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MA FY 0506-CS070102ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID G PAVEM -1 DATE(MM/DDIYYYY) 01/02/07 PRODUCER Jackson & Harmon Ins. Agency 510 N. Valley Mills Dr., #701 Waco TX 76710 Phone:254- 772 -6074 Fax:254- 772 -6864 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC0 INSURED Pavement Services Corporation P. 0. BOX 1107 Euless TX 76039 -1107 INSURER A: Republic Lloyds Insurance Co. 19208 INSURER B: Southern Insurance Co, 19216 INSURER C: Republic Underwriters Ina. Co. 24538 INSURER D: A X X COMMERCIAL GENERAL LIABILITY TXP5643065 01 INSURER E: $ 300,000 I_t1VFRAf.F_Q 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. INUK LTR NS TYPE OF INSURANCE POLICY NUMBER DATE MM/D DATE MWD LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X X COMMERCIAL GENERAL LIABILITY TXP5643065 01 03/10/06 03/10/07 PREMISES (Ea occurence) $ 300,000 CLAIMS MADE X1 OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG s2,000,000 POLICY X PRO LOC JECT AUTOMOBILE LUU31LITY COMBINED SINGLE LIMIT $1,000,000 X B ANY AUTO TCA5643066 01 03/10/06 03/10/07 (Ea accident) BODILY INJURY $ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LUU31LITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 C X OCCUR 7CLAIMSMADE UMB5645964 00 03/10/06 03/10/07 $ R DEDUCTIBLE $ X RETENTION $ 10 ' 000 WORKERS COMPENSATION AND I ER E.L. EACH ACCIDENT $1,000,000 B EMPLOYERS'LIABILITY WC5643067 01 03/10/06 03/10/07 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $ 1 , 000, 000 If yes, describe under SPECIAL PROVISIONS below OTHER A Equipment Floater TXP5643065 01 03/10/06 03/10/07 Limit 1,015,386 Deductibl 1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate holder is named as additional insured on general liability. Waiver of Subrogation in favor of certificate holder on general liability and workers compensation. CERTIFICATE HOLDER CANCELLATION C I TCO -3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN City of Coppel l NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Garreth Campbell IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 255 Parkway Blvd. AUTHORIZED Coppell TX 75019 EDREPRE AUTHORIZED REPRESENTATIVE Amon 2c ronm inn► ©ACORD