ST0003-CS080421
..
Valenti Trobec Chandler Inc.
1175 West Long Lake Road
Suite 200
Troy, MI 48098
confirm net
Insurance Certificate Experts
USA
Ci ty of Coppel!
Dir of Engineering/Public Works
Attn: Ken Griffin, P.E.
P.O. Box 9478
Coppell, TX 75019
USA
This document was brought to you by Valenti Trobec Chandler Inc. via CertificatesNow.
If you have questions regarding the content of this document, please contact
the Producer/Agent listed on the certificate of insurance at 248-828-3377 or the Named Insured
listed on the form.
To find out how you can send and receive all of your certificates of insurance
either by email, high speed fax or standard mail,
email customercare@confirmnet.com. or visit our website at
www.confirmnet.com
cc:
The data included in this notice and in the attached document is confidential to ConfirmNet
and the party responsible for bringing you this information.
Powered By CertificatesNowl1l
ACORQ. CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNY)
04/21/08
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: Zurich American Insurance ComDany
Tiseo paving Company, Inc.
INSURER B: Zurich American Guarantee 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
A ~NERAL LIABILITY GL0930734805 11/01/07 11/01/08 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anv one 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
~'L AGGRGlE LIMIT APnS PER: PRODUCTS - COMP/OP AGG $2,000,000
POLICY x~~R;: LOC
A ~TOMOBILE LIABILITY BAP591712402 11/01/07 11/01/08 COMBINED SINGLE LIMIT
$1,000,000
X ANY AUTO (Ea accident)
-
- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
-
~ HIRED AUTOS BODILY INJURY
$
X NON-OWNED AUTOS (Per accident)
-
X Blanket AI End't PROPERTY DAMAGE
- $
X Waiver of Subrogation (Per accident)
==rAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B EXCESS LIABILITY AUC926299700 11/01/07 11/01/08 EACH OCCURRENCE $ 10,000,000
~OCCUR D CLAIMS MADE AGGREGATE $ 10,000,000
$
==i DEDUCTIBLE $
RETENTION $10,000 $
A WORKERS COMPENSATION AND WC930734905 11/01/07 11/01/08 X I T~l6,)lT ;<lI,!f;,1 IOl~-
EMPLOYERS' LIABILITY $1,000,000
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
E.L. DISEASE - POLICY LIMIT $1,000,000
OTHER $
C Leased/Rented Equipment QT660945X2322TLC06 11/01/07 11/01/08 Ded: $1,000 250,000
$
$
DESCRIPTION OF OPERATlONSlLOCATlONSlVEHICLESlEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
project: Coppell Road project (from Sandy Lake Road to Cooper Lane) 1ST 00-03
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.
Coppell, TX 75019 AUTHORIZED REPRESENTATIVE ~ 4,J/t.. .p-
I USA
ACORD 25-S (7/91) mtaylor
8570024
@ 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)
POLICY NUMBER: GL093073480S
COMMERCIAL GENERAL LIABILITY
CG 25 03 03 97
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED CONSTRUCTION PROJECT{S)
GENERAL AGGREGATE LIMIT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Designated Construction Projects:
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
A. For all sums which the insured becomes legally
obligated to pay as damages caused by
"occurrences" under COVERAGE A (SECTION
I), and for all medical expenses caused by
accidents under COVERAGE C (SECTION I),
which can be attributed only to ongoing
operations at a single designated construction
project shown in the Schedule above:
1. A separate Designated Construction Project
General Aggregate Limit applies to each
designated construction project, and that limit
is equal to the amount of the General
Aggregate Limit shown in the Declarations.
2. The Designated Construction Project General
Aggregate Limit is the most we will pay for the
sum of all damages under COVERAGE A,
except damages because of "bodily injury" or
"property damage" included in the "products-
completed operations hazard", and for
medical expenses under COVERAGE C
regardless of the number of:
8. Insureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making claims or
bringing "suits".
3. Any payments made under COVERAGE A for
damages or under COVERAGE C for medical
expenses shall reduce the Designated
Construction Project General Aggregate Limit
for that designated construction project. Such
payments shall not reduce the General
Aggregate Limit shown in the Declarations
nor shall they reduce any other Designated
Construction Project General Aggregate Limit
for any other designated construction project
shown in the Schedule above.
