DATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 9/30/2015 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 Bosworth F..e~ & Associates, Inc. No : (903) 5 8 1 - 5 369 1818 WSW Loop 323 INSURER S AFFORDING COVERAGE TX Tyler INSURED INSURER B EAST TEXAS COPY SYSTEMS, NAIC# 75701 INC .; ETCS LEASING, I NC . GREG WALKER ; RICK FEDELL :Service INSURER C : INSURERD : 4545 OLD JACKSONVILLE HWY; SUITE 200 INSURER E : TYLER INSURERF : TX 75703 -0527 CERTIFICATE NUMBER:CL1593004978 REVISION NUMBER: COVERAGES 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, TE RM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFO RDED BY THE POLICIES DESCRI BED HEREIN IS SUBJECT TO ALL TH E TERMS, EXCLUSIONS AND CONDITION S OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAI MS. INSR LTR ADDL SUBR TYPE OF INSURANCE x f--- A "'"" "nl" COMMERCIAL GENERAL LIABILITY D Cl.AIMS -MADE POLICY NUMBER POLICY EXP POLICY EFF IMM/DD/YYYYI fMM/DDIYYYYl w OCCUR ACP72 4578149 8 10/1/2015 10/1/2016 f--- f--- GEN'L AGGREGATE LIMI T APPLIES PER : ~ POLICY D PROJECT D LIMITS EACH OCCURRENCE DAMAGE 1u l'<~NTED PREMISES IEa occurrence\ $ 1,000,000 $ 300 , 000 MED EXP (Any one person) s 5 , 000 PERS ONAL & ADV INJURY $ 1,000 , 000 GENERAL AGGREGATE $ 2 , 000,000 $ 2,000,000 PRODUCTS - COMP/OP AGG LOC Additional Insured OTHER: fE~~~~~~t~INGLE AUTOMOBILE LIABILITY $ LIMI T f--- A x f--f--f--- x ANY AUTO ALL OWNED AUTOS HIRED AUTOS UMBRELLA LIAB f--- A B EXCESS UAB ~ f--f--- SCHEDULED AUTOS NON-OWNED AUTOS ACP72 45781498 10/1/ 2015 10/1/20 16 H s BODILY INJUR Y (Per person) $ BODILY INJUR Y (Per accident) $ PROPERTY DAMAGE I Per accident\ $ Schedule Mod Factor 1 $ 1 , 000 , 000 OCCUR EACH OCCURRENCE $ 5 000 000 CLAIMS-MADE AGGREGATE s 5 000 ,000 I I OED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTN ER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) tt yes, describe under DESCRIPTION OF OPERATIONS below ACP7245781498 10/1/20 15 10/1/20 16 x I ~f~TlJTE I YIN D I OTHER $ 500 000 E.L. DISEASE - EA EMPLOYEE $ 500 000 E.L. DISEASE - POLICY LIMIT 500 000 E.L. EACH ACCIDENT N/A SRZG23463-16 1 /1/201 6 1/1/2017 s $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached If more s pace Is required) Certificate Holder is named as Additional Insured as respec ts all lines except Workers' Compensation. Waiver of Subrogation applies in favor of Certificate Holder as respects to General Liability, Automobile Liabil i ty , and Workers Compensation as required by written contract . CANCELLATI ON CERTIFICATE HOLDER purchase @sfasu .edu Stephen F Austin State University, its of directors, employees, representatives and volunteers 1936 North St . 75962 Nacogdoches, TX 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 REP RESENTATIVE M Boswort h/BECKY ~ CJ' ~~ © 1988-2014 ACORD CORPORATION. All rights reserved . ACORD 25 (2014/01) INS025 1?01•011 The ACORD name and logo are registered marks of ACORD