IJ~!ilIII!I,)~I MAIL
DALLAS ARF, A RA~ZD tlt. ANSZt
ATTN: JAN SEIDNER cw me~~~~sw~m~
PO BOX 660163
DALLAS ITX 75266--7230 ·
ACORU'25.S (a.~)' "'= .......... . ........... ~ ..... ,'-r; ? .:*.. ,.'* *.'-~
. ' .... .N,,,a~ ............ ~..
I ' ! III I i ! ~"
. IINSURED: ARCHITECTURAL UTILITIES, INC.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CANCELLATION BY US
This endorsement modifies insurance provided under the foilowinr
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
LIQUOR LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABIUTY COVERAGE PART.
SCHEDULE DART
Number of Days 30 Attn : Jan Seidner
PO Box 660163
Dallas, TX 75266-7230
(If no entry appears above, information required to complete this Schedule will be shown in the Declarations as
applicable to this endorsement.)
Para&q'aph 2. of CANCELLATION (Common Policy Conditions) is replaced by the following:
2, We may cancel this Coverage Part by mailing or delivering to the first Named Insured.written notice of
cancellation at least:
a. 10 days before the effective date of cancellation if we cancel for non payment of premium: or
b. The number of days shown in the Schedule before the effective date of cancellation if we cancel for any
other reason.
THIS ENDORSEMENT 18 A PART OF YOUR POLICY AND TAKES EFFECT ON THE ire-=C;iVE DATE OF YOU!
POUCY UNLESS ANOTHER EFFECTIVE DATE IS SHOWN BELOW.
POLICY CHANGE NO, =H-=t~,VE DATE OF THIS POLICY CHANGE
12/8/94
COUNTERSIGNED DATE AUTHORIZED REP ~f~~_N~'
12/8/94 SOUTHWES~O C,
CG 02 12 11 85 Copyright. Insurance Services Office, Inc., 1984 []
WC 276
(Ed. 7-84)
W~;.42 OS 01 (Ed. 7-84)
TEXAS NOTICE OF MATERIAL CHANGE ENDORSEMENT
This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a
different date is indicated below.
(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.)
This endorsement, effective on Dec. 8, 19~ at 12:01 A.M. standard time, forms a part of
Policy No. wC 21080769 Endorsement No.
of the Continental Casual tg CompanW (NAMEOFINSURANCE:COMPANY)
issued to ARCHITECTURAL UTILITIES, INC. ~
Premium (if any) $
Authorized'Re~esentati
SOUTHWEST ASSURANCE GROUP, INC.
This endorsement applies only to the insurance provided by the policy because Texas is shown in item 3.A. of the
Information Page.
In the ev..ent of cancelation or other material change of the policy, we will mail advance notice to the person or
organization named in the Schedule. The number of days advance notice is shown in the Schedule.
This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
, Schedule
1. Number of days advance notice: 30 darts
2. Notice will be mailed to: DART
ATTN : JAN SEIDNER
PO BOX 660163
Dallas, TX 75266-7230
Proj~t: East beltline Road Water Line Installation WA 94-01
,""""'., G-19369-A42
IhuT...'ncO ,
· Iml llllllll~' i "' ! i ! '['
For All the Commitments Yoo Make
Bcrtxcg STAT/~VG IFa~W TJ~I~,UTB~ ~ ~~~ ~ar.r. ~ ~~, ~S ~
~ar.r. H ~~.
~G.
PO Box 660263
Da12a~, ~X 75266-7230
ProjecC: gas~ Be2~l~ne road Wa~e~ ~ine Znsba12a~ion ~ 94-0~
This endorsement is a part of your policy and takes effect on the effective date of your policy, unless another effec-
tive date is shown below.
Must Be Completed Complete Only When This Endorsement Is Not Prepared with the Policy
Or Is Not to be Effective with the Policy
ENDT. NO. POLICY NO. ISSUED TO EFFECTIVE DATE OF
THIS ENDORSEMENT
PLUS 21080867 ARCHITECTURAL UTILITIES, INC. 12/8/94
[] Continental Casualty Company [] American Casualty Company of Reading, Pa. [] National Fire Insurance Company of Hartford
[] Transportation Insurance Company [] Valley Forge insurance Company [] Trenscontin~intal insurance Company
Countersigned by ~'~/-~'/ '~ '
G*39543-B
1199 01B
ADDITIONAL IHSURED
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
TRUCKERS COVERAGE FORM
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below:
Endorsement Effective Policy Number
12/8/94 BUA 21080772
ARCHITECTURAL UTILITIES, INC. SOUTHWEST ASSU. P,
Countersigned by
{A epresentative)
The provisions and exclusions that apply to LIABILITY COVERAGE also apply to this endorsement.
DART & St. Louis Southwestern Rai_Twag Company
Attn: Jan Seidner
PO BOX 660163, Dallas, TX 75266-7230
(Enter Name and Address of Additload IBmwed.)
is an insgrad, but only with respect to legal responsibility for acts or omissions of a person for whom Uabllity Coverage is afforded
under this policy.
The odiltoed Inmwd is not required to pay for any premiums stated in the policy or eamed from the policy. Any return premium
and any dividend, if applicable, declared by us shall be paid to you.
You are authorized to act for the eddilbmd inswed in all matters pertaining to this insurance.
We will mail the m&lllaegi inswed notice of any cancellation of this policy. If the cancellation is by us, we will give ten days notice to
The eddilkt, J haMred will retain any right of recovery as a claimam under this policy.
Project: East Beltline Road Water Line Installation WA 94-01
F~ORM TE 99 01B -- ADDFrlONAL INSURED
Texas Standard AulN,mble Endorsement
Prescribed March 18, 1992
I ' I Iii ! ! I i 'r'
I /-% TE 02 02A
CANCELLATION PROVISION OR COVERAGE CHANGE ENDORSEMENT
This enaorsement modifies imurance provided under the follower,
BUSINESS AUTO COYIRA~ FORM
GARAGE COVIRAGE FORM
TRUCKERS COVEIAGE FORM
This endorsement changes the DolicY effectWe on the inceDt~on date of the Dolicy ur~ess another date is ,naicated below:
Endorsement t~ffectwe Policy Nurn~er
12/8/94 BUA 21080772
Narnea Insurea ~ce~ove~e)
ARCHITECTURAL UTILITIES, INC. · '
30 days before This policy is cancelled or rnateria~ char.Ject
age we wdl mad notice of the cancellation or charge to:
DART, ATTN: JAN SEIDNER, PO BOX 660163, DALLAS, TX 75266-7230
(Enter Name and Address/
PROJECT: EAST BELTLINE ROAD WATER LINE INSTALLATION WA 94-01
FOIM TI 02 O2A -- CAIICw t kTION FROVISION OR COVIRAGi CHAN~ INDOISEMINT
h,_ .:km~ Made 18, letet2
I ' I III ] ] ! 1[