ACORD•
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CERTIFICATE OF LIABILITY INSURANCE
_./
DATE(MM/DO/YYYYJ
2/24/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORM ATION 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: Ir the certifi cate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. Ir SUBROGATION IS WAIVED, s ubj ect to
the term s and conditions or the policy, certain policies may require an endorsement. A stat ement o n this certlncate does not conrer ri ghts to the
c ertlncate holder In lieu or such endorsement(s).
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PRODUCER
CBH INS AGENCY INC
PO Box 630630
Nacogdoches , TX 75963-0630
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l/VC, No, Ext \·
Sure Green Inc .
Evergreen Lawn Care
4601 NW Stallings
Nacogdoches, TX 75964
569-0591
56 4 -6759
NAIC ll
All ied Insurance
INSURER B
INSURER C ·
INSURER D
INSURER E
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INSURER F :
CERTIFICATE NUMBER :
COVERAGES
I (NC. Nol ( 9 36)
INSURERt& J AF FORD ING COVE RAGE
INSURER A
INSURED
(936) 564-1735
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ADDRESS:
REVI SION NUMBER:
THIS IS TO CERTIFY THAT THE PO LICIES OF INSU RANC E LIST ED BELOW HAVE BE EN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLI CY PE RIO D
INDICAT ED. NOTWITHSTAN DING ANY REQUIREMENT, T ERM OR CONDITION OF ANY CONTRACT OR O THE R DOCUM ENT WITH RE SP ECT TO WHICH TH IS
CERTIFI CAT E MAY BE ISSUED OR MAY PERTAIN, TH E INSU RANC E AFFO RD ED BY THE POLIC IES DESCR IBED HEREI N IS SU BJECT TO AL L THE TER MS,
EXCLUSIONS AND COND ITIONS OF SUCH POLI C IES . LI MITS SHOWN MAY HAVE BE EN REDUCED BY PAID C LAIMS.
INSR
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-
A
~ UL
TYPE OF INSURANCE
LTR
INSD
o u g~
WVD
POLICY NUMBER
I
M'rX\'.llsi'vYh)
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COMMERClAL GENERAL UASIUTY
- , CLAIMS-MADE
>--
EACH OCCURRENCE
~ OCCUR
UAMA\.>t: IU
ACPGLD03007387906
$
PERSONAL & ADV IN..l!RY
$
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP AGG
$
GEN'L AGGREGATE LIMIT APPLIES PER.
o rs~&
Loc
-
-
HIRED AUTOS
-
UMBRELLA LIAB
>--
EXCESS LIAB
1000000
100000
5000
1000000
2000000
2000000
$
OTHER:
AUTOMOBILE LIABILITY
>-ANY AUTO
ALL OWNED
AUTOS
$
10/15 /2 015 10/15 /2 0 1 6 MED EXP (Any one person)
-
~ POLICY
$
~"•'1t:U
PREMISES (Ea occurrence)
D
LIMITS
(MM/DO/YYYY)
SCHEDULED
AUTOS
NON-OWNED
AUTOS
(Ea accidentt'N<>Lt: LIMI
$
BODILY INJURY (Per person)
$
BODIL y INJURY (Per accident)
$
-n,vr1...n.1T
Vr'\IYlt""\....,1-
(Per accident)
$
$
~I occuR
CLAIMS-MADE
I I
RETENTION $
DED
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mui datory In NH)
EACH OCCURRENCE
$
AGGREGATE
$
$
I STArurE
Y/ N
Cl
I I ~R,,_
EL EACH ACCIDENT
N/ A
$
EL DISEASE - EA EMPLOYEE $
If yes, descnbe under
DESCRIPTION OF OPERATIONS below
EL DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required)
CANCELLATION
CERTIFICATE HOLDER
Stephen F. Austin State
Univeristy
Procurement & Property Services
PO Box 13030
Nacogdoches TX 75962
SHOU LD ANY OF TH E A BOVE D ESC RIBED POLICIES BE CANC ELLED BE FORE
THE EXPIRATION DATE THEREOF, NOTICE WIL L BE DELIVERED IN
ACCORDANC E W ITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
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ACORD25 (201 4/0 1)
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1988-2014 ACO RD CORPORATION . All rights reserved.
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