3
ACORD
I
CERTIFICATE OF LIABILITY INSURANCE
~
DATE (MM/DD/YYYY)
6/ 12 /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 polic y , certain policies may req uire a n endorsement. A statement on this certificate does not confer rights to the
certificate holde r in lie u of such endorsement(s).
~2:1~CT Rhonda Wood
PRODUCER
M o rga n Ins ura n ce Agency,
3708
s.
I IA/C
FAX Nol: (936)632-3862
~H~NJnExtl: (936)634-7755
Ltd.
~D~~ss: rwood@morganins.com
Medford
INSURER(S) AFFORDING COVERAGE
Lufkin
7590 1 -5700
TX
NAIC #
INSURER A :ALLIED INSURANCE COMPANIES
INSURED
INSURER B :TEXAS MUTUAL INSURANCE CO
Greater Overhead Door Company of Lufkin LLC ,
OBA :
10575 HWY 90 West
22945
INSURERC :
INSURER D :
INSURER E :
Beaumont
77713
TX
COVERAGES
INSURER F :
CERTIFICATE NUMBER:CL1561 203 1 77
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. NOTllVITHSTANDING ANY REQUIREMENT, TERM OR CONDITIO N OF 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 POLICI ES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
ADDL SUBR
POUCYEFF
POLICY EXP
l uft•~
TYPE OF INSURANCE
LIMITS
LTR
POLICY NUMBER
IMM/DD/YYYYl IMM/DD/YYYYl
x COMMERCIAL GENERAL LIABILITY
1,000 ,000
EACH OCCURRENCE
$
,____
DAMAc;t; I U RcNTED
100 ,000
CLAIMS·MADE
OCCUR
A
$
PREM1<:s::<: fEa occurrence'
ACP7216206000
6/10/2015
6/10/2016
5,000
MED
EXP
(Any
one
person)
$
,___
...
~~
w
D
~
GEN'L AGGREGATE LIMIT APPLIES PER:
~ POLICY D r;~8-r
D
Loc
A
~
,___
,___
x
,____
A
B
1 , 000,000
$
2,000 , 000
PRODUCTS · COMP/OPAGG
$
2,000 ,000
COMBINED SINGLE LIMIT
tEa accidenll
BODILY INJURY (Pe< person)
ANY AUTO
ALLOVVNED
AUTOS
.....__
HIRED AUTOS
~
UMBRELLA LIAS
$
GENERAL AGGREGATE
$
OTHER:
AUTOMOBILE
LIABILITY
,___
x
PERSONAL & ADV INJURY
-
H
EXCESS LIAS
SCHEDULED
AUTOS
NON·OVVNED
AUTOS
ACP7216206000
6/10/2015
6/10/2016
OCCUR
CLAIMS·MADE
I I
OED
RETENTION$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(l,land<1f "')' '"NH)
If yes, descnbe under
DESCRIPTION OF OPERATIONS below
ACP7216206000
6/10/20 15
D
Underinsured molonst
$
1 ,000,000
EACH OCCURRENCE
$
4 000 000
AGGREGATE
$
I OTH·
I PER
STATUTE I
ER
E.L. EACH ACCIDENT
N /A
TSF-0001289095
6/10/2015
6/10/2016
1 , 000 ,000
$
BODILY INJURY (Pe< accidenl) $
PROPERTY DAMAGE
$
!Per accidenll
6/10/2016
YIN
$
$
$
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, Addilional Remarks Schedule, may be attached if more space Is required)
CANCELLATION
CERTIFICATE HOLDER
( 936 )4 68-4282
purchase@sfasu.edu
Stephen F Austin State University,
its officials, director s, employee ,
representatives and vol unteers
1936 North St.
Nacogdoc hes, 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
Terry Morgan/RHON DA
-;r-~~
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ACORD 25 (2014/ 01)
INS025 (2014011
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