ST9401WA-CS 961001.
ACORD RTIFICA `E F
LIA LITY
....... .._ ......:.. .... . ... .
DATE (MM /DD/YY) _.
URA 10/01/96 ......_._ __ .........
PRODUCER 512- 451 -7555
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
PITTS, ROLLING, SCHNELL
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
AND WAGNER
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
COMP ANIES AFFORDING COVERAGE
P O BOX 2291
COMPANY
A St. Paul Guardian Ins
AUSTIN, TEXAS 78768
INSURED
COMPANY
J C Evans Construction Co ,
!
B
Inc , etal
COMPANY
P O Box 9647
C
COMPANY
Austin TX 78766
D
cOVEAAGEs
. ........ .
THIS IS TO CERTIFY THAT 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 C ONDITIONS O F SUCH POLICIES. LI MITS SHO WN MAY HA BEEN R EDUCED BY PAID CLAIMS.
CO F TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE (MM /DDlYV) DATE (MM /DD(YY)
A
GENERAL
LIABILITY
KK09100358
10/01/96 10/01/97
GENERAL AGGREGATE
$ 2000000
X
PRODUCTS COMP /OP AGG
$ 1000000
COMMERCIAL GENER LIABILITY
CLAIMS MADE X OCCUR
PERSONAL & ADV INJURY
$ 1000000
EACH OCCURRENCE
$ 1000000
OWNER'S & CONTRACTOR'S PROT
FIRE DAMAGE (Any one fire)
$ 100000
MED EXP (Any one person)
$ 10000
A
AUTOMOBILE
LIABILITY
ANY AUTO
KK091003581
10/01/96 10/01/97
COMBINED SINGLE LIMIT
$ 1000000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
X
- - --
PROPERTY DAMAGE
$
GARAGE LIABILITY
AUTO ONLY EA ACCIDENT
$
OTHER THAN AUTO ONLY
ANY AUTO
I
EACH ACCIDENT
$
AGGREGATE
$
A
EXCESS LIABILITY
KKO9100358
10/01/96
10/01/97
EACH OCCURRENCE
$ 10000000
AGGREGATE
$ 10000000
X UMBRELLA FORM
S
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
WC STATU- 0TH -.
TORY LIMITS ER
--
_
EL EACH ACCIDENT
$
EMPLOYERS' LIABILITY
EL DISEASE POLICY LIMIT
S
THE PROPRIETOR, INCL
PARTNERS /EXECUTIVE
OFFICERS ARE. EXCL
EL DISEASE EA EMPLOYEE
$
OTHER
DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLESlSPECIAL ITEMS
RE 16' WATER MAIN IN DENTON TAP ROAD FROM
PARKWAY BOULEVARD TO S H
121 BYPASS - CERTIFICATE HOLDER SHALL BE AN ADDITIONAL
INSURED ATIMA IN
REGARD TO THE COMMERCIAL GENERAL LIABILITY
WAIVER OF SUBROGATION IN
FAVOR OF CERTIFICATE HOLDER ON ALL POLICIES
__._..... .....
cORTMOATE Ht3LDE
_
_.. _._...., ............ ..._ .....: .. ....
CANC£LLATILSN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
THE CITY OF COPPELL
EXPIRATION DATE THEREOF THE ISSUING COMPANY WILL)9&tVJSM)T4 MAIL
P O BOX 478
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT
COPPELL TX 75019����°�������
OFX)AAIKMMXMFUGXXMXY,MK MXX}KXMEWXXRFCXKMM'w_)K1DEXIXm-
AUTHORIZ EDREPRESENTATIVE
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