ST9401-CS 961001
PITTS, ROLLING, SCHNELL
AND WAGNER
P.O. BOX 2291
AUSTIN, TEXAS 78768
....:::I:III.I:IIIIII.....:I.I..:.:I:'11111'.i1.i:1111.II.II:I::~.I.::::..II ....... .:......!...........:.:.:.:..;.;:;.i.:.::::..;.....;.::::: DATE1 ~rc;ff~Y) ...
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.
COMPANIES AFFORDING COVERAGE
512-451-7555
.. ACORDTM
PRODUCER
COMPANY
A
St. Paul Guardian Ins.
INSURED
J. C. Evans Construction Co.,
Inc.; etal
POBox 9647
Austin TX 78766
COMPANY
B
COMPANY
C
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE (MM/DO/YY) DATE (MM/DDNYI
A GENERAL LIABILITY KK09100358 10/01/96 10/01/97 GENERAL AGGREGATE 2000000
X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $ 1000000
CLAIMS MADE 0 OCCUR PERSONAL & ADV INJURY 1000000
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE 1000000
FIRE DAMAGE IAny one fire) 100000
MED EXP (Anyone personl 10000
A AUTOMOBILE LIABILITY KK091003581 10/01/96 10/01/97
COMBINED SINGLE LIMIT 1000000
X ANY AUTO
ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS I Per personl
X HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
A EXCESS LIABILITY KK09100358 10/01/96 10/01/97 EACH OCCURRENCE 10000000
X UMBRELLA FORM AGGREGATE 10000000
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
THE PROPRIETOR/ INCL EL DISEASE - POLICY LIMIT
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
RE: 16' WATER MAIN IN DENTON TAP ROAD FROM: PARKWAY BOULEVARD TO: S.H.
121 BYPASS-CERTIFICATE HOLDER SHALL BE AN ADDITIONAL INSURED ATIMA IN
REGARD TO THE COMMERCIAL GENERAL LIABILITY. WAIVER OF SUBROGATION IN
FAVOR OF CERTIFICATE HOLDER ON ALL POLICIES.
. . ..... . .. ..
::tmn~Jf.llt~'jim;,Q~I:: ..:....................:.........:.::::................... .. ...:...:{..@t#N~hQtti.QN.:::::
.. ..
.................................................................................................. .............................................
...... ........................................ ..... ..... .
.::::~::.:::.~.:::.~..::;~:;~:~;~~~;~;;~:~~;;r::~::~:~::~:;~~t:~~~f~:~r::~::~:~:~~~~~:{:;~~~~t:;.:::;:~:t~:}..~:.~/:~..~.:...:.
......................... I....................
::A9....tl~$.aM.H?
.....................................;ii.........
.::.:::.:::::::::::::::::::::;c;:!:::~::::::
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ~_IllJl'iM'}!D!I MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
1IlIl[)f]lIHJIII{>>XJlJQu{mJCII:ll5IIlI:HIlIEKlHfXD[:MIIlllOlDKIIIXJIlIUIIl~>>'
ClIfX:lAK'ICJlKllI\IOX~XE{)CIlUlllllVlXXKltXIIKIItDlX:JIII.:XM~.
AUTHORIZED REPRESENTATIVE .4- (j2'
. Id~t:hn .::..' ~~:':~Q.~b.iArd:~N...:i..:'
THE CITY OF COPPELL
POBOX 478
COPPELL TX 75019