DATE(MM/DD/YYYY)
yACORCf
CERTIFICATE OF LIABILITY INSURANCE
11/03/2015
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(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 endorsements).
CONTACT
NAME:
PRODUCER
Marsh USA,Inc.
PHONE
(A/C. No. Extt:
1166 Avenue of the Americas
NewYotk.NY 10036
Attn: NewYork.Certs@marsh,com
FAX
(AfC.NoJ:
»Ess:
Fax:212-948-0500
INSURER(S) AfVORDING COVERAGE
NAICff
11125
INSURER A:Sompo Japan Insurance Company of America
INSURER B:
Marine America Insurance Company
INSURED
Canon Solutions America, inc.
10945
!
'
One Canon Park
INSURER C:
Melville. NY 11747
INSURERD:
'
INSURER E;
i
INSURER F:
1
NYM07403519-15
REVISION NUMBER:5
CERTIFICATE NUMBER:
COVERAGES
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.
ADOL SUBR
INSR
LTR
TYPE OF INSURANCE
INSQ.
POUCY NUMBER
CLL6404741-05
COMMERCIAL GENERAL UABIUTY
POUCY EFF
fMM/DD/VYYYl
11/01/2015
POUCY EXP
<MM/DD/YYYY1
11/01/2016
UMPTS
1,000,000
EACH OCCURRENCE
DAMAGE TO RENTED
CLAIMS-MADE
OCCUR
PREMISES(Ea occurrence^
1,000.000
MED EXP(Any one person)
GEN-L AGGREGATE LIMIT APPLIES PER;
POLICY[I]
0LOO
PERSONAL & ADV INJURY
1,000.000
GENERAL AGGREGATE
2,000.000
PRODUCTS ■ COMP/OP AGG
1,000,000
COMBINED SINGLE LIMIT
1.000.C0O
OTHER:
AUTOMOBILE UABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
ACV40995R0(MA)
11/01/2015
11/01/2016
FTA40003D0(AOS)
11/01/2015
11/01/2016
SCHEDULED
AUTOS
NON-OWNED
AUTOS
(Ea accidentl
BODILY INJURY(Per person)
BODILY INJURY(Per acddent)
PROPERTY DAMAGE
(Per acddenti
COMP/COLLDED
CU6404740-05
UMBRELLA UAB
OCCUR
EXCESS UAB
CLAIMS-MADE
11/01/2015
11/01/2016
1.000
EACH OCCURRENCE
1,000,000
AGGREGATE
1,000,000
RETENTION $10.000
DED
WORKERS COMPENSATION
AND EMPLOYERS'UABIUTY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes. describe under
Y/N
H
WCD40058G0(AOS)
11/01/2015
11/01/2016
WCR40003DO (HI)
11/01/2015
11/01/2016
V
PER
^
STATUTE
OTHER
E.L. EACH ACCIDENT
1,000,000
E.L DISEASE - EA EMPLOYEE
1,000,000
E.L. DISEASE - POLICY LIMIT
1,000,000
N/A
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD101,Additional Remarks Schedule, may be attached If more space Is required)
Stephen F. Austin State University, its officials, directors, employees, representatives and volunteers are included as addiOonal insured (except workers'compensation) where required by written contract. This
insurance Is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named Insured and where required by written contract Waiver of subrogation is
applicable wtiere required by written contract with respect to Workers Compensation.
Stephen F Austin State University
its officlais, diredors, employees, representatives and
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
volunteers
ACCORDANCE WITH THE POUCY PROVISIONS.
THE EXPIRATION
DATE THEREOF, NOTICE WILL BE DELIVERED IN
1936 North SL
Nacogdoches,TX 75962
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
William Moliica
1
ACORD 25 (2014/01)
The ACORD name and logo are registered marks of ACORD