ACORD®
CERTIFICATE OF LIABILIT Y INSURANCE
~
DATE (MM/DDNYYY)
I
05/06/2016
THIS
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
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.
to
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject
to the
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights
certificate holder in lieu of such endorsement(s).
CONTACT
MARSHALL YOUNG INSURANCE
401 N. Ridgeway Dr.
P.O. BOX39
CLEBURNE
PRODUCER
N6UC •
Rusty Walker
~.H.~N_,E~ ~~··
(817)645-9155
E·MAIL
rusty@marshallyoung .com
4nnocc-c- .
TX
76033-0039
I ~!-.~
u-
.(817)641-2538
NAIC#
IN!:llRERl!:I AFFORDINI':: COVO:l>Al'::E
'""""c" A .Liberty Mutual Insurance Co.
'""""c" 8 .American Hallmark of Texas - Redpoint
INSURED
Aqua Rec Inc
606 Profit St
Azle
11Jc- 11 Cl!J:R
r. ·
'""""c" D •
TX
76020-
INClll>CI>
E•
11UC'llRJ:R
~
•
REVISION NUMBER:
CERTIFICATE NUMBER:
COVERAGES
FOR THE POLICY PERIOD
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE
RESPECT TO WHICH THIS
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TE RM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH
TO ALL THE TERMS,
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
1~;:
A
'"""
GENERAL LIABILITY
-
....
ADDL SUBR
TYPE OF IN SURANCE
Pn1 ll"V
~
.!:Sl-rl~~~.
NUMBER
..
POLICY EXP
02/01/2016 02/01/2017
BKS55929243
x D M ERCIAL GENERAL LIABILITY
0
CLAIMS·MADE
OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
Xl
-
POLICY
n
ANY AUTO
All OWNED
AUTOS
HIRED AUTOS
~
f--
UMBRELLA LIAB
ncn
I
Ste Af~
1,000,000
MED EXP IA!lv one oersonl
$
PERSONAL & ADV INJURY
s
GENERAL AGGREGATE
$
2,000,000
PRODU CTS - COMP/OP AGG
$
2,000,000
o/1r!~
H
OCCUR
CLAIMS-MADE
~~~~l~~~.~INGLE LIMIT
t
BODILY INJURY (Per person)
s
BODILY INJURY (Per accidenl)
$
~0~9~~-~~.~AMAGE
$
EACH OCCURRENC E
$
AGGREGATE
$
$
$
.- ·-· ic-
15,000
1,000,000
$
WORKERS COMPENSATION
AND EMPLOYERS' LIA BILITY
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE [ ]
N/A
OFFICER/M EMBER EXCLUDED?
(Mandatory in NH)
lf1!es, describe1~~t;! ___
1,000,000
s
LOC
SCHEDULED
AUTOS
NON-OWNED
AUTOS
I "~ ~N
$
cc<arn::c" • Co
$
AUTOMOBILE LIABILITY
EXCESS LIAB
B
n
~~,9;.
LIMITS
EACH OCCURRENC E
DAMAGE TO RENTED
h ...
AHWC1584
04/15/2016 04/15/2017
X
I
T~.s;~T.~:;.
I
I OJ~-
E.l. EACH AC CI DENT
$
E.l. DISEASE - EA EMPLOYEE S
i,..,..,
E.l. DISEASE - POLICY LIMIT
S
1,000,000
1,000,000
1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101 , Add itional Remarks Schedule, If more spa ce ls required)
CANCELLATION
CERTIFICATE HOLDER
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WlLL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Stephen F. Austin State Univers ity,
its officials, directors, employees,
representatives and volunteers.
1936 North St.
Nacogdoches
AI008329
AUTHORIZED RE PRESENTA TIVE
TX
75962-
© 1988-2010 ACORD CORPORATION. All rights reserved .
ACORD 25 (2010/05)
The ACORD name and logo are registe red marks of ACORD
DATE (MM/DD/YYYY}
CERTIFICATE OF LIABILITY INSU RANC E
04/18/20 16
THIS CER TIF ICATE IS ISSUED AS MATTER OF INFORMA TION
ON LY AN D CONFER S NO RIGH TS UPON THE CERTIFIC AT E
HOLDER . TH IS CERTIFIC ATE DOES NOT AMEND , EXTEND OR
ALT E R THE C OVERAG E AFFORD ED BY THE POLICIES BELOW.
