TR9702-CS 970806Certificate of Insurance '
l II' c I I" ! !I R ,A 1 I S't I]) A7 -A VlA I I1'l: UI I" -AI \11()\ 0V1 1 -' t 0V1 1-.16 V0 I'IGI I S 1, P0\ FOL I I-:RCIF7CATE HOLDIA, THIS CERTIFICATE IS NOT
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This is to Certify that
DURABLE SPECIALTIES, INC. Name and LIBERTY
P.O. BOX 318788 / address of MUTUAL,
DUNCANVILLE, TX 75138 Insured.
Is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is subject to all their
terms, exclusions and conditions and is not altered by any requirement, term or condition of any contract or other document with respect to which this certificate may be
issued_ -- -
-- -r -- EXP. DATE
• CONTINUOUS
TYPE OF POLICY C EXTENDED
POLICY NUMBER
LIMIT OF LIABILITY
POLIC TERM
WORKERS
COVERAGE AFFORDED UNDER WC EMPLOYERS LIABILITY
LAW OF THE FOLLOWING STATES:
COMPENSATION
� EtodilylnjuryBV Accident
�
5131/98
Each
WC7- 1 91 - 41 9383 -01 7 TX $500,000 Accide
Bodily Injury By Disease
$500,000 Policy
Limit
Bodily Injury By Disease
$500,000 Each
Pe rson
-�
_-
'General Aggregate -Other than Products/Completed Operations
GENERAL I
i
LIABILITY
$2,000,000
5/31/98
YY2 -191- 419383 -047 Products/Completed Operations Aggregate
X❑ OCCURRENCE
$1,000,000
Bodilv Injury and Property Damaqe Liability
❑ CLAIMS MADE
Per
$1,000,000 Occurrence
Personal and Advertising Injury
Per Person/
RETRO DATE
$1.000.0 Organization
Other Other
AUTOMOBILE
$1,000,000 Each Accident- Single Limit
LIABILITY
B.I. and P.D. Combined
❑X OWNED 5/31/98
AS7- 191 - 419393 -037 Each Person
Each Accident or Occurrence
NON OWNED
L] HIRED
— -
Each Accident or Occurrence
_ -- - - -- —
- - - i
OTHER
5/31 /98
UMBRELLA
Thi l -191- 4193$3 027 $3,000,000 Bodily Injury, Property Damage, Personal Injury and Advertising Injury
$3,000,000 General Aggregate Limit (Other than Products/ Completed Operations & Auto)
Operations Aggregate Limit
EXCESS LIABILITY
$3,000,000 Products/ Completed
ADDITIONAL COMMENTS
REF: Beltline & Lakeshore Dr. Job
I
If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date.
SPECIAL NOTICE -OHIO: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS
AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD.
NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE Liberty Mutual Group
THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED --
UNDER THE ABOVE POLICIES UNTIL AT LEAST 3D DAYS
NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO: s
City of Coppell
CERTIRCATE 255 Parkway Blvd. PAM PADGETT
HOLDER Coppell TX 75019 AUTHORIZED REPRESENTATIVE
L_—
IRVING, TX DL (800) 443 -269 8/6/97
OFFICE PHONE NUMBER DATE ISSUED
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