2008/11/11 Buxton Company Certificate of Liability Insurance„tie
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07/13/2009
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Wortham Insurance & Risk [ ig't
1600 West Seventh Street
Fort Worth, TX 76102-2505
817 336-3030
INSURED
Buxton Company
2651 S. Polaris Drive
Fort Worth, Tic 76137
COVERAGES
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURERA:
Valley Forge Insurance Company
20508
INSURER B:
Continental Casualty Company
20443
INSURER c:
Federal Insurance Company
20281
INSURER D:
National Fire Insurance Co of H
2O478
INSURER E:
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I SR
LTR
ADDT
INSRE
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDD/YY
POLICY EXPIRATION
DATE MM/DD/YY
LIMITS
A
GENERAL LIABILITY
P2093358583
07/13/09
07/13/10
EACH OCCURRENCE
$1 000 000
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
PREMISES Ea ocrun-ence
5300 OOO
MED EXP (Any one person)
55 000
CLAIMS MADE ), OCCUR
PERSONAL & ADV INJURY
S1,000,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
S2 00O 000
PRO-
POLICY LOC
JECT
D
AUTOMOBILE
LIABILITY
P1 079708301
071"13/09
07/13/10
is
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
ALL OWNED AUTOS
BODILY INJURY
S
SCHEDULED AUTOS
(Per person)
HIRED AUTOS
X
BODILY INJURY
S
x
NON -OWNED AUTOS
(Per accident)
PROPERTY D�AMAGE
S
(Per accident)II
GARAGE LIABILITY
AUTOONLY- t=AACCIDENT
S
OTHER THAN EA ACC
S
ANY AUTO
S
AUTO ONLY: AGG
R
EXCESS/UMBRELLA LIABILITY
P2093460191
07/13/09
07/13/10
EACH OCCURRENCE
s5,000,000
AGGREGATE
s5,000,000
OCCUR CLAIMS MADE
S
S
DEDUCTIBLE
X RETENTION $10000LJMJT'
S
A
WORKERS COMPENSATION AND
WC2093007771
05/03/09
05/03/'1 0
TWOSTATU- OTH-
F
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
0,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - EA EMPLOYEE
S1,000,000
OFFICERIMEMBER EXCLUDED?
YES
If yes, describe under
E.L. DISEASE - POLICY LIMIT
$1 ,000,000
SPECIAL PROVISIONS below
C
OTHER E & O
68017554
11/11/08
11/11/09
3,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
kx Workers Comp Information”
Other States Coverage
Proprietors/Partners/Executive Officers/Menbers Excluded:
Tom Buxton, Chmn
(See Attached Descriptions)
City of Menifee
29714 Haun Road
Sun City, CA 92586
ELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
ACORD 25 (2001/08) 1 of 3 #S108718/M108714
AUTHORIZED REPRESENTATIVE
18KKL O ACORD CORPORATION 19£