Chateaus-CS081216
ACORDTlA
CERTIFICATE OF LIABILITY INSURAN
DATE (MM/DDNYYY)
PRODUCER
Phone: 214-227-1010
Harnem/Pro-Source Insurance Agency
2121 W. Springcreek Parkway #210
Piano, TX 75023
12/16/2008
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.
INSURED
INSURERS AFFORDING COVERAGE
INSURER A: America First L10 ds of Texas
INSURER B:
INSURER C:
INSURER D:
INSURER E:
NAIC#
KC Constsruction Services, Inc.
10606 Shady trail, ste 21
Dallas, TX 75220 2.1 L..{-/35o.. 7GG'I
I
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~~!l ~~~9.'~ TVOC POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
A ~ERAL LIABILITY I CP3006530586 12/15/2008 12/15/2009 EACH OCCURRENCE $ 1 000 000
DAMAGE TO RENTED
LOMMERCIAL GENERAL LIABILITY EB..EMISES (Ea oCfurenc<tl_ D,OOO.OO~
~ CLAIMS MADE [X] OCCUR MED EXP (Anyone person) $ 5 000
I-- PERSONAL & ADV INJURY $ 1 000 000
I-- GENERAL AGGREGATE $ 2 000.000
~'L AGGRrlE LIMIT AnS PER: PRODUCTS - COMP/OP AGG $ 2J)00.0~
X POLICY P'~WT LOC
A ~TOMOBILE LIABILITY 3006530594 12/15/2008 12/15/2009 COMBINED SINGLE LIMIT
(Ea accident) $ 1 000.000
I-- ANY AUTO
I-- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
I--
~ HIRED AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Per aCCident)
I-- PROPERTY DAMAGE $
(Per accident)
RAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A OESS/UMBRELLA LIABILITY CU306530594 12/15/2008 12/15/2009 EACH OCCURRENCE $ 5 OOO.O~
OCCUR [X] CLAIMS MADE AGGREGATE $ 5 000.000
$
8 DEDUCTIBLE $
X RETENTION $ 100000 $
B WORKERS COMPENSATION AND 46WECPI8900 09/02/2008 09/02/2009 X I T~~J;r:}1;~~ I IOJ~-
EMPLOYERS' LIABILITY ~~CH ACCIQ~ti~.___ $_..:1,99.Q,0_OQ___
ANY PROPRiETOR/PARTNER/EXECUTIVE
'OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ 1 OO..Q.,OOO
If yes, describe under E.L. DISEASE. POLICY LIMIT $ 1 000 000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CITY OF COPPELL IS NAMED AS ADDITIONAL INSURED. A WAIVER OF SUBROGATION APPLIES IN FAVOR OF THE NAMED
INSURED.
CERTIFICATE HOLDER
CANCELLATION
CITY OF COPPELL
255 PARKWAY BLVS
Coppell, TX 75019
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA TlON
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL.l.L DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTA TIVES.
AU ENTA TIVE
ACORD 25 (2001/08)
GAA
@ACORD CORPORATION 1988
Printed by GAA on December 16, 2008 at 01 :39PM