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CERTIFICATE OF INSURANCE (Attachment D) I DATE(MM /DDIYY)
<br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
<br />AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
<br />AFFORDED BY THE POLICIES MOW.
<br />INSURERS AFFORDING COVERAGE
<br />INSURED INSURER A:
<br />INSURER B:
<br />INSURER C:
<br />INSURER D:
<br />INSURER E:
<br />COVERAGES
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE .. P
<br />REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPE
<br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TH S, CL
<br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR POLICY EFFECTIV Y TD
<br />LTR TYPE OF INSURANCE I POLICY NUMBER DATE (MM'DD/YYI�, E (MMIDD/YY)
<br />GENERAL LIABILITY
<br />A E COMMERCIAL GENERAL LIABILITY
<br />mCLAIMS MADE EDCCUR
<br />❑ OWNER'S & CONT PROT
<br />❑ OWNER'S PROTECTIVE LIABILITY
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />❑ POLICY ■ PROJECT r_1
<br />LOC
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />B ALLOWNEDAUTOS
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />NON -OWNED AUTOS
<br />GARAGE LIABILITY
<br />Y PERIOD INDICATED. NOTWITHSTANDING ANY
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
<br />SIONS AND CONDITIONS OF SUCH POLICIES.
<br />LIMITS
<br />EACH OCCURRENCE
<br />FIRE DAMAGE (Anyone fire)
<br />MED EXP (Anyone person)
<br />PERSONAL &A.DVINJURY
<br />GENERAL AGGRECATE
<br />PRODUCTS — COMP /OP AGG
<br />$ 1,000,000
<br />$ 50,000
<br />$ 5,000
<br />$ 1,000,000,
<br />$ 1,000,000
<br />$ 1,000,000
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />BODILY INJURY
<br />(Per person)
<br />BODILY INJURY
<br />(Per accident)
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />AUTO ONLY -EA ACCIDENT
<br />OTHER THAN EA ACC
<br />AUTO ONLY AGG
<br />EACH OCCLRENCE
<br />AGGREGATE
<br />E WC STATU- L] OTHER
<br />TORY LIMITS
<br />E L EACH ACCIDENT
<br />E L DISEASE -EA EMPLOYEE
<br />E.L DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$ 500,000
<br />$
<br />1 OTHER I $ 500,000
<br />Professional Liability I PER CLAIM /AGGREGATE I $ 500,000
<br />DESCRIPTION OF OPERATIONS/ LOCATION /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
<br />City of San Marcos is named as additional insured on all Commercial General Liability and Automobile Liability policies. General Liability,
<br />Automotive Liability and Worker's Compensation policy to include a Waiver of Subrogation in favor of the City of San Marcos. (All
<br />Endorsements must be submitted with the certificate.)
<br />CERTIFICATE HOLDER I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
<br />City of San Marcos SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BY CANCELLED BEFORE THE
<br />Attn: Capital Improvements EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30
<br />p p DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
<br />630 E. Hopkins FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
<br />THE INSURER, ITS AGENTS OR REPRESENTATIVES.
<br />San Marcos, Texas 78666 AUTHORIZED REPRESENTATIVE
<br />ATTACHMENT "D" -THE CITY OF SAN MARCOS INSURANCE REQUIREMENTS
<br />❑ ANY AUTO
<br />EXCESS LIABILITY
<br />C
<br />❑ OCCUR ❑ CLAIMS MADE
<br />❑ DEDUCTIBLE
<br />❑ RETENTION $
<br />D
<br />WORKERS COMPENSATION AND
<br />EMPLOYER'S UABIL17Y
<br />Y PERIOD INDICATED. NOTWITHSTANDING ANY
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
<br />SIONS AND CONDITIONS OF SUCH POLICIES.
<br />LIMITS
<br />EACH OCCURRENCE
<br />FIRE DAMAGE (Anyone fire)
<br />MED EXP (Anyone person)
<br />PERSONAL &A.DVINJURY
<br />GENERAL AGGRECATE
<br />PRODUCTS — COMP /OP AGG
<br />$ 1,000,000
<br />$ 50,000
<br />$ 5,000
<br />$ 1,000,000,
<br />$ 1,000,000
<br />$ 1,000,000
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />BODILY INJURY
<br />(Per person)
<br />BODILY INJURY
<br />(Per accident)
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />AUTO ONLY -EA ACCIDENT
<br />OTHER THAN EA ACC
<br />AUTO ONLY AGG
<br />EACH OCCLRENCE
<br />AGGREGATE
<br />E WC STATU- L] OTHER
<br />TORY LIMITS
<br />E L EACH ACCIDENT
<br />E L DISEASE -EA EMPLOYEE
<br />E.L DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$ 500,000
<br />$
<br />1 OTHER I $ 500,000
<br />Professional Liability I PER CLAIM /AGGREGATE I $ 500,000
<br />DESCRIPTION OF OPERATIONS/ LOCATION /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
<br />City of San Marcos is named as additional insured on all Commercial General Liability and Automobile Liability policies. General Liability,
<br />Automotive Liability and Worker's Compensation policy to include a Waiver of Subrogation in favor of the City of San Marcos. (All
<br />Endorsements must be submitted with the certificate.)
<br />CERTIFICATE HOLDER I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
<br />City of San Marcos SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BY CANCELLED BEFORE THE
<br />Attn: Capital Improvements EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30
<br />p p DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
<br />630 E. Hopkins FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
<br />THE INSURER, ITS AGENTS OR REPRESENTATIVES.
<br />San Marcos, Texas 78666 AUTHORIZED REPRESENTATIVE
<br />ATTACHMENT "D" -THE CITY OF SAN MARCOS INSURANCE REQUIREMENTS
<br />
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