Rolling Oaks MC-CS090201
A CORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY)
__ _.... - TM 1/30/2009
PRODUCER (972) 771-4071 FAX: (972) 771-4695 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
K & S Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2255 Ridge Road, Ste, 333 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
P. 0, Box 277
Rockwall TX 75087 INSURERS AFFORDING COVERAGE NAIC#
.--.-
INSURED INSURER A. Con tinental Insurance 35289
The Fain Group, Inc. INSURER B Commerce & Industry Ins.
P,O. Box 750 INSURER C Na tional Fire Insurance 20478
INSURER D
Ft Worth TX 76101 INSURER E
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
INSR ADD'L TYPE OF INSURANCE POLICY NUMBER P~.k+~~~~~6g~~ Pg~I.f:(~~6~~N LIMITS
~NERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GFNERAL LIABILITY ~~~~[f,U9E~~~~~?ence\ $ 100,000
A l CLAIMS MADE 0 OCCUR C2094456382 12/1/2009 2/1/2010 MED EXP IAnv one nerson) $ 5,000
~ Additional Insured G140331A 1/01 PERSONAL & ADV INJURY $ 1,000,000
~ Waiver of Sub rogatio CG2404 10/93 GENERAL AGGREGATE $ 2,000,000
~lL AGGRE~E LIMIT AnES PER PRODUCTS - COMP/OP AGG $ 2,000,000
POLICY X ~rp.T LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
- $
~ ANY AUTO lEa accident)
A ALL OWNED A.UTOS C2094456401 2/1/2009 2/1/2010 BODILY INJURY
- (Per person) $
- SCHEDULED AUTOS
~ HIRED AUTOS BODILY INJURY $
~ NON-OWNED AUTOS (Per accident)
~- Additional Insured CA0403 6/04 PROPERTY DAMAGE
$
X Waiver of Subroaatio CA2089 6/04 (Per accident)
RAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY AGG $
EXCESS/UMBRELLA LIABILITY Follows Form Ro""r" $ 10,000,000
~ OCCUR o CLAIMS MADE AGGREGATE $
$
B ;i DEDUCTIBLE BE037527B47 2/1/2009 2/1/2010 $
X RETENTION $10,000 $
C WORKERS COMPENSATION AND WC420304A 1/00 I T~~~T~I,\t" I 01~-
EMPLOYERS' LIABILITY 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE Waiver of Subrogation E.L EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? WC20944564l5 2/1/2009 2/1/2010 E.L DISEASE - EA EMPLOYEE $ 1,000,000
If yes, describe under $ 1,000,000
SPECIAL PROVISIONS below EL DISEASE - POLICY LIMIT
A OTHER Leased/Rented C2094456382 2/1/2009 2/1/2010 $150,000 W/$1000 Oed
Equipment/Business
Personal Property C2094456382 2/1/2009 2/1/2010 $16,700 w/$1000 Ded
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate Holder should be known as Additional Insured when required by written contract.
City of Coppell
255 Parkway Blvd.
Coppell, TX 75019
CANCELLA TION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 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
CERTIFICATE HOLDER
INSURER,ITS AGENTS OR REPRESENTATIVES,
AUTHORIZED REPRESENTATIVE
~~ -~~-.!..--
Johnny Moss/CHERYL
ACORD 25 (2001/08)
INS025 (0108).08a
@ ACORD CORPORATION 1988
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