3:09 PM
'16/5/11
ACORD®
~
DATE (MM/DDIYYYY)
I
CERTIFICATE OF LIABILITY INSURANCE
05/11/2016
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 Al TER 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).
~~~~ACT BRENDA ANDERSON
\',lj8N~o Ext\: (800)469-4318
~·ir~~ss: BRENDA@.NACRM.COM
PRODUCER
NACRM/TIB TRANSPORTATION INSURANCE BROKERS
PO BOX 414
LOMETA, TEXAS 76753
/ i_ifc
Nol:
(512)752-3030
INSURER(S) AFFORDING COVERAGE
INSURER A:
INSURED
NAIC#
LANCER INSURANCE COMPANY
INSURER B:
CHUCK'S TRAVEL COACHES, INC .
P.O . BOX 8723
TYLER, TEXAS 75711 -8723
INSURER C:
INSURER D:
INSURER E:
INSURER F:
CERTIFICATE NUMBER:
COVERAGES
REVISION NUMBER:
101032
THIS IS TO CERTI FY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING AN Y REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W ITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TH E INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS ,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS .
INSR
LTR
A
ADDL ~_UBR
INSR WVD
TYPE OF INSURANCE
x
>---
1~Shl%~1 1~3rc\%TMY1
COMMERCIAL GENERAL LIABI LITY
- ~ CLAIMS-MADE
0
OCCUR
GL 157739 #5
05/06/16
05/06/17
LIMITS
EACH OCCURRENCE
DA!Y'!~~s '· Y. KENTED
PREMISES (Ea occurrence)
$
MED EXP (Anv one person)
$
$
PERSONAL & ADV INJURY
$
GENERALAGGREGATE
$
GEN'L AGGRE GATE LIMIT APP LIES PER:
PRODUCTS - COMP/OP AGG
$
PROn
JECT
POLICY
AUTOMOBILE LI ABILITY
\,;_OM01(<CU _:SINGLE LIMIT
(Ea accident)
$
BOOIL Y INJURY (Per person)
$
BODILY INJURY (Per accident)
P_" u.-ci:" r µAMl\..,E
(Per accident)
$
EACH OCCURRENCE
$
-
Xl
A
POLICY NUMBER
GENERAL LIABILITY
-
ANY AUTO
ALL OWNED
AUTOS
-
-
x
,___
HIRED AUTOS
UMBRELLA LIAB
EXCESS LIAB
X
x
_
$
wc
n
BA164571 #5
SCHEDULED
AUTOS
NON-OWNED
AUTOS
05/06/16
05/06/17
H
5,000,000
$
$
OCCUR
D
$
AGGREGATE
CLAI MS-MADE
I I
RETENTION $
OED
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
$
I T°'b~~,· ~;g;, I
I VE~,_
E.L. EACH ACCIDENT
NIA
$
E.L. DISEASE - EA EMPLOYEE $
E. L. DISEASE - POLICY LIMIT
A
PHYSICAL DAMAGE
1,000,000
100,000
5 000
1 000 000
2,000 ,000
BA164571 #5
05/06/16
05/06/17
$
$5,000 DEDUCTIBLE
SPECIFIED PERILS/ COLLISON
>ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
:ERTIFICATE HOLDER IS ADDED AS ADDITIONAL INSURED WITH RESPECT TO THE OPERATIONS OF THE NAMED INSURED.
CANCELLATION
;ERTIFICATE HOLDER
STEPHEN F. AUSTIN STATE UNIVERSITY.ITS
OFFICIALS, DIRECTORS , EMPLOYEES ,
REPRESENTATIVES AND VOLUNTEERS
1936 NORTH ST
NACOGDOCHES, TEXAS 75962
1CORD 25 (2010/05)
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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