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AC"RO~ CERTIFICATE OF LIABILIT`l {NSURANCE <br />DATEQdhUDDlYYYY) <br />a/i7/2ol0 <br />PRODUCER (972) 771-A071 FAX: (972) 771-4695 <br />K& S Insurance Agency <br />2255 Ridga Road, Ste. 333 <br />THIS CERTIFICATE lS ISSUED AS A MATTER OF INPORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />FiOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED SY THE POLICIES BELOW, <br />P. 0. Box 277 <br />Rockvrall TX 75087 <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSUREO <br />INSURERA:QBE Specialty Insurance Co. <br />lisis <br />Josh Bray Cb3 Sanitation SOZlSt10riS <br />iNSUReR a: Praetorian Insurance Company <br />37257 <br />P. O. Box 6190 <br />INSURER C: St Paul Surplus Lines Ins Co <br />30981 <br />iNSURER o: Texas Mutual Insurance Co, <br />22945 <br />Paris ~ TX 75461 <br />INSURERE'Chartl5 Specialty Insurance <br />26883 <br />~nvconcr_c <br />v TNE POLIC(ES OF INSURANCE L(STED BELOW HAVE BEEN 1SSUED TO THE fNSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />7ERM OR CONDl710N OF ANY CONTRACT OR OTHER DOCUM[N7 VNTH RESPECT TO WtiICH THIS CERTIFICATE MAY BE ISSUED OR <br />ANY REQUIREMEN7 <br />, <br />THE INSURANCE AFFORDEQ BY THE POLICIES DESCRIBED NEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />MAY PERTAIN <br />, <br />POL[CIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDIJCED BY PAID CLAIMS. <br />INSR DD' <br />L D TYPE CE <br />POLICY NURIBER <br />POLICYEFFECTWE <br />pq E ,VDD Y <br />POLICYEXPIRATION <br />DA E 111NQp Y <br />LIhtITS <br />GENERALLIAB0.ITY <br />&1CHOCCURRENCE <br />$ 1,000,000 <br />X <br />COiAIAERCIAL GENERAL LtA81LITY <br />DAAIAGE TO RENTED <br />R fd S(Ea occurrerlce) <br />S 100,000 <br />A <br />CLA11dS1.1ADE - FX] OCCUR <br />QSYTXQ002722 <br />8/18/2010 <br />8/18/2011 <br />MEDEXP(Myoneperson) <br />S 5,000 <br />PERSONAL & AQV INJURY <br />$ 1,000,000 <br />GENERAL AGGREGA7E <br />S 2,000,000 <br />GEN'LAGGREGAT£L1MfiAPPLiESP6R: <br />PRODUC7S-C01.1P/OPAGG <br />5 Included <br />~ <br />POLICY X PE O LOC <br />AUT <br />OMOBILE LIABiLRY <br />I <br />COIdBINEO SINGIE LIi,1R <br />$ 1,000 <br />000 <br />X <br />ANY AUTO <br />i <br />(Eo acddenl) <br />, <br />B <br />ALL04WEDAUTOS <br />ZCTX0001215 <br />8/18/2010 <br />8/18/2011 <br />gODiLYINJURY <br />~ <br />SCHEDULEO AUTOS <br />(Pet person) <br />X <br />HIRED AUTOS <br />BODILYINJURY <br />$ <br />X <br />NON-04^NED AUTOS <br />(Peracdden!) <br />PROPERTY DAMAGE <br />5 <br />(Par acadent) <br />GARAGELIABILITY <br />AUTOONLY - EAACCIDENT <br />5 <br />ANY AUTO <br />OTHER THAN EA ACC <br />S <br />H <br />AUTO ONLY: AGG <br />5 <br />EXCESS/UidBRfiLLALIA6ILITY <br />EP.CHOCCURRENCE <br />5 5,000,000 <br />I CLAIMS MADE <br />X OCCUR F <br />AGGREGATE <br />$ 5 OOO OOO <br />- <br />S <br />C <br />DEDUCTIBLE <br />609125406 <br />8/18/2010 <br />8/18/2013 <br />~ <br />1 <br />X <br />RETEN710N $ 10,000 <br />, <br />$ <br />D <br />WORKEftS COMPENSATION <br />X WC STATU- OTH- <br />AND Eh4f'LOYERS' LIAOILITY <br />ANY PROPRIETOWPARTNERlE)CECUTIVE Y1N <br />E.L. EACHACCIDENT <br />$ 1, 0001000 <br />OFFICER/G4El.1BER EXCLUDED7 ❑N <br />(Mandatory tnNH) <br />001102162 <br />8/16/2010 <br />8/18/2011 <br />E.L.DISEASE-EA[MPLOYE <br />S 1 000 000 <br />I <br />I <br />If yas, descabe onder <br />SPECIAL PROVISIONS babw <br />F.L. DISEASE - POLICY LIMIT <br />$ 11000,000 <br />E <br />OTHERTT3715pOrtdtlOri <br />LS4766550 <br />e/18j2010 <br />8/18/2011 <br />$1,000,000 Occ. <br />Po1J.ution <br />$2,000,000 Agg. <br />DESCRIPTiON OF OPERATfONS / LOCATIONS lVEHICLES / EXCLUSIONS ADDED BY ENOORSERiENT! SPECIAL PROVISIONS <br />City of Paris is named additional insured on general liability policy (CG2033 07-04) Nhen required by written <br />contract. <br />C9.ty of Paris <br />P. 0. Box 9037 <br />Paris, TX 75461 <br />e(,nRn,)r r,)nn4mai <br />SHOULD ANY OFiHE ABOVE DESCRIBED POLICIES BE CANCELLHD BEFORE THE EXPIRA716N <br />DATE 7HEREOF, THE ISSUING INSURER 4NILL ENDEAVOR TO h7AIL 30 DAYS VJRITTEN <br />NOTICE TO THE CERTIFICATE HOLtiER NAhtED 70 7fiE LEFT, BUT FAILURE TO 00 SO SHALL <br />IMPOSE NO OBLIGATfON OR LIABtLITY OF ANY KIND UPON THE 1NSURER, ITS AGENiS OR <br />REPRESENTATIVES. <br />AUTHOft1Z£D REPRESENTATNE <br />R Daiker-1/DIANE <br />Cc) 1988•2009 ACORD CORPORA710N. AIl rinhFs reserved. <br />INS025 (2c09o1).01 The ACORD name anci logo ara reyistorecl marks of ACORD <br />