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November 04, 2015 12:53 PM
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SILVE-7
OP ID: SL DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
05/17/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT Shawn Warren NAME: FAX PHONE (A/C, No): (A/C, No, Ext): 405-799-3311 E-MAIL ADDRESS:
[email protected]
PRODUCER
Universal Insurance Agency Inc PO Box 6327 Moore, OK 73153 Pat Lee
405-799-3330
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A : Great American Ins Companies INSURED
Silver Star Construction Co Paving Materials, Inc. 2401 S Broadway Moore, OK 73160
25615
INSURER B : Charter Oak Fire Insurance Co INSURER C : INSURER D : INSURER E : INSURER F :
COVERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR
TYPE OF INSURANCE
ADDL SUBR INSD WVD
POLICY NUMBER
POLICY EFF POLICY EXP (MM/DD/YYYY) (MM/DD/YYYY)
COMMERCIAL GENERAL LIABILITY CLAIMS-MADE
OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER: PROPOLICY LOC JECT
LIMITS
EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence)
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP AGG
$
COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person)
$
$
OTHER: AUTOMOBILE LIABILITY
ANY AUTO ALL OWNED AUTOS HIRED AUTOS
$
SCHEDULED AUTOS NON-OWNED AUTOS
$
BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident)
$ $
X A
UMBRELLA LIAB EXCESS LIAB
X
EACH OCCURRENCE
OCCUR
TUU557813909
CLAIMS-MADE
05/19/2016 05/19/2017
10,000 X RETENTION $ DED WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE N/A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below
B
Rented Leased Equi
$
AGGREGATE
$
5,000,000 5,000,000
$ PER STATUTE
OTHER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT
QT6606F385008-COF-16
05/19/2016 05/19/2017 R/L
$
400,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER
CANCELLATION
CITYM-2 City of Moore 301 S. Howard Moore, OK 73160
ACORD 25 (2014/01)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE
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