2025-043 - Authorizing the execution of an Agreement with the Texas Department of Transportation (TxDOT) for the temporary closure of closure of State right-of-way in support of the 2025, 2026

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„ „u CERTIFICATE OF INSURANCE Form 1560 (Rev. 07124) Previous editions of this form may not be used. Page 1 of 2 Agents should complete this form by providing all requested information, then either email, fax, or mail this form as noted at the bottom of page two. Copies of endorsements listed below are not required as attachments to this certificate, This certificate is issued as a matter of Information only and confers no rights upon the certificate holder. This certificate does not confer any rights or obligations other than the rights and obligations conveyed by the policies referenced on this certificate. The terms of the policies referenced in this certificate control over the terms of the certificate. insured: City of Paris Street/Mailing Address: PO Box 9037 City/State/Zip: Paris, TX 75461-9037 Phone Number: ( 903 ) 784-9205 WORKERS' COMPENSATION INSURANCE COVERAGE: Endorsed with a Waiver of Subrogation in favor of TxDOT. Carrier Name: TML Intergovernmental Risk Pool Carrier Phone #: (512__) 49i-2300 Address: 1821 Rutherford Lane, First Floor _ City, State, Zip: Austin TX 78754-9194 Type of insurance Policy Number Effective Date Expiration Date Limits of Liability: Workers' Compensation 5823 10/1/2025 10/1/2026 tN.IL..,Than; Statutory - Texas COMMERCIAL GENERAL LIABILITY INSURANCE: Carrier Name: TML Inter oyernmental Risk Pool Carrier Phone #: ( 512 ) 4912300 Address: City, State, Zip: Type of Insurance: Type of Insurance: Policy Number: Effective Date, Expiration Date: Limits of Liability: Commercial General Liability Insurance 5823 10/1/2025 10/1/2026 Not Less Than: $ 600,000 each occurrence BUSINESS AUTOMOBILE POLICY: Carrier Name: TML In i Rlsk Pool _ Carrier Phone #: (512 ) 491-2300 Address: City, State, Zip: Type of Insurance: Policy Number: Effective Date: Expiration Date: Limits of Liability: Business Automobile Policy SB23 10/1/2025 10/1/2026 Not Less Than: $ 600.000 combined single limit UMBRELLA POLICY (if applicable): Carrier Name: N/A —� Carrier Phone #:- Address: City, State, Zip: Type of Insurance: Policy Number: Effective Date: Expiration Date: Limits of Liability: Umbrella Policy Should any of the above described policies be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions. THIS IS TO CERTIFY to the Texas Department of Transportation acting on behalf of the State of Texas that the Insurance policies named are in full force and effect. if this form is sent by facsimile machine (fax), the sender adopts the document received by TxDOT as a duplicate original and adopts the signature produced by the receiving fax machine as the sender's original signature. Agency Name Address City, State, Zip Code TML Intergovernmental Risk Pool, 1821 Rutherford Ln. First Floor Austin TX 78613 (512 ) 491-2380 9 IU 2025 �' Authorized Agent's Phone Number Authorized Agent Original Signature Date The Texas Department of Transportation maintains the information coftected through this form, Wt rfew exceptions, you are entitled on request to be Informed about the information that we collect about you. Under §§552.021 and 552.023 of the Texas Government Code, you also are entitled to receive and review the information. Under §559.004 of the Govemment Code, you are also entitled to have us correct Information about you that Is incorrect.