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<br />A6 CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM /DD /YYYY)
<br />F 05/22/2012
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER 1- 703 - 827 -2277
<br />NAMEACT
<br />PHONE FAX 703 - 827 -2279
<br />N x : 703- 827 -2277 A/C No:
<br />Ames & Gough
<br />ADDRESS: admin ®amesgough.com
<br />8300 Greensboro Drive
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />Suite 980
<br />McLean, VA 22102
<br />INSURERA: HARTFORD CAS INS CO
<br />29424
<br />INSURED
<br />INSURERB: HARTFORD ACCIDENT & IND CO
<br />22357
<br />INSURER C CONTINENTAL CAS CO
<br />20443
<br />Freese and Nichols, Inc.
<br />INSURER D:
<br />4055 International Plaza
<br />INSURER E:
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Suite 200
<br />Fort Worth, TX 76109
<br />INSURER F:
<br />$ 10,000
<br />nwcnwnr•o /`CDTICIf -ATF NUMBER: 27234399 REVISION NUMBER:
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<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INS R
<br />LT
<br />TYPE OF INSURANCE
<br />ADDLLIMITS
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM /DD /YYYY
<br />POLICY EXP
<br />MM /DD /YYYY
<br />li�dy/
<br />4.,p _
<br />A
<br />GENERAL LIABILITY
<br />X
<br />X
<br />42 UUN RB3636
<br />10/23/1
<br />10/23/12
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ee occurrence
<br />$ 300, 000
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />MED EXP (Any one person)
<br />$ 10,000
<br />F__,__1 OCCUR
<br />CLAIMS -MADE
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP /OP AGO
<br />$ 2,000,000
<br />$
<br />POLICY X PRO- X LOC
<br />X
<br />X
<br />42 UUN RB3636
<br />10/23/13
<br />10/23/12
<br />Ea acccdent SINGLE LIMIT
<br />1,000,000
<br />A
<br />AUTOMOBILE LIABILITY
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per accident)
<br />$
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />Pea cdentDAMAGE
<br />$
<br />X X
<br />HIRED AUTOS AUTOS
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />42 XHU RB2596
<br />10/23/1
<br />10/23/12
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10, 000, 000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />X
<br />42 WB EG3778
<br />10/23/1
<br />10/23/12
<br />X WCSTATU- OTH-
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER /EXECUTIVE
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />OFFICER /MEMBER EXCLUDED ❑
<br />NIA A
<br />(Mandatory in NH)
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />If Yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />C
<br />PROFESSIONAL LIABILITY
<br />A 00 821 44 22
<br />10/23/1
<br />10/23/12
<br />Per Claim 5,000,000
<br />Annual Aggregate 10,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />2012 Lift Station Condition Assessment
<br />The City and its employees, officers, officials, agents and volunteers are included as additional insureds with respect
<br />to General and Auto Liability. Waiver of Subrogation applies to General, Auto and Workers Compensation as required
<br />by written contract and allowed by law.
<br />M C unI nco CANCFI I ATinN
<br />ACORD 25 (2010/05)
<br />FreeseNichols
<br />27234399
<br />© 1988 -2010 ACORD CORPORATION. An rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of San Marcos
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Attn: Capital Improvements Department
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />630 East Hopkins
<br />AUTHORIZED REPRESENTATIVE
<br />San Marcos, TX 78666
<br />li�dy/
<br />4.,p _
<br />USA
<br />ACORD 25 (2010/05)
<br />FreeseNichols
<br />27234399
<br />© 1988 -2010 ACORD CORPORATION. An rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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