ST9301-CS051031ACJPRD_ CERTIFICATE OF LIABILITY INSURANCE
10/31/05
6054 Livernois
Tiseo Paving Company, Inc.
P.O. Box 270040
Dallas, TX 75227
COVERAGES
1-248-828-3377
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS HO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES HOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
IHSURERS AFFORDING COVERAGE
INSURER B:St Paul Travelers Insurance Company
INSURER C:Zurich American Insurance Com~an~
INSURER D:
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE 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.
C GE~NERAL LIABILITY ~LO9307348 11/01/05 11/01/06 EACH OCCURRENCE $1,000,000
I CLAIMS MADE j~ OCCUR MEO EXP (Any one person} $ B,000
C AUTOMOBILE LIASIL~Y TAP9307347 11/01/05 11/01/06
X ~&iver of Subrogation {Pe~acc~de,t)
A EXCES~ LIABILITY 3205621 11/01/05 11/01/06 EACH OCCURRENCE ; 10,000,000
X j OCCUR J j CLAIMS MADE AGGREGATE ; 10,000,000
C WORKERS COMPEHSATION AND WC9307349 11/01/05 11/01/06 X ITORYLIMiT~J
B Le&led/Rented Equipment QT660945X2322 11/01/05 11/01/06 Ded: $1,000 $ 250,000
CERTIFICATE HOLDER J I ADDI'nONAL INSURED; INSURER LE"R'ER: -- CANCELLATION
City of Coppell
Dir of Engineering/Public Works
· ttn: Ken Griffin, P.E.
E.O. Box 9478
Cop~ell, TX 75019
USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NONCE TO THE CERTIRCATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMP(~E NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE IN~JRER, ITS AGENTS OR
ACORD 25-S (7/97) pzTan · ACORD CORPORATION 1988
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IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 certificate 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 25-S (7/97)
6054 Livernois
Troy, MI 48098
USA
DJ= of Engineering/Public Works
Attn: Ken Griffin, P.E.
P.O. Box 9478
Coppell, TX 75019
USA
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