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P|-APG-002 (01t07) <br />Hired and Nonowned Auto Liability: Applies only if a limit is shown below. <br />Liability $ run <br />Uninsured Motorists Coverage (lL and LA) $ run <br />Underinsured Motorists Coverage (lL only) $ Nn <br />Stop Gap Liability: Applies only if a limit is shown below (OH, ND, WA, WV, WY). <br />Each Person $ N/A <br />Each Occurrence $ N/A <br />Bodily lnjury by Disease Aggregate $ N/A <br />Item 11: Coverage and Premiuml <br />Your policy consists of the following coverage when a premium is indicated. lf a premium is not shown, <br />there is no insurance coverage. This premium may be subject to adjustments. <br />covERAGE PART(S) PREM|UM FOR pOLtCy pERtOD <br />Commercial General Liability Coverage $1 15.00 <br />Hired and Nonowned Auto Liability Coverage $ <br />Stop Gap (OH, ND, WA, WV, WY), if applicable $ <br />State Tax, Fees, Surcharges $ 35.00 <br />TOTAL CERTIFICATE PREMIUM including State Tax, Fees, Surcharges $150.00 <br />Countersigned <br />{J* U,tA <br />Date: 06/2212021 By: <br />THIS CERTIFICATE OF INSURANCE, TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE <br />PART(S), COVERAGE FORM(S) AND ENDORSEMENT(S) ATTACHED TO THE MASTER pOLtCy, COMPLETE <br />THE ABOVE NUMBERED POLICY. <br />The following notice is provided pursuant to the Texas lnsurance Code Article 21.54. The insurer may not be <br />subject to all insurance laws and regulations of this state. The member benefits described are guaranteed through <br />an insurance contract. The Special Markets Purchasing Group, lnc's insurance policy is underwritten by <br />Philadelphia lndemnity lnsurance Company and rated A+ X by the A.M. Best Co. in 2006. <br />Page 2 of 2