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IZURANCE CERTIFICATE d v r a 0 w t U 0 c E `o d d 0 u_ THIS IS TO CERTIFY THAT the policy or policies, if any, described in items 1 through 6 have been issued by the Texas Employers Insurance Association, and/or the Employers Casualty Company, and/or the Employers National Insurance Company, and/or the Employers Casualty Corporation, and/or the Employers National Insurance Corporation Isurer or Insurers to the Insured designated in this certificate, and that each such policy or policies, subject to the limits of liability, exclusions, provisions, conditions and terms thereof, are in full force and effect as of the date of this certificate. If any such policy is cancelled or is not renewed at the request of either the Insured or the er, or if any such policy or any renewal thereof is changed in any manner or for any reason so as to affect this Certificate, ten days' prior written notice will be mailed e insurer to the certificate holder, herein named. THE CERTIFICATE OF INSURANCE AS SHOWN IN THIS CERTIFICATE REMAINS IN EFFECT UNTIL TEN DAYS' PRIOR TEN NOTICE IS MAILED TO THE CERTIFICATE HOLDER (at the address shown below) AS ABOVE PROVIDED, or if a date is shown in the column headed "expiration date," such insurance shall expire either upon such date, or upon the date specified in written notice mailed ten days prior thereto, whichever date shall first occur. This certification is not a joint but is a separate undertaking of each of the insurance carriers shown below. This certificate of insurance is not on insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance 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. City of San Marcos Attn: City Secretary 630 East Hopkins San Marcos, Texas NAME AND ADDRESS OF INSURED Brath, Inc. Box 331 Round Rock, Texas 78661 Attn: Terry Haygood c 0 m a E `o v t 0 EFFECTIVE DATE OF IHIS CERTIFICATE November 9, 1981 ISSUED AT Austi;., Texas T8X85 EITIPLOYBRSI InsuRance A880C1118TIon EMPLOYeRS CBSUBLTY company EMPLOYERS NBTIOn8L InsuRance company EMPLOYBRS CBSUOLTY CORPORBTIOn EMPLOYERS NBTIOn8L InsuRance CORPORaTIon , Dist. INSURANCE IN FORCE LIMITS OF LIABILITY NOT LESS THAN Expiration Eac h Accident - - Date Each ( Occursnes) Per Policy STATE AND Kind Policy Number Person Per Policy Provisions Or Aggregate LOCATION OF OPERATIONS Item 1 Coverage Q',j-, 6 4 Fully Complies With Requirements of a E A VL? 1 Texas Workmen's Compensation Law a U Disease Only STATE OF TEXAS e a Coverage E 3 u' B And Renewal Therefor If Blond Soo Heading XXX $100,0W ; 100r000 Item Z Coverage Fully Complies With Requirements a A of State Law E Disease Only p Coverage W I 3 B And Renewal Thereof H Blank - Sea Heading $100,000 7 A/? A/? ;100 000 r Item 3 o l 047 5 y '(r v : X X $ 300 000 Not G $ l 0 - y nlur "i 1f , • Products On y U.S.A., ITS TERRITORIES OR c o E POSSESSIONS AND CANADA e o c 0 U e Property Damage And Renewal Thereof If Blank- See Heading XXX lOO OOO• ; , $100,000. Item 4 Bodily Q 598255 s 250 000 s o0o 500 Not e = Injury , . , e Applicable U.S.A., ITS TERRITORIES OR POSSESSIONS AND CANADA Q y' o Property Damage And Renewal Thereof If Blank- See Heading XXX 1002 ^n $ Owe Not Applicable Item 5 $183 450 Fi t ild rs B IM 87225 . re Ex ded C v e g u e Risk And Renewal If Blank- TT Y1i & Mala.cio s M?.$chxe r Fire Station #I? - Broa Thereof See Heading $ S $ W at ar dal Item 6 $ $ $ And Renewal If Blank- Thereof See Heading $ f $ RKS olicies will not be cancelled or materially altered until after 10 days written notice has been given to the certificate holder. d- TECO 4590-D (3-79)