SW FY 0607-CS070109ACORD CFRTIFICATE OF LIABILITY INSURANCE
f,�jjjrp 6p IN
ONLY AND 06NFl! OCR
DALLAS TX 7 5218
Of POLICY NUMBER 'AT � Y14. LA1192m
TYPE OF INSURAN
L LCZ
1 000,000
ANYAUITC
i ALL OWNED XJ -43 BOULY III
I SPEC 1:6. PROM aws
�
RGL345603-01
Pa;icy Number
RGL345503
evious Policy Number
imed Insured and Mailing Address (No.. Street. Town or City
FRANCISCO ESTRADA DBA
STRADA CONCRETE
1623 GARZA AVE
DALLAS, TX 75216
Republic — Vanguard Insurance Company
PHOENIX, ARIZONA
ADMINIS TRA 77 VE OFFICES:
P.O. &OX 40600 - 7411 JOHN SMITH OR., SUITE 1400
Couoly, State. Zip Code) San Antonio, Taxes 78229
Prod ucar: 402
SOUTH & WESTERN GENERAL AGENCY
P.O. BOX 9015
ADDISON, TX 75001
, licy Period: From 04 -15 -06 to 04 -15 -07 at 12:01 A-M. Standard Time at your mailing address shown above.
RETURN FOR THE PAYMENT OF THE PREMIUM. AND SUBJECT TO ALL THE TERMS OF THIS POLICY
IG er_RGF WITH Vntl Tn PROVIDE THE INSURANCE AS STATED IN THIS POLICY.
=orrna and Endorsements applyingto this Policy and made part of this policy at time of isbue: See Attached Schedule of Forrne -
.wntereignad: 06 -06 -06 SOUTH 6 WESTERN GENERAL AGENCY
s AD_DISON, TX 75001
-IGL95 (04/06 ) -INSURED-
Authorized Representative JIM
.IMITS OF INSURANCE
3eneral Aggregate Urntt (Othe( Than ProdUC16— Completed Operations)
S
1,000,000
Products- .Completed Operations Aggregate Limit
$
1,000,000
Personal and Advertising Injury Limit
$
1,000
tack Occurrence Limit
$
1. 0 0 0. 0 0 0
Fire Damage Limit
$
100,000
Any One Fire
Medical Expense Limn
$
5,000
Ary One Person
1ESCRIPTION OF BUSINESS AND LOCATION OF PREMISES
- omr of Business:
Individual Joint Venture
Partnership Organ¢ation (Otherihan Partnership orJoirlt Venture)
lusine" Description: DRIVEWAY REPAVING
.ocationof AA Premises You Own, Rerd or Occupy:
CC: 113
SAME AS ABOVE
2 REMIUM
Rate
Advenee Premlum
Classification Code No.
Prernium Basis
Pr/CO All Other
PrrCO All Other
DRIVEWAY, PARKING AREA 92215
80,ODO (p)
5.32 22.14
426 1,771
OR SIDEWALK PAVING OR
REPAVING
ADDITIONAL INSURED
ALL LISTED (e)
FLAT
220
I
I
Premium Basis Coos
Total Premium
$ 2,417.00
(sl A-a (m) Admissions (s) Each
Policy Fee
S 295 .00
FULLY EARNED
(u) ursts (g0rose Sales (p) Payroll
Vo) Total Cost
State Tax
S 129-21
Premium shown Is payabW at inception.
Stamping Office Tax
S 2.66
=ORM8 AND ENDORSEMENTS
Total Advance Premium
$ 2 , 793 :
=orrna and Endorsements applyingto this Policy and made part of this policy at time of isbue: See Attached Schedule of Forrne -
.wntereignad: 06 -06 -06 SOUTH 6 WESTERN GENERAL AGENCY
s AD_DISON, TX 75001
-IGL95 (04/06 ) -INSURED-
Authorized Representative JIM
FaX
To: City of Coppoll AIT: Mr. KEN F.emc Francisco Estrada
Fax 972 - 304 -7041
Phone:
Re
urgent For Review
oatet January 9, 2007
Pages: 3
CC:
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ESTRADA CONCRETE INSURANCE FOR BID# SIDEWALKS
PAVEMENT REPAIRS
• phone: 469-87746635 ' 469 -583 -2906 Fax: 214.372.3623