CERTIFICATE OF LIABILITY INSURANCE
lL<JKLJ
5/11/2016
THIS CERTIFICATE IS ISSUED AS A MATIER OF INFORMATION ONLY AND CONFERS NO RIG HTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER TH E 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 requ ire an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
Rikki Lei h Willou
936 564-1735
ODUCER
INS AGENCY INC
>o Box 630630
lacogdoches, TX 75963-0630
~BH
Grogan's Clean Care LLC
dba Nacogdoches Clean Care
1605 McKewen
Nacogdoches, TX 75965
- 722
iURED
INSURER A :
Al lied Insurance
INSURER B :
Fi rstCornp Underwriters Group,
INSURER C :
INSURER 0 :
INSURER E :
INSURER F :
REVISION NUMBER:
CERTIFICATE NUMBER:
) VERAGES
NAIC f
INSURER(S) AFFORDING COVERAGE
THI S IS TO CERTIFY THAT TH E POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLI CY PERIOD
INDICATED. NOIWITHSTANDING ANY REQUIREMENT, TERM OR CONDITI ON OF AN Y CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTI FICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO Al l THE TERMS,
EXCLUSI ONS AND CONDITIONS OF SUCH PO LICIES. LIMITS SHO\NN MAY HAVE BEEN REDU CED BY PAI D CLAIMS.
I
ADDL SUBR
INSD WVD
TYPE OF INSURANCE
I
~
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1M'tXt~g;wyyl
t'ULll.;Y t:Xt'
=1
CLAIMS-MADE
~I
OCCUR
ACPGLD0301716 8898 5 /2/2 016 5/2/2017
GEN'L AGGREGATE LIMIT APPLIES PER:
[]Loe
JECT
POLICY []PRO-
MED EXP (Ally one person)
$
5.000
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP AGG
$
1 000.000
2 000,000
2 000.000
·-
AL L OWNED
AUTOS
-
HIRED AUTOS
_x_
UMBRELLA LIAB
f---
EXCESS LIAB
'
I
$
$
AUTOMOBILE LIABILITY
~ ANY AUTO
nnn nnn
inn nnn
$
OTH ER:
-
1
EACH OCCURRENCE
~~• I t:U
PREMISES I Ea occurrence)
Ul\Ml\l.:>t: I U
-
Fl
LIMITS
I (MM/00/YYYYl
COMMERCIAL GENERAL LIABILITY
f---
'
POLI CY NUMBER
ACPBAPD301716 8898 5 /2/2 016 5/2/2017
SCHEDULED
AUTOS
NON-OWNED
AUTOS
(Ea accident~INbLt: LIMI'
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
·~vno~
I Y DAMAGE
(Per accident)
1,000,000
$
$
~I occuR
ACPBAPD301716 8898 5 /2/2 016 5/2/2017
CLAIMS-MADE
EACH OCCURRENCE
$
AGGREGATE
$
I I
RETENTION $
OED
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
mY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
x
YI N
[]
N/ A
MWC0078979-02
5/ 2/2 016 5/2/2017
I
sfrTuTE
I Iu1n-
$
ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below
1,000,000
E.L. DISEASE - POLICY LIMIT
$
1,000,000
1,000,000
1,000,000
SCRIPTION OF OPERATIONS I LOCATI ONS /VEHIC LES (ACORD 101 , Additional Remarl<s Schedule, may be atta ched if more space is recu ired)
CANCELLATION
:RTIFICATE HOLDER
Stephen F. Austin State University
~ H G l .' L(l A'~Y
-O F T-1 E
Procurement Services Dept.
PO Box 13030
Nacogdoches, TX 75962
: ORD 25 (2014/01)
The ACORD name and logo are registered marks of ACORD
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DE 8Gf'JE :::C• POL t:::I E~ BE C /-J-l C ELL ED BEFORE
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