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/"Y4 A.r+� Y DATE (MMfD01YYYY)
<br />INSURANCE 08/1512023
<br />..........
<br />,. CERTIFICATE OF LIABILITY
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
<br />CERTIFICATE DOES NOTAFFIRMATWELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
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<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s).
<br />......... ,_ .... _ �-_.,... ,,� ,� �.� ..... M �..�......
<br />PRODUCER ,,,,,,h T' Toni Jackson
<br />No" 903 7 X"^iI (903) 785-8434
<br />1705 Lamar Avenue ADDRESS: I ......_"�p on:fen....................�e a�.." ..�.........- �...............�.�..._
<br />y 0838
<br />ani® lets diey.com
<br />P.O. Box 459. .mm INGNG GE ................... ... ._ .
<br />INSUrAi S AFFORDCOVERANAIC f
<br />Paris TX 75461-0459 INSURERA: Ohio Security Insurance Company 24082
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<br />IrosurtED INsuRERe. State Auto Insurance Companies � 000858
<br />Adams Lawn Service LLC INSUia Rc:
<br />835 Cedar Crkn.,�_ .... .... .._...� ........... ..
<br />INSURER 0:
<br />Reno TX 75462 INwSURER,. F:
<br />....................
<br />..,_.... .
<br />COVERAGESCERTIFICATE NUMBER: CL2381509998
<br />RE�VISION NUMBER:
<br />......... . ... . .....�.
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />I OUT 1�tD � � "E"' "IL"'a'
<br />"'
<br />TYPE OF INSURANCE POLICY NUMBER MAVIlG'5,7�"^Y"MYY Mh1dYJrVPb"r"1"�'
<br />.EACH
<br />COi1NERCIALGENERALLIABILITY
<br />OCCURRENCE(S
<br />$ 1000000
<br />�
<br />1,000,000
<br />CLAIMS -MADE OCCUR
<br />K! I S €A�ABI�E
<br />$_„
<br />MED E%P,.��",.Y e!!e..4"e!5°
<br />15,000
<br />$
<br />A Y BLS65130968 08110/2023 08/10/2024
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<br />PERSONAL INJURY
<br />_. �.
<br />$ 1,000,000
<br />GEN'LAGGREGATE LIMITAPPLIES PER:
<br />� _---
<br />GENERALAGGREGATE
<br />---- '00 .._..,.
<br />m$ D
<br />PRO•
<br />x POLICY 0 JECT LOC
<br />PRODUCTS COMPlOPAGG
<br />...n.. o PAGG
<br />..._.�
<br />$ 2,000,000.. _.
<br />OTHER:
<br />Schedule__..
<br />Mod Factor 1
<br />.
<br />$
<br />�..W�..._ .AUTOMOBILELIABi.. .... .. p,n.n. n. ....�.� ... m..........
<br />�. .... ... ..... ..m ........,
<br />.._.
<br />COMBINER BINGLECIIT
<br />$ 1,000,000 ''...
<br />_M.___ �.
<br />ANYAUTO
<br />BODILY INJURY(Per person)
<br />$
<br />B OWNED SCHEOULEO 10172730CA 05101/2023 05/01/2024
<br />AUTOS ONLY AUTOS
<br />BODILY YINJURY (Per accident)
<br />$
<br />HIRED
<br />�*
<br />Rtt DAMAGE
<br />, .....�.... .........„.,,,
<br />$
<br />AUTOS ONLY AU ros ONLY
<br />..
<br />r tlernl w_...
<br />m w„......� -,,,w,,.....
<br />-
<br />19
<br />BAPLS
<br />$
<br />UMBRELLA LUIS OCCUR
<br />EACH OCCURRENCE
<br />$
<br />EXCESS LAB CLAIMS -MADE
<br />AGGREGATE
<br />$
<br />.m... .,„.,,..
<br />� $
<br />WORKERS COMPENSATION
<br />PER 0TH -
<br />AND EMPLOYERS' LIAMUTY Y 1 N
<br />OFFlCCEEXCCLUDEDT ECUTIVE ❑ N f A
<br />(Mandatory in NERR
<br />E L DISEASE -IEA
<br />Ifyes.desedbeunder
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<br />..._..........,.a�..-�..- „
<br />DESCRIPTION OF OPERATIONS below
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<br />I
<br />E.L. DISEASE- POLICY LIMB
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<br />DESCRIPTION OF OPERATIONS f LOCATIONS 1 VEHICLES (ACORD 101, Additional Nional Remarks Schedule, mey beseeched IF more �� ���������• �
<br />.. space is renulmd)
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<br />Workers Comp can be issued once employees reach 5.
<br />Liability policy Includes Blanket additional insured, since required by contract, City of Paris is an additional insured on policy.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Paris ACCORDANCE WITH THE POLICY PROVISIONS.
<br />135 SE 1 St St - �� .� _._.._...... ............ .w .�..-...�-ti-,, ,..w
<br />AUTHORIZED REPRESENTATIVE
<br />Paris TX 75460
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<br />1988-2016 ACORD CORPORATION. All rights
<br />w�reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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