DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
4/27/2016
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 .
PRODUCER
MHBT Inc.
8144 Walnut Hill Lane
16th Floor
Dallas TX 75231-TX
INSURER A :
INSURED
NCHCOR1
Chem-Aqua, Inc.
2727 Chemsearch Blvd .
Irving, TX 75062
INSURERS :
INSURER C :
INSURERD:
INSURER E :
INSURER F :
COVERAGES
REVISION NUMBER:
CERTIFICATE NUMBER: 786717952
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 REQU IREMENT, TERM OR CONDITION O F 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
LIMITS
TYPE OF INSURANCE
(~~lb%Tv~~\ ,:ai5%J'v~y,
POLICY NUMBER
INSR WVD
LTR
B
--x
D
ERAEYV716
GENERAL LIABILITY
4/30/2016
4/30/2017
COMMERCIAL GENERAL LIABILITY
x
-
CLAIMS-MADE
~ OCCUR
Blkt Contractual
GEN'L AGGREGATE LIMIT APPLIES PER:
I
A
POLICY
[Xl P,~,9.,:
n
x
-
-x
-
ANY AUTO
ALL OWNED
AUTOS
-
HIRED AUTOS
-
UMBRELLA LIAB
>---
ISAH09041989
4/30/20 16
4/30/2017
SCHEDULED
AUTOS
NON-OWNED
AUTOS
-x
H
EXCESS LIAB
MED EXP (Any one person)
$25,000
PERSONAL & ADV INJURY
$1,000,000
GENERALAGGREGATE
$2,000 ,000
PRODUCTS ·COMP/OP AGG
$2,000,000
$
IEa acciden~~I N(.jLt: LIMI I
$5.000 000
BODILY INJURY (Per person)
$
$
EACH OCCURRENCE
OCCUR
CLAIMS-MADE
$
AGGREGATE
RETENTION $
OED
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE
N/A
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
EJ
$1,000 ,000
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
$
IPer accident\
$
I I
A
$1,000,000
LOC
AUTOMOBILE LIABILITY
-
EACH OCCURRENCE
DAMAe>t: TO RENTED
PREMISES IEa occurrence\
$
WLRC48604122
4/30/20 16
4/30/2017
x I T'1,~;T~J,¥;:; I
I OJ~-
E.L. EACH ACCI DENT
All States
$2,000,000
E.L. DISEASE - EA EMPLOYEE $2,000,000
g~i~~rti~g~ O'~~PERATIONS below
E.L. DISEASE· POLICY LIMIT
$2,000 ,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101 , Additional Remarl<s Schedule, If more space Is requ ired)
The General Liability policy includes Blanket Additional Insured Endorsements
The Automobile Liability policy includes Blanket Additional Insured Endorsement
Blanket Endorsements apply to the Certificate Holder only when there is a written contract between the Named Insured and the Certificate
Holder that requires such status .
CANCELLATION
CERTIFICATE HOLDER
Stephen F. Austin State University, its officials,
directors , employees, representatives, and volunteers
1936 North St.
Nacogdoches TX 75962
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
~4-r
I
ACORD 25 (2010/05)
© 1988-2010 ACORD CORPORATION . All rights reserved.
of ACORD
marks
registered
are
logo
and
name
ACORD
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