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Sep 6• 2011 9:19WM Pierson ard Ferdle,/ <br />No.923" P, 1/,3 <br />MIDDIYYYY~ <br />CERTIFICATE QF LIABILITY INSU, V1 De <br />NCE 5/23/20 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.1 HIS <br />CER7IFICATE DOES NOT AFFIRMATIVELY OR NEGATIVFIY AMEND, BXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CON371TUTE A CONTRACT BLTVYEEN THE ISSUING INSURER(S), AUTNORIZED <br />REPRESENTAliYE OR PRODUCER, AND THE CERT1pICATE HOLDER. <br />IMPORTANT: If the certiflcate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBR06ATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain pdicles may require an endorsement. A statement on this certlflcate does not confer rights to the <br />certifcate holder 1n lieu of such endorsement s. <br />PRODUCER <br />NAME: M~rty Brunson <br />Pierson & Fendley PHO~ .(903) 784-0836 Fnx <br />1705 Lamar Avenue E.MAL C No :(9~~ 785-8439 <br />P.O. Box 459 A ~ss: <br />PROWCER ~00007390 <br />Paris TX 75961-0459 <br />iNSURED INSURHt(g) AFFORDING COVERAGE NAIC * <br />~OUNTY WhSTE C~I,LEG'PION LLC dba IN9URERB:SP~' 'ViCe LIO s Qrou <br />TRASITY BUS INESS INSURER C: <br />712 COUNTY Ttpp~D 4410 0 ~~URER D: <br />POWDERLY TX 75473-4725 I~URERE: <br />COVERAGES ~sur~RF : <br />CERTIFlCATE NUMBER:CL1152301339 <br />THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAIM D ABOVEBFOR.THE POLICY PERIOD <br />INDICATED. NOTWffHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY 8E 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 M,qY HAVE BEEN REDUCED BY PAID CLAIMS. <br />vSz <br />_TR TYPE OF INSURANCE IN~ ~yyp POLICY NUdgER E F MM~ ICY EXP <br />GENERAL LIABILITY LIIAITS <br />X COMMEF'CIAL G=NEPAL LIABILITI' <br />EACH OCCURRENCE g <br />1, OOO, OOC <br />A rLAIMS-MADE ~OCCUR P7204955575 <br />/4/2011 /4/2012 PREMISES Eaoccurrence Y <br />100,00C <br />_ <br />MED E;{P (My one Frerson) ~ <br />5, D 0C <br />PERSONAL 3 FDV INJURY g <br />1, OOO, OOO <br />GEPPL AGG:~EGtiTE LIM T APpLIES PER. <br />GENEFAL AGGREGATE g <br />2,000,000 <br />X PGLICY ECT LOC <br />PRODUC-S- COfAP10D AGS $ <br />2, OOO ~ OOO <br />AUTOMOBILE LIA&LIN <br />g <br />_ ANY AJTO <br />CONBINED SINGLE LIMI- <br />(Ee accident) ~ <br />1,000,000 <br />A _ ALI. O1NNED AUTOS P7204955575 <br />/4/2011 14/2014 BODILY INJURY (De- p=reon) $ <br />X SCHEDULED AUTOS <br />BODILI' INJURY pe' a.cHent) g <br />X HIRED AUTOS <br />PROPERTY DA.MAGE <br />x NoN-OwvED Auros <br />(Peracr,idant) g <br />$chedule Mod Fador 1 q <br />UMBRELLA LIAB OCCUR <br />PIP-Basic 9 <br />2, 500 <br />EXCESS LIAB CLNMS-MA]E <br />EACH OCCURRENCE g <br />DEDUCTIBLE <br />AGGREGATE q <br />RETENTIJN $ <br />g <br />B WORKERS COMPENSATION <br />AND EMPLOYER3' LIA8ILIN Y/N <br />g <br />11'C STAT <br />- OTH- <br />ANY PROPF?IE7CR1PA7TNERF~CUTIV= <br />OFFICER.'MEMBER =XCLUGEW F~ N IA <br />T <br />R <br />(Mandatory inNH) RZB21805-11 <br />Ifyes,descrbeurder <br />E.L. EACH ACGIDE~T <br />/8/2011 /8/2012 1 <br />100 000 <br />DESCRIFiION 0- OP-RATIONS bplow <br />E.L7ISEAS_-EAEM E $ <br />PLOYE <br />100 QQ~ <br />E.L. DISEAS= - POLICY LIMIT $ <br />500.0001 <br />DESCRIPTION OF OPERATIONS! LOCATIONS! VEHICLES (ACaeh ACORD 101, AddltlenU FUmrks gehstluls, Nmore spaes b requirocq <br />Certificate holder shown as additional insured <br />SHOULD ANY OF THE ABOVE DESCRIBm POLICIES BE CANCELLED BEFORE <br />TNE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Clty Of P3r'13 ACCORDANCE WITH TFIE POLICY PROVISIONS. <br />PO Hox 9037 <br />Paris, TX 75461-9037 AVTIDRIZEDREPRESEMATIVE <br />8` <br />tt Frierson/CL2 <br />ACORD 25 (2009/09) <br />INS025 rz(,oeo9) The ACORD name and logo are regiatered ma0 1988-2009 <br />rks o AC RDORD CORPORATION. All rights reserved. <br />