ACORD
'-.~'-'~~""I
I
CERTIFICATE OF LIABILITY INSURANCE
~
6/10/2015
THIS CERTIFICATE IS ISSUED AS A MAnER
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(SI, 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 ondorsement. A statement on this cortificate does not confor rights to the
certificate holder In lieu of such ondorsement(s).
CONTACT Jocelyn
PRODUCER
Chambless
NAME:.
Knight & Traylor
E Loop 281 Ste C-l
Insurance
Bockman,
450
Agency
--.-
PA:g.N~O.E)lt);
(903)234-8505
r..e~,NOI.::.HJ2H.8711
~DMoA~~ss:
jocelynchambless@bockmoninsurance.com
!'lALC:II__
INSURER{SJAFFORDING CqYERAGE
Longview
INSURED
D.
Hagen,
Compliance
E,
INSURERA ;Evanston
-
INSURER B AmTrus
Connie
450
75605
TX
Inc.
DBA
and
Drug
Alcohol
Testing
Ins
Co
----
o_f_~.Cl~S:~_s_
3_5378
--
Inc
INSURERC:
Services
~fiSURER D:
281.
Loop
Insu.ra~ce_Co.
t
-~-
C-2
Ste.
Jt(S.u.~E~ E,:
75605
TX
Longview
COVERAGES
INSURERF:
CERTIFICATE
NUMBER:15
-16
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.
NOT\'V1THSTANDING
ANY REQUIREMENT,
TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT "lv1TH 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 SHDVvN MAY HAVE BEEN REDUCED BY PAlO CLAIMS
-INSRf
IliOOCYEFF~~OUCYEX~[
A.~.,or~~\~~I
TYPEOF INSURANCE
LTR
LIMITS
POLICY NUMBER
MMiODIYYYY MM'DDIYYYY
X
I
A
X
COMMERCIAL
l
GENERAL
CLA,MS.MADE
Professional
Claim
l
UAB'LlTY
W
~EACH OCCURRENCE
tlAMACE-'trfREr,iTED
,_E8EMISl;s'(E_a_Qg:l.wence)
OCCUR
Liability
I
SM907689
__
6/6/2015
6/6/2016
MEOEXP (Any one per~onl
de~
Ma~e/$2,_500
PERSONALSo ADV INJURY
GEN'l AGGREGATELIMIT APPLIES PER
X
I
I
OTHER
H
AN'! AUTO
ALL O'.\NED
AUTOS
HIRED AU10S
UMBRELLA
B
B
PRODUCTS. COMPIOPAGG
Lee
,
SCHEDULED
AUTOS
NON-Dv\'NED
••..
UTOS
h
LlAB
EXCESS L1AB
I
GENERAL AGGREGATE
AUTOMOBILE LIABILITY
X
B
:=J
jr8i
POLle'! [ ~
I
I
6/6/2015
BODILY INJURv (Per aCOdent)
PROPERTVDIoMt.GE
(Par aCCIdent;
6/6/2016
I
EACH OCCURRENCE
CLAIMS.MADE
-
I AND EMPLOYERS' LIABILITY
WORKERS
CPPll19660
OCCUR
RETENTIONS
1 [)E~l
~,..~t"81r'1I:D
SINGLE LIMIT
[Ea aCCIdent)
80DIL Y INJl,;Rv (Per !=e'SOl1j
AGGHEGATE
,I
YIN
,,"Iv PROPRIETOR'PARTNERlEXECUTiVE
OF'FICERIMEM8EREXCLUDED?
(Mandatory In NH)
N1A
~~s~2?~;~~
O~~PERATIONS
I
I
below
50,000
5,000
1,000,000
3.000.000
1,000,000
1,000,000
l°rriER
WC3173945
6/6/2015
6/6/2016
X
WC3173945
6/6/2015
6/6/2016
EL DISEASE. EA Er/PLD'!E
I
~f~TUTE
E L EACH ACCIDENT
0
1,000,000
S
I
COMPENSATION
,
,
,
,
,
,
,
,
,
,
,
,
,
,
S
E l DISEASE - POLICY liMIT
,
,
1.
p_qq
,_OQQ.
1, _OQ...O, 09~
1,000,000
I
I
I
I
I
DESCRIPTlONOF OPERATIONSI LOCATIONSI VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is requiredj
The general
liability
policy
includes
Stephen
F Austin
State
University,
its
officials,
employees.
representative
&: Volunteers
as an additional
insured.
The Texas
Workers'
includes
a Waiver
of Subrogation
in favor
of
Stephen
F Austin
State
University,
its
employees,
representative
&: Volunteers.
CERTIFICATE
HOLDER
directors,
Compensation
officials,
policy
directors,
CANCELLATION
purchase@sfasu.edu
Stephen
F
Austin
State
directors,
Volunteers
employees,
1936
St,
North
Nacogdoches,
TX
University,
representative
of
its
&
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
75962
Danny Bockm~n/JJC
ACORD 25 (2014/01)
IN!=in251~'.lnl1
The ACORD name and logo are registered
~
.
& ....•••
S!- ~
@ 1988.2014 ACORD CORPORA TlON. All rights reserved.
marks of ACORD