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ST0102-CS031028 DATE (MM/DDffYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE lO/ZS/zoo3 PRODUCER (248)828-3377 FAX (248)828=3741 THISCERTIFICATEISISSUEDASAMAIfcKOFINFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Valenti, Trobec, Chandler, 1nc. HOLDER. THISCERTIFICATEDOESNOTAMEND, EXTENDOR 6054 Livernols Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Troy, MT 48098 3ill A. Oberlee iNSURERS AFFORDING COVERAGE NAIC# INSURED Tiseo Paving Company, Inc. INSURERA: Zurich American Insurance Compan~ P.O. Box 270040 ~NSUR~RE: National Union Fire Tnsurance Co~ =any Oallas, TX 75227-0040 ~NSURERC: Travelers Insurance Company INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVVITHSTANDIN~ 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. GENERALLIABIUTY GLO9307348-01 11/01/2003 11/01/2004 EACH OCCURRENCE I$ 1,000rOOu DAMAGE TO RENTEDI $ 000 I CLAIMS MADE ~10CCUR MED EXP (Any one per$0~l) $ 5,000 A X Per Project' PERSONAL&ADVINJURY $ 1,O00rOO0 ~_~ Aggregate - CGZ S03 GENERAL AGGREC~RTE $ 2 ~ 000 ! 00~ AUTOMORILEUABIUTY TAP9307347-01 11/01/2003 11/01/2004 COMBINED SRIGLE LIMIT $ Ea accident) 1 ? 000 ~ 000 A EXCESS/UMSRELLAUAEIUTY ~ 320 56 71 11/01/2003 11/01/2004 EACH OCCURRENCE $ 10,000~00~ X I OCCUR ~ CLAIMS MADE/ AGGREGATE $ 10 p 0OO, 00C B $ X RETENTION $ ~ $ WORNERSCOMeENSA~O"^"D / NC9307349-01 11/01/2003 11/01/2004 X ITna¥,,U,T.~I IO~"H- EMPLOYERS' LIABILrTY / ---.L EACH ACCIDENT $ 1,000 ! 00( / ~T,EB / T-660-945X2322-TIL-03 11/01/2003 11/01/2004 Leased/Rented Equipment ontractors Equipment ~ $250,000 C $1,000 Deductible idditional Insured as respects General Liability: City of Coppell ;aiver of Subrogation in favor of City of Coppell ~ERTIFICATE HOLDER City of Coppe11 255 Parkway P.O. Box 478 Coppell, TX 75019 ACORD 25 (2001108) (~N~;H ~TION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE iNSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Del Val enid/V48 ©ACORD CORPORATION 1988