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CERTIFICATE OF LIABILITY INSURANCE
~
DA TE (MMIDD/YYYYl
12/15/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 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: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed . If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsemen t. A statement on this certlflcate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER
~~~~~CT Commercial Lines
Bartlett Baggett & Shands
~,Ji.ljl• ( 936)632-4496
I r.ti~ Nol: 1936) 63 2- 1125
~oMt~~ss: e lbpa@bbsins.com
PO Box 9
1204 s First Street
Lufkin
INSURE RCS! AFFORDING COVERAGE
TX
75902
NAIC #
INSURER A :Sta te
Auto Mutual Ins Co
25135
INSURED
INSURER B :Texas
Mutual Insurance Co
0013
Ace Paint Contracting , DBA: James E , Gardiner, Jr ,
356 Lone Star Road
INSURER C :
INSURER D :
INSURER E :
Lufkin
TX
7590 1
INSURER F :
CERTIFICATE NUMBER:CL1552700572
COVERAGES
REVISION NUMBER:
TH IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTINI THSTANDING ANY REQU IREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUM ENT \'VITH RESPECT TO Vv1-11CH 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 RED UCED BY PAID CLAIMS.
NSR
LTR
ADDL ISUBR
TYPE OF INSURANCE
x
1.. on
COMMERCIAL OEN!;RAL LIABILITY
""'"
1&SM%)'.;..~~1 ,f.Sh\iYvVv~,
POLICY NUMBER
I CLAIMS-MADE [iJ OCCUR
A
1,000 , 000
'
100 , 000
MEO EXP (Any one P6fson)
$
5 , 000
PERSONAL & AfJV INJURY
$
1,000,000
GENERAL AGGR EGATE
$
2,000 , 000
PRODUCTS - COMP/OP AGG
$
2,000 , 000
"'°"'I
PBP2 681B30
6/9 /2 0 15
6/9 /201 6
,___
GEN'L AGG REGATE LIMIT APPLIES PER:
D
$
D~~~ESI Y1Ea occurrence\
t:D
PREMI
,___
~ POLICY D jf8;:
LI MITS
EACH OCCURRENCE
LOC
$
OTHE R:
AUTOMOBI LE LIABILITY
A
AfN AUTO
IALL OWNED
> - AUTOS
HIRED AUTOS
1--
x
~-
x
.__
x
1--
19
A
a
x
UMBRELLA LIAB
EXCESS LIAS
COM B INE,~lSINGLE LIM IT
$
BODILY INJURY (Per person)
$
__( !'.;JL~cclde
>--
SCHEDULED
AUTOS
NON-OWNED
AUTOS
PY
BAP2 352006
6 /9 / 201 5
6/ 9/20 1 6
lPR.,9~.;,~1!.~AMAGE
OCCUR
CLAIM S-MADE
Ix I
10 00 0
OED
RETENTION $
WORKERS COMPENSATION
ANO EMPLOYERS' LIABILITY
YIN
ANY PROPRIETOR/PARTNER/EX ECUTIVE
NIA
OFFICER/MEMBER EXCLU DED?
(Mandatory ln NH}
If ~e s describe under
0 SCRIPTION OF OPERATIO NS bek>w
D
BODILY INJURY (Per accident} $
PBP268 1830
6/9/2015
·---·
$
$
1,000 , 000
EACH OCCURRENCE
$
1 000 000
AGGREGATE
$
1 000 000
6/9 /201 6
x I ~f~TUTE I I ~~H-
$
$
1 000 000
12/2 0 /2015 12/ 20/ 201 6 E.L. DISEAS E - EA EMPLOYEE $
1 000 000
E.L. DI SEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS I LOCATIONS I VEH ICLES (ACORD 101, Addl tfonal Remarks Schedule,
·- - - - -
Uhderinsured motorist
E.L. EACH ACCIDENT
TSF0001164131
1,000,000
may ~
$
1 000 000
atlachod If more apac e Is ra qulredj
The General Liability & l\uto Liability Policies
includes a b l anket automatic additional insured and
waiver of subrogation provision that provides addi tionall ins u red and wai ver status when there is a
written contract between the named insured and the certificate holder requiring suoh status .
The
Workers' Compensation policy has a blanket waiver provis i on t hat provides the waiver of subrogation
status when there is a written contract between the named ins u red and the certificate holder requiring
euoh status .
CERTIFICATE HOLDER
(936)468-4282
CANCELLATION
purchase@sfasu.edu
Stephen F . Austin State University,
Its Officials, Directors, Employees,
Representatives & Volunteers .
P.O. Box 1 3030
Nacogdoches, TX 75962
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE .
THE EXP I RATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVIS IONS .
AUTHORIZED REPRESENTATIVE
Je ff Horn/ BRC
ACORD 25 (2014/01)
INS025 (201401)
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