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Speiss Construction Co., IncDATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER 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).CONTACT PRODUCER NAME:FAX PHONE (A/C, No):(A/C, No, Ext):E-MAIL ADDRESS:INSURER(S) AFFORDING COVERAGE NAIC #INSURER A :INSURED INSURER B :INSURER C :INSURER D :INSURER E :INSURER F :COVERAGES CERTIFICATE NUMBER: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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.ADDL SUBR INSR POLICY EFF POLICY EXP TYPE OF INSURANCE LIMITS POLICY NUMBER LTR (MM/DD/YYYY)(MM/DD/YYYY)INSD WVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $DAMAGE TO RENTED CLAIMS-MADE OCCUR $PREMISES (Ea occurrence)MED EXP (Any one person)$PERSONAL & ADV INJURY $GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT $OTHER:COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $(Ea accident)BODILY INJURY (Per person)$ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $HIRED AUTOS (Per accident)AUTOS $UMBRELLA LIAB EACH OCCURRENCE $OCCUR EXCESS LIAB CLAIMS-MADE AGGREGATE $$DED RETENTION $PER OTH-WORKERS COMPENSATION STATUTE ER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $N / A OFFICER/MEMBER EXCLUDED?(Mandatory in NH)E.L. DISEASE - EA EMPLOYEE $If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)CERTIFICATE HOLDER CANCELLATION 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 © 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)SPIECON-01 YADAVYO 10/30/2014 Certificates@willis.com Willis Insurance Services of California, Inc.c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 37230-5191 (877) 945-7378 (888) 467-2378 Starr Indemnity & Liability Company 38318 Spiess Construction Co., Inc.PO Box 2849 Santa Maria, CA 93457 Lloyd's B7874 A X 1,000,000 X X X 1000025275 09/01/2014 09/01/2015 300,000 10,000 1,000,000 2,000,000 X X 2,000,000 1,000,000 A X X X SISIPCA08304314 09/01/2014 09/01/2015 X Comp Ded $1,000 X Coll Ded $1,000 X A X 1000001459 10/01/2014 10/01/2015 1,000,000 Y 1,000,000 1,000,000 B Builders Risk W0185314PNB 09/01/2014 09/01/2017 Limit $1,604,356 THIS CERTIFICATE VOIDS AND REPLACES PREVIOUSLY ISSUED CERT DATED 9/23/2014 SCCI Job : #21433 City of Denton IFB #54760-2499 Utility Relocation Phase II.The City of Denton, its Officials, Agents, Employees and Volunteers are included as Additional Insureds as respects to General Liability and Auto Liability, as required by written contract or agreement.The General Liability and Auto Liability policies shall be Primary and Non-Contributory with any other insurance in force for or which may be purchased by SEE ATTACHED ACORD 101 City of Denton 901B Texas Street Denton, TX 76209 AGENCY CUSTOMER ID:LOC #:Page of ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE:ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,FORM NUMBER:FORM TITLE:ACORD 101 (2008/01)© 2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD SPIECON-01 YADAVYO 1 1 1 Spiess Construction Co., Inc.PO Box 2849 Santa Maria, CA 93457 Willis Insurance Services of California, Inc.SEE PAGE 1 SEE PAGE 1 SEE P 1 SEE PAGE 1 ACORD 25 Certificate of Liability Insurance Description of Operations/Locations/Vehicles:Additional Insureds.Waiver of Subrogation applies in favor of Additional Insureds with respects to General Liability, Auto Liability and Workers Compensation, as permitted by law. © Copyright 2014 National Council on Compensation Insurance, Inc. All Rights Reserved.WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 42 03 04 B (Ed. 6-14)TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page.We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us.This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule.The premium for this endorsement is shown in the Schedule.Schedule 1.( )Specific Waiver Name of person or organization ( X )Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver.2.Operations:3.Premium:The premium charge for this endorsement shall be 2.0 percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described.4.Advance Premium:This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)Endorsement Effective 10-01-2014 Policy No. 1000001459 Endorsement No.Insured Spiess Construction Co., Inc.Premium Insurance Company Countersigned by ___________________________________________Starr Indemnity & Liability Company WC 42 03 04 B (Ed. 6-14)  1983 National Council on Compensation Insurance.WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84)OKLAHOMA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.Schedule Where required by written contract This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)Endorsement Effective 10-01-14 Policy No. 1000001459 Endorsement No.Insured Spiess Construction Co., Inc.Premium Insurance Company Countersigned by ___________________________________________Starr Indemnity & Liability Company WC 00 03 13 (Ed. 4-84)  1983 National Council on Compensation Insurance.WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84)NEVADA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.Schedule Where required by written contract This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)Endorsement Effective 10-01-14 Policy No. 1000001459 Endorsement No.Insured Spiess Construction Co., Inc.Premium Insurance Company Countersigned by ___________________________________________Starr Indemnity & Liability Company WC 00 03 13 (Ed. 4-84) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) ©1998 by the Workers’ Compensation Insurance Rating Bureau of California. All rights reserved.From the WCIRB’s California Workers' Compensation Insurance Forms Manual ©2001.W A I VER OF OUR RIGHT T O RECOVER FROM O T HERS ENDO R SE M EN T −−−−C A L I FORN I A We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule.The additional premium for this endorsement shall be _____% of the California workers’ compensation premium otherwise due on such remuneration.Schedule Person or Organization Job Description Notes:1.This endorsement may be used to waive the company’s right of subrogation against named third parties who may be responsible for an injury.2.The sentence in ( ) is optional with the company. It limits the endorsement to apply only to specific jobs of the insured, a nd only to the extent that the insured is required to obtain this waiver.This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)Endorsement Effective Endorsement No.Insured Policy No. 1000001459 Insuranc e Co mpany Countersigned By 1 0-01-14 Starr Indemnity & Liability Company Spiess Construction Co., Inc.Where required by written contract