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<br /> 06/21/95 10:24 '5'512 396 4656 CITY SA..I'{ ll\RCOS C¡I{ II ~O03
<br /> (16/21/95 0& ~ 49 "£'j'S12 8321(180 J..j,. ~V... "."u~~~..
<br /> -.:wOT FOm1 No.. ~ SOO {~- 1'2.-9"1) P<'~1J$ -edi1icm of this-form mà:t .,<:>. b4 used. NOTl2: Copies of the endorsements listed
<br /> . . belo",.'" not ~u¡...d .. .""d,-
<br /> TEXA$ men!!: 1.0 this CE!rtificat~.
<br /> OEPARTMEUi OF TRANSPORTATION' REC"ETV1::'f)
<br /> , CERTtflCA TE OF INSUAANCE '-'. . L.L!
<br /> . FOR STATEwWlDE BID CONTRACTS .' '\ Q
<br /> TM ~med contTQcr~r mall not çornl1Wn~ wo~ umll ha/w has o!.:rtainea 'tM: rnlnim~ j~ Q1\œ sp.!!dfied in SèCtion ~, ~o.?, JrJ e~~ne<J
<br /> ~~ fQl!tIwing andðrsemen't$: fhQ Tœ ¡)t:parttMlit of Tr.an.pol't<ltíott ., an Ad1:!1tJe~1 lÞ$Urttd. TOr coverag~;"~ f!~t:L~r :~nd il, Wå~ óf
<br /> $ubn:lg¡;Ú~ ir1 fò'tOf of t~ W111!! depat'(m~~t under (;CV~ragti::2, 3 and 4. ÓfÙy œnmc&'tEs cl i'MU!~1\«: ptlt1tshtki-l:iý.hiis i:t!!:IF(rt:int:¡tt,~,
<br /> flcceptabl-tJ a~ pracf of i",ural1c~ COMm'i:rd:o1 wr~t$.' t;ärl:fficatas,;¡re u~ptab t:. --, ~ .,... , '-'
<br /> ŠEci1ôN 1-ID"iN1WICATIÓÑ DAtA --...-.. -.,< -- - .. '-'-'
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<br /> 1.1 IM-Ut«)ii Cðl'l'UacttH"~ Name
<br /> . cii;;,y qf San MarGQS -
<br /> 1.:2 strRt/M~ilif'l1) Addr~
<br /> ~3~ ::: :n:in~ - 11.4 -- ~ 'T'P.ìG'1 S .- ~~~
<br /> .-- . -- 11.5 0(:1';:10\
<br /> ~~. _% o' ~. - --
<br /> 1..6 Phone Number
<br /> Al'e.ðCœe{ 5121 353-4444
<br /> <:$£&10,.1 iI'..1VTËöi'ïNsUnArJCE 0___'_" --- ._0 - '_. .,.. p- 0- " """.
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<br /> Type Policy Eff~ctive Expí~tion Limits of Liability
<br /> Numbi;!r: Date: D3te: Notlas:s.Than:
<br /> 2. WORKERS1 COME'ENSATION
<br /> 2.1 8475 2.2 10-1=94. 2.3 .1O-1-gS SUi'tutory- Texæ;
<br /> Endorsed wit!' tl W~iv.er of ~ubrog;rtiof' in favor of the- T~ D~þartm.(it cfirJ'lnsportation.
<br /> ~. COMMERCIAL GËNEAAL UA81LITY
<br /> Bodily 11"11ury/Property 3.1 8475 32 10-1-94 ).3 lO-l-qc:; $600,000 combined
<br /> Damage single limiteøch
<br /> Limits of Liability - $3,000,000 occur. '¡ Qèt:urrent::G aM in the
<br /> aggregate
<br /> Endo~ with the T~w$ D2\:ldrtmen't afTnsnsportðtion as ~O Additional Jn~ured and Iõlodor~d with.a Wt.lÏ't1ef
<br /> (Jif SubrógatiM 1n favor of the T~jQs Departm~nt ofT~nspolUtioT'l.
<br /> 4. TEXAS BUSINe~S,A.UTOMOBILE ftOUC{
<br /> A. Bodily It'1jury 4.1 Pd15 4.~ 1 n...J -94 4.,3 10:-l-95 $.250.000 Cð. person
<br /> Limits of Liability - $3,000,000 occ. $500,000 ea.. ocwrrenœ
<br /> tl. Prnþert'Jl'Damage '4.4 8L17S 4...5 In-l-qtl 4.6 '()-1-95 $1 00,000 ~. o('um~nce
<br /> EndOftQd with the T~:œ> Department.ðfTransportatiol'l as an Additional In$Ured and enrlor'S.ed with a W~ì\iêf
<br /> of Subroga'Ûoo In favor Qf the Te~ Department. "f TrarrsP9~tion.
<br /> S.' UMBRElLA POLICY (If AppIic:able)
<br /> 5.1 '5,2. ,..,. 5.3 $
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<br /> '5ECflON III ¥ CERTIfiCATION -~- T "', ,~ -.,.,.- ,
<br /> '--'-""-"" -~- - _.
<br /> l1'lli. C~roflcate of In5IJP.b'Ice ~ther ~ffirrn¡¡¡tl>rely ot negatively arnl1fldS, extend!, 0/ alters the ~..e(.age M'fOrdW by ¡!ie abo~ irn:ut¡¡~ poUc~
<br /> j~u~d byttæ In£ur.mœ cornp;:u>y I\amed below.
<br /> CanceU¡rtiart of the insurë 1H;'o2 polici~ shall !'Iðt be- made I.lnT.'Íl THI({T'i' OÁ Y5 AFTER the IJnd«rs!!;lnll:d ;:rgent or his/he/' ccmp:ony 113$ ~t wn;mn
<br /> not:iazs by œrtiiierl rtt.1~1 to 1:~ «>I'I'{f~ and the Te:tJI. ~~ttmènt ofTrartSpOft;lÚon.
<br /> THIS ISro CERTU'Y-IXI the TeJal' D<.p4t1:!\'I~nt o1Tramparutjoo, lidhtg Qt1 !.eMit oft:he $t:òtè of TeXM, mm 'tI1~ i~rJsnc:e policieS ilbOlre mee, an
<br /> the r,,~ulfc!m~nts Sõtipulated above ~I'KI $f.!Ó} pdlcies ilre in full for<e 1!I1\d effucc.
<br /> -- ' .. -
<br /> 6.1 I\Wne (tf l&ur:.nœo,mp«J"lY 7.1 ~8~ 9f~Underwri ter
<br /> D
<br /> 6.:2 cïmPJlny Addrq<.s - 7.2 Agerrt'sAddtClSS
<br /> 2 I E. 7th Street s
<br /> 53 city
<br /> Au
<br /> 7.6 AJJthOri2!e-d AgQrrt.'s PHone No.
<br /> AIeaCode (512) 320-1:12;5
<br /> - .--- ,'-~ _. -. - -
<br />R '% 512 396 4656
<br /> 06-21-95 10: 18AM PO03 tt:1R
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