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DocuSign Envelope ID : ECA8B837-2B92-49BC-9B91 -297A3D5049C1
<br /> V111U111.Tr . IJYJJI BGEINC1
<br /> ACORDTm CERTIFICATE OF LIABILITY INSURANCE
<br /> DATE (MM/DD/YYYY)
<br /> 12/18/2023
<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 have ADDITIONAL INSURED provisions or be endorsed .
<br /> If SUBROGATION IS WAIVED , subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br /> this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s) .
<br /> PRODUCER NAME : Stephanie Anguiano/Michelle W.
<br /> USI Southwest PHONE 713 490 -4600 FAX
<br /> 9811 Kat Freeway Suite 500 E-MAILo, Ext : A/c, No
<br /> y y ' ADDRESS : stephanie . anguiano@usi . com
<br /> Houston , TX 77024 INSURER(S) AFFORDING COVERAGE NAIC #
<br /> 713 4904600 INSURERA : Continental Insurance Company 35289
<br /> INSURED INSURER B : Valley Forge Insurance Company 20508
<br /> Brown and Gay Engineers , Inc .
<br /> INSURER C : Lexington Insurance Company 19437
<br /> DBA BGE , Inc .
<br /> 10777 Westheimer, Suite 400 INSURER D
<br /> INSURER E :
<br /> Houston , TX 77042
<br /> INSURER F :
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER .
<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 CONTRACTOR 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 /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
<br /> A X COMMERCIAL GENERAL LIABILITY 6075541416 12/31 /2022 12/3112023 EACH OCCURRENCE $ 110001000
<br /> CLAIMS-MADE X] OCCUR PREMISES (Ea RENTED
<br /> ) $ 190003000
<br /> I
<br /> MED EXP (Any one person ) $ 5 , 000
<br /> PERSONAL & ADV INJURY $ 1 , 000, 000
<br /> GEN 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 , 000 , 000
<br /> POLICY � JECOT F LOC PRODUCTS - COMP/OP AGG $ 2, 000 , 000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY 6075541433 12/31 /2022 12/31 /202 CMINED
<br /> Ea acc dentSINGLE LIMIT 1 , 000 , 000
<br /> X ANY AUTO BODILY INJURY (Per person) $
<br /> OWNED SCHEDULED BODILY INJURY (Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> X AUTOS ONLY X AUTOS ONLY Per accident
<br /> $
<br /> A X UMBRELLA LIAB X OCCUR 6075541464 12/31 /2022 1213112023 EACH OCCURRENCE s16 , 000 , 000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 16 00O 000
<br /> DED X RETENTION $ 10000 $
<br /> B WORKERS COMPENSATION 675641447 12/31 /2022 12/31 /202 X PER STATUTE OTH-
<br /> AND EMPLOYERS' LIABILITY
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E. L. EACH ACCIDENT $ 1 , 000 , 000
<br /> OFFICER/MEMBER EXCLUDED? I NJ N / A
<br /> (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1 , 000 , 000
<br /> If yes, describe under
<br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE POLICY LIMIT $ 1 , 000 , 000
<br /> C Professional 031566521 12/31 /2022 12131 /2023 $5 , 000 , 000 per claim
<br /> Liability $ 10 , 000 , 000 annl aggr.
<br /> CLAIMS MADE
<br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required)
<br /> Blanket Additional Insured on all policies (except Professional Liability and Workers Compensation ) , is
<br /> provided to the Certificate Holder, when required by written contract or written agreement between the
<br /> Named
<br /> Insured and the Certificate Holder, but limited to the operations of the Named Insured per policy forms
<br /> CNA75079XX 10116 , including completed operations (GL) ; CA2048 10113 (Auto ) .
<br /> (See Attached Descriptions )
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Oran a Count SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Attn : Chris Sandt ACCORDANCE WITH THE POLICY PROVISIONS .
<br /> 300 west tryon street
<br /> P . O . Box 8181 AUTHORIZED REPRESENTATIVE
<br /> Hillsborough , NC 27278 -
<br /> © 1988-2015 ACORD CORPORATION . All rights reserved .
<br /> ACORD 25 (2016103) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br /> #S42930234/M38415019 PFMZP
<br />
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