ACORD~
CERTIFICATE OF LIABILITY INSURANCE
~
Page
1
of
DATE (MMIDD/YYYY)
I
1
02/1 7 /2016
THIS CERTI FICATE IS ISSU ED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVE LY AMEND, EXTEND OR AL TER THE COVERAGE A FFORDED BY THE POLICIES
BELOW. THIS CERTI FICATE OF INSURANCE DOES NOT CONSTITUTE A CO NTRACT BETWEEN THE ISS UING INSURER(S), AU THORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If t he certificate holder is an ADDITIONAL INSURED, the policy (ies)must be endorsed. If SUBROGATION IS WAIVED , subject to
the terms and co ndit ion s of the policy, certa in policies may requ ire an endorsement. A statement on th is certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
2?~~ACT
PRODUCER
Willis of Minnesota , Inc .
c/o 26 Century Blvd.
P. 0 . Bo x 305191
3723 0 - 5 1 91
Nashville, TN
~A~~NNEO
877 - 9 45 - 7 378
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1
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888 -46 7 - 2 378
c e r t i f i c a t es @w i l l i s . com
INSURER(S)AFFORDING COVERAGE
NAIC#
INSURER A: Old Republic Insurance Company
INSU RED
24147-001
INSURERS:
3M Company
3M Insurance Department
Bldg 224-5S-29
St. Paul, MN
55144
INSURER C:
INSURERD:
INSURER E:
INSURERF:
1
CERTIFICATE NUMBER· 2413635 0
COVERAGES
REVISION NUMBER·
THI S IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING AN Y REQUIREMENT, TERM OR COND ITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RES PECT TO WH ICH 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.
IN;:
~~~L ~~
TYPE OF INSURANCE
COMMERCIAL GENERAL LIABILITY
X
A
POLICY NUMBER
MWZY 301339
ICLAIMS-MADEW OCCUR
POLICY EFF
3/1/2014
POLICY EXP
3/1/2 0 1 7
'---
,.--~'L AGGREGATE LIMIT APPLIES PER:
POLICY D
PROJECT
D
LOC
LIMITS
EACH OCCURRENCE
$
~~too&EsM1,~~nceJ
MED EXP (Anyone person)
s
s
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
-
EXCESS LIAB
OED
A
-
-
UMBRELLA LIAS
-
I
000
000
000
00 0
PERSONAL & ADV INJURY
$
5
000
$
5
000
0 00
PRODUCTS- COM PlOP AGG
$
5
000
000
$
MWTB
AUTOMOBILE LIABILITY
x
-
000
GENERAL AGGREGATE
OTHER:
A
5
1
30 0 812
3/1/2014
3/1/20 1 7
SCHEDULED
AUTOS
NON-OWNED
AUTOS
H
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY(Per person)
$
BODILY INJURY(Per accident)
$
rp~~~~~~t?AMAGE
$
2 ,000 ,000
$
OCCUR
EACH OCCURRENCE
$
CLAIMS-MADE
AGGREGATE
s
jRETENTI ON $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE~ N I A
OFFICER/MEMBER EXCLUDED?
MWC306927
00
3/1 /20 16
3 / 1/2 0 17
X
I :T'=..'i,ITI=
I
lu~~-
s
2, 000 ,000
E.L. DISEASE- EA EMPLOYEE $
2, 000 ,000
E.L. DISEASE- POLICY LIMIT
2, 000 ,000
E.L. EACH ACCIDENT
ff.4~~~~~~~b~ ~~~er
ohCRIPTION OF OPERATIONS below
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Additonal Remarks Schedule, may be attached if more space is requ ired)
CANC ELLATION
CERTIFICATE HO LDER
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLE D BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH TH E POLICY PROVISIONS.
Stephen F. Austin State University, i t s officials
directors, employees, representatives & volunteer s
1936 North St.
75962
Nacogdoches, TX
25 (2 0 14/0 1)
p ;L
~
p 1:2 0 32 1 77 Cert:~4l36350
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C o 11:4 85 2941
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T