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Home My WebLink About(0021) Rhino Removal COI May 2021.pdfACOR F 0 �� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDr)NYYY) 5/6/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND ORALTER 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). PRODUCER Davis -Dyer -Max Insurance P.O. Box 495429 Garland TX 75049 NAME: Sheri Ressman PHONE (972)864-0400 FAX No); (972)278-9400 E4ML heri.ressman@davis-dyer-max.com INSURERS AFFORDING COVERAGE NAIC # INSURERA: Burlington Insurance Company 23620 INSURED NTX Waste Pros, LLC Rhino Removal 3575 Lone Star Circle #303 Fort Worth TX 76177 INSURERB:Clear Blue Insurance Company 28860 INSURERC:Texas Mutual Insurance Company 22945 INSURER D: Evanston Insurance Company 35378 INSURERE:Gray Surplus Lines Insurance Company 15889 INSURER F: Scottsdale Indemnity Company 15580 COVERAGES CERTIFICATE NUMBER:2021-22 LIABILITY 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OFINSURANCE ADOL SUER POLICYNUMBER POLICY MMIDD EFF PMIDD EXP LIMITS X COMMERMALGENERALLIABIL17Y EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE 50 OCCUR DAMAGE To RENTED PREMISES IE, ocwrrence $ 100,000 MED EXP (Any one person) $ 5,000 295BO13083 4120/2021 4/20/2022 PERSONAL &ADV INJURY $ 1,000,000 GENLAGGREGATE LIMITAPPLIES PER: I GENERALAGGREGATE $ 2,000,000 POLICY a] PRI JECTLOC PRODUCTS-COMP/OPAGG $ Included Assault B,BalteryaublimR $ 100,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea arradent $ 1,000,000 BODILY INJURY (Per person) $ B ANYAi TO ALL OWNED F-_-1 SCHEDULED AUTOS AUTOS X Y AQIYTX003525-01 4/20/2021 4/20/2022 BODILY INJURY (Per accident) $ PROPERTYDAMAGE Per accident $ X NON -OWNED HIRED AUTOS X AUTOS $ UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 E X EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ 1295BO13083 4/20/2021 4/20/2022 WORKERS COMPENSATION AND EMPLOYERS' LU1BILI Y Y / N X PER OTH- ST TOTE ER E.L. EACH ACCIDENT $ 1 000 000 C ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEM13ER EXCLUDED? Lil (Mandatory In NH) NIA 0002013661 4/20/2D21 4/20/2022 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below. EL. DISEASE-POUCYLIMIT $ 1,000,000 D Contractor Pollution Liability CPLHOL106264 4/20/2021 4/20/2022 $1,000,oD0-Each Oaurrence $10,000 Dad. F Employment Practices Liability EX13377433 4/30/2021 4/20/2022 $1,D0o,000-Each Oaunence $2,500 Ded. DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If morn spare Is required) The General Liability polic7 includes a blanket automatic additional insured endorsement that provides additional insured status to the certificate holder only when there is a written contract between the named insured and certificate holder. The General Liability & Workers' Compensation policies include a blanket automatic waiver of subrogation endorsement only when there is a written contract between the named insured and the certificate holder. CERTIFICATE HOLDER CANCELLATION The City of Fort Worth 200 Texas St Fort Worth, TX 76102 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 Hughston/SR 4,,- 7- All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 po14D1)