PRODUCER
HALEY CARTER STATE FARM
408 BOYD CT
AZ LE , TX 7 6020
NAIC #
INSURERS AFFO RDING COVERAG E
State Farm Mutual Auto Insuranc e Com any
INSURER A:
INSURED
AQUA- REC INC
606 PROFIT ST
AZLE, TX 76 0 20
25178
25178
INSURER B:
INSURER C:
INSURER D:
INSURER E:
COVERAGES
ANDING
INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED . NOTWITHST
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THEER
TO WH ICH THIS CERTIFICATE MAY BE ISSUED OR
RESPECT
WITH
DOCUMENT
OTH
OR
CONTRACT
ANY
OF
N
CONDITIO
OR
TERM
ENT.
ANY REQUIREM
HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AN D CONDITION S OF SUCH
MAY PERTAIN , THE INSURANCE AFFOR DED BY THE POLICIES DESCRIBED CLAIMS.
PAID
BY
CED
DU
RE
BEEN
AVE
H
MAY
SHOWN
LIMITS
E
POLICIES. AGGREGAT
EFFECTIVE POLICY EXPIRATION
INSR ADD'L
LTR INSRD
- :::J
POLICY NUMBER
TYPE OF INSURANCE
POLICY
DATE (MMIDDNY)
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
-
CLAIMS MADE
-
n
D
OCCUR
GENL AGGREGATE LMT APPLIES PER
x
POLICY
n
PROJECT
nLOC
D06
008
028
124
152
IAUTOMOBIL E LIABILITY
i
-x
-x
-Fl
ANY AUTO
ALL OWNED AUTO S
SCHEDULED AU TOS
6493
91 0 5
3351
1968
4853
03/22/1 6
03/22/1 6
11/16/1 5
03 /13/16
01/24/1 6
LIMITS
DATE (M MIDD/YY)
09/22/1 6
09/22/1 6
05/16/1 6
09/13/1 6
07/24/1 6
HIRED AUTOS
EACH OCCURRENCE
DAMAGt 1 v Rt:NTt:U
PREMISES (Ea occurrence)
$
MED EXP (Any one oersonl
$
PERSONAL & ADV INJURY
$
$
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP AGG
$
COMBINED SI NGLE LIMIT
(Ea accident)
$
BOD ILY INJURY
(Per person)
s
1 , 000 , 000
BODILY INJURY
(Per accident)
s
1 , 000 , 000
PROPERTY DAMAG E
(Per accident)
$
1 , 000,000
NON-OWNED AUTO S
AUTO ONLY - EA ACCIDENT
GARAGE LIABILITY
OTHER THAN
AUTO ONLY:
ANY AUTO
EXCESS/UM BRELLA LIABILITY
OoccuR
R
D
CLAIMS MADE
AGG $
EACH OCCURRENC E
$
AGGREGATE
$
$
$
DEDUCTIBLE
RETENTION
$
EA ACC $
we STATU-J I OTHITORY
ER
LIMITS
$
WORKER S COMPENSATION AND
EMPLOYERS ' LIABILITY
ANY PROPR IETOR/PARTN ER/E XECUTIVE
OFFICER/MEMBER EXCLUDED?
E.L. EACH ACC IDENT
E.L DISEASE - EA EMPLOYEE
EL. DISEASE - POLICY LIMIT
If yes, describe under
SPEC IAL PROVISIONS below
$
$
s
s
OTHER
S A DD ED BY ENDORSEME NT I SPECI AL PROVIS IONS
DESCRI PTION OF OPERATION S I LOCA T IO NS I VEHICLES I EXCLUSION
2 0 12 CHEVROLET SI LVERADO PU VIN#1GB2CVCG4CZ143270
2013 ISUZU NRR STAKE BED VIN#JAL E5Wl67D 7300644
2009 DODGE RJl.M 1500 PU VIN#lD3 HB16P89 J509355
2009 DODGE RAM 1500 PU VIN#lD3 HB16P09 J503517
2009 DODGE RAM 1500 PU VIN#lD3 HB16P09 J526649
CERTIFICATE HOLDER
STEPHEN F AUSTIN STATE UNIVERSITY
PO BOX 6085
NACOGDOCHES , TX 7596 2
CANC ELLATION
THE EXPIRATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
2Q
MAIL
TO
DEAVOR
EN
WILL
INSURER
NG
ISSUI
HE
T
DATE THEREOF,
LEFT, BUT FAIL URE
DAYS WRITIEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
KIND UPON T HE
TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY
INSU RER, ITS AGENTS OR REPRESENT A TIVES.
AUTHORIZED REPRESENTATIVE
Judy Butler , SSA
e reg1s ra ion no ices in 1ca e owners 1p o
132849
03-13-2007
All rights reserved
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend , extend or alter the coverage afforded by the policies listed thereon .
ACORD 25 (2001/08)