BGMELEV-01
CWHOOLERY
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
11/3/2015
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 policy(ies) must be endorsed. 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).
CONTACT
Certificate Department
NAME:
PHONE
(A/C, No, Ext): (703) 667-5940
E-MAIL
ADDRESS: certs@preferins.com
PRODUCER
Preferred Insurance Services, Inc
4035 Ridge Top Road, Suite 150
Fairfax, VA 22030
FAX
(A/C, No):
(703) 991-4838
INSURER(S) AFFORDING COVERAGE
INSURER A : Hartford
INSURED
NAIC #
Underwriters Insurance Company
30104
INSURER B :
INSURER C :
BGM Elevator Inspections, LLC
516 Young Road
Hallsville, TX 75650
INSURER D :
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 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.
INSR
LTR
A
ADDL SUBR
INSD WVD
TYPE OF INSURANCE
X
POLICY NUMBER
POLICY EFF
POLICY EXP
(MM/DD/YYYY) (MM/DD/YYYY)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE
X
13UENOJ7360
OCCUR
11/07/2015 11/07/2016
GEN'L AGGREGATE LIMIT APPLIES PER:
PROPOLICY X JECT
LOC
LIMITS
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP AGG
$
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person)
AUTOMOBILE LIABILITY
HIRED AUTOS
1,000,000
300,000
10,000
1,000,000
3,000,000
3,000,000
$
OTHER:
ANY AUTO
ALL OWNED
AUTOS
$
SCHEDULED
AUTOS
NON-OWNED
AUTOS
$
$
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
EXCESS LIAB
CLAIMS-MADE
AGGREGATE
$
DED
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
$
PER
STATUTE
Y/N
OTHER
E.L. EACH ACCIDENT
N/A
$
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: Evidence of Insurance
CERTIFICATE HOLDER
Stephen F Austin University
Purchasing
PO Box 13030 SFA Station
Nacogdoches, TX 75962
ACORD 25 (2014/01)
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
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