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CERTIFICATE OF LIABILITY INSURANCE
~
DATE(MM/DDNYYY)
05/0312016
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 have ADDITIONAL INSURED provisions or 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
PRODUCER
NAME:
Aon Risk s erv ices ce ntral , I n c .
PHONE
No.): ( 800) 363-0105
(A/C , No. Ext): (866) 283-7122
St . LO UlS MO o ffice
E-MAIL
8182 Maryl and Av enu e
ADDRESS
:
St Lo uis MO 6310 5 USA
I rffc.
INSURER(S) AFFORDING COVERAGE
INSURED
Cleaver-Broo k s sales and servi ce, Inc .
2403 Appelt Drive
Ho u s t on TX 7701 5 USA
NAIC#
INSURER A:
Zurich American I ns co
INSURER B:
Ame r ican Zu rich Ins c o
16535
40142
INSURER C:
Everest Nation al
10120
Insurance Co
INSURER D:
INSURER E:
INSURER F:
COVERAGES
CERTIFICATE NUMBER: 570062008784
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLIC IES OF INSURANCE LISTE D BELOW HAVE BEEN ISSUED TO THE IN SUR ED NAMED ABOVE FOR THE POLICY PERIOD
INDICAT ED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTH ER DOCUMENT WITH RESPECT TO W HICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , TH E INSURANCE AFFORDED BY THE POLIC IES DESCRIBED HEREIN IS SUBJ ECT TO ALL T HE TER MS,
EXCLUS IONS AND CO NDITIONS OF SUC H POLICIES . LIMITS SHOWN MAY HAVE BEEN REDUC ED BY PAI D CLAI MS.
Limits shown are as requested
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INSD WVD
TYPE OF INSURANCE
LTR
c
x
x
Ci
COMMERCIAL GENERAL LIABILITY
::=J CLAIMS-MADE
0occuR
Incl Contractua l Liab per
rvL•'- <0Ar
rvL• '- " "
POLICY NUMBER
LIMITS
(MM/DD/YYYYl (MM/DD/YYYY
OS / Ol / 20H 05/ 01/ 201 7 EACH OCCURRENCE
CF8G LUUU 75 161
SIR applies per policy ter ns & condi ions
U><IW<'-' ~ TO K ~ l'I I ~ u
PREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
policy terms
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY 0PROX JECT
GJ Loc
$2,000 , 000
$300 , 000
GENERALAGGREGATE
$2 , 000,000
$4, 000,000
PRODUCTS - COMP/OP AGG
$4,000,000
OTHER:
A
x
-
-
x
c
x
-
ANY AUTO
OWNED
AUTOS ONLY
>-HIRED AUTOS
ONLY
>-$500 Comp/Coll Ded
UMBRELLA LIAB
EXCESS LIAB
A
$1 , 000 , 000
N
~
.ElIV
PROPERTY DAMAGE
(Per accident)
H
OCCUR
CLAIMS-MADE
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05 / 01/ 2016 0 5/ 01/ 2017 EACH OCCURRENCE
XC8EX00003161
$10,000,000
AGGREGATE
WC 595497703
Al l States we
WC59549800 3
wo r k ers copensat i on - WI
~
g~;~~~iro~ 0';9~PERATIONS below
05 / 01/ 2016 05 / 01/ 2017
05 / 01/ 2016 05 / 01/ 2017
I
$10,000 ,000
x PER
STATUTE
E.L. EACH ACCIDENT
I
l ~~H$1,000 , 000
E.L. DISEASE-EA EMPLOYEE
$1,000,000
E.L. DISEASE-POLICY LIMIT
$1,000 , 000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required)
Additional Named Insureds are as follows : Aff i liated Power ser v i c es . Cisco Bo i ler serv ices compa ny, I nc . , IMTS, LLC, Jerryco
Machine & Boi le r wo r ks LP , JMEW Management Inc . , GP , T i gert Compan y Inc . Affi l iated staffin~,LP , J er ry co Repa i r solutio n s, and
Gle nda l e Power & Heat . ce r t i f i cate Holder is ad ded as an Additional I ns u r ed ex cluding wo r ers' c ompensation and Employ ers '
Liabi l i ty as required bb wr i tten contract but l i mite d to the operations o f t he I n s u re d under s ai d
co ntrac t, and al way s su ject to the policy terms , condition s and e xc lu s i o ns . Waiver of s ubrogat ion i s granted i n favo r of the
cert i fica t e hol de r as r eq uired by wr i tten contract bu t limite d to the op e rat ion s of t h e i n s u red under sai d contract, an d al way s
su bject t o the polic y terms , condi t i on s and ex cl u sions . Pri mar y and No n c ontri bu tory wordi ng applie s to t he Ge neral Liabi l i ty
CANCELLATION
CERTIFICATE HOLDER
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
St ev en F Austin St ate univers ity
Attn : Li nda Bianco
60 8 co l l ege Street
Nac ogdoches TX 7 596 2 USA
AUTHORIZED REPRESENTATIVE
©1988-2015 ACORD CORPORATION . All rights reserved .
The ACORD name and logo are registered marks of ACORD
"'
z
BODILY INJURY (Per accident)
OED x RETENTION $10 '000
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
YI N
ANY PROPRIETORI PARTNERI EXECUTIVE
NI A
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
ACORD 25 (2016/03)
<Xl
0
0
0
BODILY INJURY ( Per person)
SCHEDULED
AUTOS
NON-OWNED
AUTOS ONLY
I I
B
.....
0
.....
05 / 01/ 2016 0 5/ 01/ 2017 COMBINED SINGLE LIMIT
IEa accident\
BAP 59 549 7 5- 03
AUTOMOBILE LIABILITY
-
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(.)
AGENCY CUSTOMER ID :
570000057318
LOC#:
ADDITIONAL REMARKS SCHEDULE
AGENCY
NAMED INSURED
Aon Risk Services Central, Inc .
cleaver-Brooks sales and Service, Inc.
Page _ of _
POLICY NUMBER
See Certificate Number:
570062008784
CARRIER
NAICCODE
See Certificate Number: 570062008784
EFFECTIVE DATE :
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHE DULE TO ACORD FORM,
FORM NUMBER:
ACORD 25
FORM TITLE :
Certificate of Liability Insurance
Additional Description of Operations I Location s I Veh icles:
and Auto policies noted above . The referenced workers compensation policy includes USL&H and Mar1t1me
covera~e .. Certificate Holder is included as an Additional Insured on the General Liability and Automobile
Liability as required by written contract but limited to the operatio ns of the Insured under said contract,
and always subject to the policy terms, conditions and exclusions . waiver of subrogation is granted in favor
of the cert i ficate holder as required by written contract but limited to the operations of the insured under
said contract , with the respect to the General Liability, Automobile Liability and workers' compensation, and
always subject to the policy terms, conditions and exc lu sions.
ACORD 101 (2008/01)
© 2008 ACORD CORPORATI ON. All ri ghts reserved .
The ACORD name and logo are reg istered marks of ACORD