ST9902-CS061019 (4)
ACORQu CERTIFICATE OF LIABILITY INSURANCE I DATE (MMJDDNY)
10/19/06
PRODUCER 1-248-828-3377 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Valenti Trobec Chandler Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1175 West Long Lake Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 200
Troy, MI 48098 INSURERS AFFORDING COVERAGE
Delano Valenti
INSURED INSURER A: National Union Fire Insurance Comoanv
Tiseo Paving Company, Inc.
INSURER B: Zurich American Insurance Company
P.O. Box 270040 INSURER C: St Paul Travelers Insurance Company
Dallas, TX 75227 INSURER D:
I INSURER E:
COVERAGES
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.
I~~: TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
B GENERAL LIABILITY GL09307348 11/01/06 11/01/07 EACH OCCURRENCE $1,000,000
-
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 300,000
I CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ 5,000
X Blanket AI PERSONAL & ADV INJURY $1,000,000
-
~ Waiver of Subrogation GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APnS PER: PRODUCTS - COMP/OP AGG $2,000,000
""I POLICY ~ ~rR,: LOC
B AUTOMOBILE LIABILITY TAP9307347 11/01/06 11/01/07 COMBINED SINGLE LIMIT
- $1,000,000
X ANY AUTO (Ea accident)
-
- ALL OWNED AUTOS BODILY INJURY
(Per person) $
SCHEDULED AUTOS
-
X HIRED AUTOS BODILY INJURY
I-- (Per accident) $
X NON-OWNED AUTOS
I--
X Blanket AI End't PROPERTY DAMAGE
I-- $
X Waiver of Subrogation (Per accident)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS LIABILITY 3205621 11/01/06 11/01/07 EACH OCCURRENCE $ 10,000,000
GJ OCCUR D CLAIMS MADE AGGREGATE $ 10,000,000
$
R DEDUCTIBLE $
RETENTION $10,000 $
B WORKERS COMPENSATION AND WC9307349 11/01/06 11/01/07 X I T~~~T~Tllfi:: I IOJ~.
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $1,000,000
E.L. DISEASE. EA EMPLOYEE $ 1,000,000
E.L. DISEASE. POLICY LIMIT $ 1,000,000
OTHER $
C Leased/Rented Equipment QT-660-945X2322 11/01/06 11/01/07 Ded: $1,000 250,000
$
$
DESCRIPTION OF OPERATlONSlLOCATIONSlVEHICLESlEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
project No. ST 99-02A - West Sandy Lake Road, Phase 1
Certificate Holder is Named Additionally Insured
Waiver of Subrogation Applies
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Coppell DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
Dir of Engineering/Public Works NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Attn: Ken Griffin, P.E. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. Box 9478
REPRESENTATIVES.
Coppe1l, TX 75019 AUTHORIZED REPRESENTATIVE ~ ~J/L ~
I USA
ACORD 25-S (7/97) pryan
5063217
@ ACORD CORPORATION 1988
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 25-5 (7/97)
Valenti Trobec Chandler Inc.
S Tq~-ol 4
"
1175 West Long Lake Road
Suite 200
Troy, MI 48098
USA
City of Coppe~~
Dir of Engineering/Public Works
Attn: Ken Griffin, P.E.
P.O. Box 9478
Coppell, TX 75019
USA
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