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ST9302-CS030618Cliant#c 20289 ILA GI ccl G ACORD.M CERTIFICATE OF LIABILITY INSURANCE °~' 0618103 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HRH Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 5520 LBJ Freeway, Sixth Floor HOLDER. THIS CERTIFICATE DOES NOTAMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Dallas, TX 75240 972 385-9922 INSURERS AFFORDING COVERAGE NAIC p INSURED M l' El i INSURER A: Employers Mutual Casualty Company e s ectr c Service, InC. 1810 S Ak d INSURER B: ar . D ll T 75215 INSURER C: a as, exas INSURER D: INSURER E: COVERAGES r- THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO 7HE 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLL V EFFECTVE DATE MMlDOlYY POLICY EXPIRATION DATE MM/DDIYY LIMITS A GENERAL LIABILITY 2D2535904 07/01/03 OlIO11O4 EACH OCCURRENCE $1 OOO OOO X COMMERCIAL GENERAL LIABILITY DARMAGE TO RENTED n S3OO DDD CLAIMS MADE a OCCUR MED EXP (Anyone person) $$ QOQ PERSONAL & ADV INJURY $1 OOO OOO GENERAL AGGREGATE $2 OOO OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 OOO OOO POLICY X jERa LOC A AUT OMOBILE LIABILnY 2E2535904 07/01/03 U7101104 X ANVAUTO COMBINED SINGLE LIMIT (Ea accident) $1,DDQ,pDD ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accitlent) PROPERTY DAMAGE $ (Per accitlent} GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESSIUMBRELLA LIABILITY 2J2535904 07/01/03 U7/U1/Q4 EACH OCCURRENCE $10 QQQ QQQ X OCCUR ~ CLAIMS MADE AGGREGATE $10 000 000 $ DEDUCTIBLE $ )( RETENTION $ 10000 $ A WORKERS COMPENSATON AND 2H2535904 07!01103 07/01104 WC STATU- OTH- EMPLOYERS' IAB Y Y I I T L ILIT ANY PROPRIETORlPARTNER/EXECUTIVE E.L. EACH ACCIDENT $SOO,000 OFFICER/MEMBER EXCLUDED? It d rib d E.L, DISEASE - EA EMPLOYE $SOO,000 yes, esc e un er SPECIAL PROVISIONS below E.L, DISEASE - POLICY LIMIT $500,000 A °TMER Inland 202535904 07/07/03 07/01/04 $100,000 Leased or Marine Rented Equipment E500 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS Project: Sandy Lake Road, Coppell City of Coppell is additional insured with a waiver of subrogation provided for the General Liability Policy. City of CoppeN Engineering Department 255 Parkway Blvd. Coppell , TX 75019 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, 7HE ISSUING INSURER WILL ENDEAVOR TO M{UL .~~ DAYS WRnTEN :E TO THE CERTIFlCATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL iE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ^~~^~ ~~ ~~~~ „~~/ I or t iFSTTZTbT/mTTZUy3 KMC ©AGORD CORPORATION 1988 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 endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this cert~cate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of 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. ACORD 25S (2001!08} 2 of 2 #S112161/M112093