4. The limits shown in the Declarations for Each
Occurrence, Fire Damage and Medical
Expense continue to apply. However, instead
of being subject to the General Aggregate
Limit shown in the Declarations, such limits
will be subject to the applicable Designated
Construction Project General Aggregate
Limit.
B. For all sums which the insured becomes legally
obligated to pay as damages caused by
"occurrences" under COVERAGE A (SECTION
I), and for all medical expenses caused by
accidents under COVERAGE C (SECTION I),
which cannot be attributed only to ongoing
operations at a single designated construction
project shown in the Schedule above:
1. Any payments made under COVERAGE A for
damages or under COVERAGE C for medical
expenses shall reduce the amount available
under the General Aggregate Limit or the
Products-Completed Operations Aggregate
Limit, whichever is applicable; and
2. Such payments shall not reduce any
Designated Construction Project General
Aggregate Limit.
C. When coverage for liability arising out of the
"products-completed operations hazard" is
provided, any payments for damages because of
"bodily injury" or "property damage" included in
the "products-completed operations hazard" will
reduce the Products-Completed Operations
Aggregate Limit, and not reduce the General
Aggregate Limit nor the Designated Construction
Project General Aggregate Limit.
CG 25 03 03 97
Copyright, Insurance Services Office, Inc., 1996
D. If the applicable designated construction project
has been abandoned, delayed, or abandoned
and then restarted, or if the authorized
contracting parties deviate from plans, blueprints,
designs, specifications or timetables, the project
will still be deemed to be the same construction
project.
E. The provisions of Limits Of Insurance (SECTION
III) not otherwise modified by this endorsement
shall continue to apply as stipulated.
CG 25030397
Copyright, Insurance Services Office, Inc., 1996
Additional Insured - Automatic - Owners, Lessees Or
Contractors - Broad Form
@
ZURICH
Policy No. Eff Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer Add'!. Prem Return Premo
$ $
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
A. WHO IS AN INSURED (Section II) is amended to include as an insured any person or organization whom you are required
to add as an additional insured on this policy under a written contract or written agreement.
B. The insurance provided to additional insureds applies only to "bodily injury", "property damage" or "personal and advertis-
ing injury" covered under Section I, Coverage A, BODILY INJURY AND PROPERTY DAMAGE LIABILITY and
Coverage B, PERSONAL AND ADVERTISING INJURY LIABILITY, but only if
1. The "bodily injury" or "property damage" results from your negligence; and
2. The "bodily injury", "property damage" or "personal and advertising injury" results directly from:
a. Your ongoing operations; oc
b. "Your work" completed as included in the "products-completedoperationshazard",
performed for the additional insured, which is the subject of the written contract or written agreement.
C. However, regardless of the provisions of paragraphs A. and B. above:
1. We will not extend any insurance coverage to any additional insured person or organization:
a. That is not provided to you in this policy; or
b. That is any broader coverage than you are required to provide to the additional insured person or organization in the
written contract or written agreement; and
2. We will not provide Limits of Insurance to any additional insured person or organization that exceed the lower of
a. The Limits of Insurance provided to you in this policy; or
b. The Limits of Insurance you are required to provide in the written contract or written agreement.
D. The insurance provided to the additional insured person or organization does not apply to:
1. "Bodily injury", "property damage" or "personal and advertising injury" that results solely from negligence of the addi-
tional insured; or
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
U-GL-I 175-A CW (9/03)
Page 10f2
2. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering or failure to
render any professional architectural, engineering or surveying services including:
a. The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field
orders, change orders or drawings and specifications; and
b. Supervisory, inspection, architectural or engineering activities.
E. The additional insured must see to it that:
I. We are notified as soon as practicable of an "occurrence" or offense that may result in a claim:
2. We receive written notice of a claim or "suit" as soon as practicable; and
3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by an-
other insurer under which the additional insured also has rights as an insured or additional insured.
F. The insurance provided by this endorsement is primary insurance and we will not seek contribution from any other in-
surance available to any additional insured person or organization unless the other insurance is provided by a contractor
other than you for the same operations and job location. Then we will share with that other insurance by the method de-
scribed in paragraph 4.c. of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS.
Any provisions in this Coverage Part not changed by the terms and conditions of this endorsement continue to apply as writ-
ten.
U-GL-I 175-A CW (9/03)
Page2of2