DR0501-CS060410ACORO CERTIFICATE OF LIABILITY INSURANCE CSR JA DATE (MM /DDlYYVY)
- VORTCOI 04/10/06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Wm. W. George & Associates, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
An ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
10,000 N. Central, # 1
1
Dallas TX 75231
Phone:214- 691 -5522 Fax:214- 691 -1537
INSURED
Vortex Construction G.P., Inc.
9744 Brockbank Dr.
Dallas TX 75220
INS URERS AF FORDING COVERA NAIC #
!INSURER A. old Republic Lloyds of Texas
IN B: Old R epublic Insurance Co.
(INSURER C: American Intl Line
III INSURER D:
INSURER E I
r nvI=0AC1=c
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.
SR
LTR
�4DD F - - - -- -
IINSRD TYPE OF INSURANCE
- POLICY EFFECTIVE
POLICY NUMBER DATE MM /DD/YY
POLICY EXPIRATION
DATE MM /DDIYY
LIMITS
j I GENERAL LIABILITY
F
A X I I X COMMERCIAL GENERAL LIABILITY
TCP- 4466506 07/09/05. 07/09/06
EACH OCCURRENCE
$ 1,000,000
T AMA
PREMISES (Eaoccurence)
S 100,000
MED EXP (Any one per
$ 10,0
CLAIMS MADE OCCUR
PE RSONAL & ADV IN
$ 1,000, 0 00
GENERAL AGGREGATE
$ 2,000,000
PRODU - COMP /O A
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
I
Emp Ben.
1,000,000
j POLICY X EC LOG
B X
AUTOMOBILE LIABILITY
r X '', ANY AUTO
I COMBINED SINGLE LIMIT
BAA- 1468600 07/09/05 j 07/09/06 (Eaaccident)
5 1,000,000
$
ALL OWNED AUTOS
I� I SCHEDULED AUTOS III
BODILY INJURY
(Per person)
$
- X_ HIRED AUTOS
X NON -OWNED AUTOS
BODILY INJURY
(Per accident)
i I
-
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
$
- --- --
$
OTHER THAN E A A
AUTO ONLY: AGG
EXCESS /UMBRELLA LIABILITY
III
EACH OCCURRENCE
$ 5,000,000
C X —_ OCCUR CLAIMS MADE '.. BE9029551 07/09/05
07/09/06
AGGREGATE i s
5,000,000
i$
- _ - - -_-
$
1 1 DEDUCTIBLE�
$
1 RETENTION S
WORKERS COMPENSATION AND
X TORY LIMITS ER
EMPLOYERS' LIABILITY
B WC- 1468599 07/09/05 ]
AN PROPRIETO R/PARTNERiEXECUTIVE
07/09/06
E.L. EACH ACCIDENT
- � - - - - --
$ 100
—
1000 000
OFFICER/MEMBER EXCLUDED?
E.L. DIS EASE - EA EMPLOYEE
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT $ 1000000
OTHER
A 'Equipment Floater CEF 4466507 07/09/05
07/09/06
Max /Item $50,000
Amt Ins. $100,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
RE: Wagon Wheel Park Outfall Structure, Project #DR 05 -01. City of Coppell
is additional insured on general liability & auto liability as required by
written contract. Waiver of subrogation in favor of additional insured on
general liability, auto liability & workers' compensation.
CERTIFICATE HOLDER CANCELLATION
CITYCOP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
City of Coppell NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Attn: Engineering Dept. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. Box 478
Coppell TX 75019 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
John Burruss
ACORD 25 (2001/08) 9 AGURD GURPURAIIUN 7955
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 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 (2001/08)