25406
ACORD'"
CERTIFICATE OF LIABILITY INSURANCE
~
DATE (MMIOOIYYYY)
I
03/21/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY DR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE 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).
~~AA1~l;T
PRODUCER
-PHO"NE
MARSH USA INC.
20 CHURCH STREET
HARTFORD, CT 06103
FAX
(Ale, No):
lAIC, No, ElIt):
E-MAIL
ADDRESS:
INSURERtSI AFFORDING COVERAGE
NAICII
19682
~~UB.~R A :Hartford Fire Insurance Company
INSURED
_19'!4S_
INSURER8 :National Union Fire 1~~u_r,:lr:u::_~?0Ea.l"ly~fPjttsburg~..~
CARRIER CORPORATION
ONE CARRIER PLACE
FARMINGTON, CT 06034-4015
INSURERC :New Hampshire Insurance Company
23841
-
INSURERD:
INSURERE:
INSURERF:
CERTIFICATE
COVERAGES
NUMBER:P52E6HM6
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
INsRl
,ADDCSUBRI
PODCYEFFIPOLICYEXP
LIMITS
LTR
TYPE OF INSURANCE
IIN;I:1'"wvr;1
POLlCY NUMBER
MMIDDIYYYYl I/MMIDOIYYYY
A
GENERAL LIABILITY
I
02CSET10004
04/01/2015
04101/2016
1,000,000
EACH OCCURRENCE
~
I
DAMAGElO~~NT!:O
X
COMMERCIAL GENERAL LIABILITY
$2,000,000 general
300,000
~RE"'1IS~1~a
occurr~ll.ce\
aggregate per location:project
10,000
CLAIMS,MADE ~
OCCUR
$10,000,000 policy
MED EXP (Anyone person)
general aggregate
1,000,000
PERSONAL & ArN INJURY
-
I
rvl
I
~'L
;u.m
AGGRE~
PER:
~~PUCTS
ILOC
02CSET10000(AID)
I
_
I
02CSET10019 (HI)
'Hartford Underwnters
ANY AUTO
ALL OVv'NED
AUTOS
04:01/2016
(E~~~~;~IlSINGLE LIMIT
I
UOCCUR
EXCESS LIAB
I I CLAIMS-MADEi
EACH OCCURRENCE
AGGREGATE
2,000,000
rl..!:J
7.11
,
,
,
,
1,000,000
,
$
I
OED
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY
Y/ N
ANY PROPRrETORJPARTNERlEXECUnVE
OFFtCERiMEMBEREXCLUDED?
NI A
(Mandatory In NH)
~~~~~?~~:~
~~hpI'Q~.TlnN5 below
S
S
BODILYINJURY (Per person)
BODILYINJURY{Per accldenl)
P'RtIPE-RTvDAMAGE
(Per a~o;ldo:;~
UMBRELLA lIAB
I
04:01/2015
Ins
SCHEDULED
AUTOS
NON..QV'JNED
AUTOS
HIRED AUTOS
. CO';lPiOP AGG
S
AUTOMOBILE LIABILITY
~
B
C
AP~S
I ~~RTI
I POLICY I
A
2,000,000
GENERAL AGGREGATE
-
I,
CT WC(SIR 2.5MM)EX COV-9883956
iMULTI.017731557,
IMULTI.017731558, CA-017731559,
,FL-017731560, MUlTI-017731561,
MA-017731562, MN-017731563,
~,~;P~7731564, PA-Q17731565,
04/0112015
04/0112016
X
IT~~",sr~~~.S
I I°J~.I
S
1,000,000
E L. DISEASE. EA EMPLOYEE S
1,000,000
E,L, EACH ACCIDENT
-£-L~
~
P..ouc~l
__"
:
'.DCQ.OQC
5
S
5
DESCRIPTIONOF OPERATIONSI LOCATIONSIVEHICLES (Attach ACORD 10', Additional Rllmarks Schedule, if more 'paclI is requlrttd)
CERTIFICATE
HOLDER
STEPHEN F AUSTIN UNIVERSITY
LARRY BAilEY
CENTRAL RECEIVING
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POliCIES BE CANCELLED
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
BEFORE
AUTHORIZEDREPRESENTATIVE
WILSON AT COLLEGE
NACOGDOCHES, TX 75962
Page1 of 1
ACORD 25 (2010/05)
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