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Atmos-CS190314CERTIFICATE OF LIABILITY INSURANCE DATE (MMlDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTfFICATE 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: I the certificate hoider is an ADDITIONAL INSURED, the policy(iesj must have ADDITIONAL INSURED provisions or 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 oes not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Higginbotham In urance Agency, Inc. NAME: Michele Lane 500 W. 13TH PHONE 817-336 2377 FAX Fort Worth TX 7l E•MAII Afc No1:817-347-6981 INSURED CROSS82 r—ilA: LyanSEOn inSuranceCompany 35378 Cross Ublites, LL INSURERS: Federal Insurance Com 20281 an P.O. Box 330686 INSURER C: Service Lloyds Insurance Company Fort Worth TX 7 163 _43389 COVERAGESIrvsu RER F: CERTIFICATE NUMBER: 933596859 THIS IS TO cI THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED ENAMEDnABOVEBFOR THE POLICY PERIOD NDICATED. NO ITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MA BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND ONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. VSR Al SUBR .TR TYPE F INSURANCE I SU POLICY NUMBER POLICY EFF POLICY EXP A X COMMERCIA GENERAL LIABILITY MMlDDfYYY MMIDD1YyYY UMITS MKLV4PBCD00338 3/14/2019 3/14/2020 CLAIMS- ADE EACH OCCURRENGE $ 1,000,000 OCCUR 6 i.r Tn acnircn GENT AGGREGATI LIM17 APPLIES PER. POLICY 1 ' I JECOT 71 LOC D AUTOMOBILELIABI ITY X ANYAUTO OWNED SCHEDULED AUTOSHIRED ONLY ❑ AUTOS Y AUTOS ONLY I��II E HEXCESS L I X OCCUR C IWORKERSCOMPE AND EMPLOYERS' (Mandatory In I If yes, describe under DESCRIPTION OF OI B LeasedrRented Equir Schedule PHPK1953404 HOigF_XcZ01KTMIV YIN EJ1l I VVC01000772019A 45469918 DESCRIPTION OF OPERATI NS! LOCATIONS 1 VEHICLES (ACORD 101, Addpional Remarks Schedule, may be attached if more space is required) The General Liability and Automobile Liability policy includes a blanket automatic additional insured endorsement that provides additional insured status (including CompletedOperations) and General Liability, Automobile Liability and Workers' Compensation policy includes a blanket waiver of subrogation endorsement to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. The General Liability Policy has a blanket Primary & Non Contributory endorsement that affords that coverage to certificate holders only where there is a written contract between the Named Insured and the certificate holder that requires such status. Ronald Day 8 Tyrone tasby are excluded from the Workers Compensation policy See Attached... CERTIFICATE HOLD R SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Atmos E ergy Corporation (Category 1) ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Dor Howard 5430 LB Freeway, Suite 700 Dallas T 75240-2601 AUTHORIZED REPRESENTATIVE ACORD 25 (2018103) Cs 198 8 -2015 A The ACORD name and logo are registered marks of ACORD RD CORPORATION. All rights reserved. MED EXP (Any one person) s5,000 PERSONAL S ADV INJURY $ 1,000,1 GENERAL AGGREGATE $2,non ,OOC PRODUCTS - COMPIOP AGG S 2,000 nnn $ 3/14/2019 3/14/2020 GOMBINEDSINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE $ Per accident 3/14/2019 3/14/2020 EACHOGCURRENCE $5,000,000 AGGREGATE $5,000,000 $ 3114/2019 3!1412020 X PEROTH- STATUTE ER EL. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,OOD E.L. DISEASE - POLICY LIMIT $ 1,000,000 3114!2019 3/14/2020 Limit $101 see Below DESCRIPTION OF OPERATI NS! LOCATIONS 1 VEHICLES (ACORD 101, Addpional Remarks Schedule, may be attached if more space is required) The General Liability and Automobile Liability policy includes a blanket automatic additional insured endorsement that provides additional insured status (including CompletedOperations) and General Liability, Automobile Liability and Workers' Compensation policy includes a blanket waiver of subrogation endorsement to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. The General Liability Policy has a blanket Primary & Non Contributory endorsement that affords that coverage to certificate holders only where there is a written contract between the Named Insured and the certificate holder that requires such status. Ronald Day 8 Tyrone tasby are excluded from the Workers Compensation policy See Attached... CERTIFICATE HOLD R SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Atmos E ergy Corporation (Category 1) ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Dor Howard 5430 LB Freeway, Suite 700 Dallas T 75240-2601 AUTHORIZED REPRESENTATIVE ACORD 25 (2018103) Cs 198 8 -2015 A The ACORD name and logo are registered marks of ACORD RD CORPORATION. All rights reserved. AGENCY CUSTOMER ID: CROSS82 LOC #.- ADDITIONAL :ADDITIONAL REMARKS SCHEDULE Page 1 of AGENCY Higginbotham Insijr2nce Agency, Inc. NAMED ENSURED ~ Cross Utilries , LLC 10LICY N -Ma. P.O. Box 330686 Fort Worth TX 76183 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 28 FORM TITLE: CERTIFICATE OF UABfLITY INSURANCE The Umbrella policy is Follow Form. The Automobile Lia114policy has a Primary & Non Contributory endorsement that affords that coverage to certificate holders only where there is a written contract between th Named Insured and the certificate holder that requires such status ACORD 401 (2008101) 2008 CORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks o ACORp