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MA FY 0506-CS060309 ACORD. CERTIFICATE OF LIABILITY INSURANCE O.,D GJ BATE MM,BD' PAWM-1 / 03/09/06 PEODUCBR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Jackson & Ha=mon Ins. Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 510 N. Valley H~.lls Dr., #701 ALTER THE COVERAGE AFFORDED BY THE POUClES BELOW. Waco TX 76710 Phone: 254-772-6074 Fax: 254-772-6864 INSURERS AFFORDING COVERAGE MALE# ~NSUEED INSURERA Republic Insurance Company 38318 ~N__SURERB Republic Insurance Group 38318 Pavement Services Corporation ~NSURERC: Southern Insurance Co. 19216 PO Box 1107 INSURERD Euless TX 76039-1107 INSURER E COVERAGES THB 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 LTR INSRE I~PE OF INSURANCE POLICY NUMBER DATE IMMIDS/YY} DATE IMMIDD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ I ~ 000 · 000 A X X COMMERCIAL GENERAL LIABILITY TXP564306501 03/10/06 03/10/07 PREMISESIJAMA~E IL~I~LN,EU(Ea occurence) $ 300 , 000 --- ~ CLAIMSMADE ~ OCCUR MED EXP(Anyoneperson) $ 10,000 PERSONAL &ADVINJURY $ i, 000, 000 GENERAL AGGREGATE $ 2 1000 ¢ 000 PRODUCTS COMP/DP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER ,POL,CY j °, LOC flPV AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ i, 000,000 C X ANY AUTO TCA564306601 03/10/06 03/10/07 (Ea accident) EXCESS/UMBRELLA LIABIUTY EACH OCCURRENCE $ 5 i 000 · 000 S ~ OCCUR ~ CLAIMS MADE UMB564596400 03/10/06 03/10/07 AGGREGATE $5,000,000 $ RETENTION $10000 $ EMPLOYERS'LIABILITY WC564306701 03/10/06 03/10/07 E L EACH ACCIDENT $ 1,000,000 SPECIAL PROVISIONS below EL DISEASE - POLICY LIMIT $ i, 000 ~ 000 OTHER A Equipment Floater TZP564306501 03/10/06 03/10/07 Limit 1,015,386 Deductibl 1,000 Certificate holder is named as additional insured on general liability. Waiver of Subrogation in favor of certificate holder on general liability and workers compensation. CERTIFICATEHOLDER CANCELLATION CITCO-3 City of Coppell ATTN: Garreth Campbell 255 Parkway Blvd. Coppell TX 75019 SHOULD ANY OF THE ABOVE DESCRIBED POUCIEE BE CANCELLED BEFORE THE EXPIRATIO{~ DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITrEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Rowland Jackson ACORD 25 (2001108) © ACORD CORPORATION 1988