DATE (MM/D D/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
1/18/20 1 6
THIS CERTIFICATEIS 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 SUBROGATIONIS 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
CONTACT
NAME:
USAA INSURANCE AGENCY INC/PHS
812846 P : (888) 242-1430 F : (888)
PO BOX 33015
SAN ANTONIO TX 78265
PHONE
fy\
(AJC, No , Ext):
r~. No )
- (88 8 i 2 42-1430
8 8 8 ) 443-6112
(
INSURER(S) AFFOROING COVERAGE
INSURED
NAIC#
INSURER A :
Hartford Lloyd ' s Ins Co
38253
INSURERS :
Hartford Underwriters Ins Co
30104
INSURER C :
I-2-I TECHNOLOGIES LLC
1324 LOC HNESS DR
ALLEN TX 75013
COVERAGES
INSURER 0 :
INSURER E :
INSURER F :
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLI CIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI OD
INDICATED. NOTWITHSTANDING AN Y REQUIREMENT , TERM OR CONDITION OF AN Y CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
AFFORDED BY THE POLICI ES DE SCRIBED HEREIN IS SUBJECT TO ALL THE
CERTIFI CATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE
TERMS .EXCLUSIONS AN D CONDITIONS OF SUCH POLICI ES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS .
--
INSR
.
...
ADDL SUHR
T YPE OF INSURANCE
, .,
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POLIC Y NUM BE R
POLICYEFF
IMM/DD/YYYYJ
POLICY EXP
LIMITS
COMMERCIAL GENERAL LIABILITY
I
A
CLAIMS-MADE
PRODUCTS - COMP/OP AGG
sl , 000 , 000
s300 , 000
slO , 000
sl , 000 , 000
s2 , 000 , 000
s2 , 000 , 000
COMBINED SINGLE LIM IT
(Ea accident )
sl , 000 , 000
BODILY INJURY (Per person)
$
EACH OCCURRENCE
~ OCCUR
DAMAGE TO RENTED
PREM ISES (Ea occurrence)
x General Li ab
65 SBA PW8612
03/24/2016
03 / 2 4/ 201 7
MED EXP (Any one person)
~
PERSONAL & ADV INJURY
R
~
GENERAL AGGREGATE
G EN'L A GGREGATE LIMIT APPLI ES PER :
POLICY
0
PROJECT
D
LOC
OTH ER:
$
AUTOMOBILE LIABILITY
~
ANY AUTO
~
B
~
x
ALL OWNED
AUTOS
~
x
HIRED AUTO~
~
.....__
-x
~
UMBRELLA LIAB
EXCESS LIA B
OEDI
SCHEDUL ED
AUTOS
NON-OWNED
AUTOS
65 UEC II6768
01/18 / 2016
01/18/2017
PROPERTY DAMAGE
H
$
OCCUR
CLAIMS-MADE
EACH OCCURRENCE
$
AGGREGATE
$
$
!RETENTION$
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDE D?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATION S below
$
$
(Per accident )
WO RKERS COMPENSATION
AND EMl'LOYERS' LIABILITY
B
BODILY INJURY (Per accid ent)
X
Y/N
D
NI A
-
IPER
STATUTE
I
I OTHER
E.L. EACH ACCID ENT
65 WEC KZ 7 15 4
09/29/2015
09/29/2016
E.L. DISEASE- EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
s1 , ooo , ooo
s1 , ooo , ooo
sl , 000 , 000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES {ACORD 101 , Add itional Remarks Sch edule, may be attached if more space Is required )
Those usual to the Insured ' s Opera ti ons .
CERTIFICATE HOLDER
Stephen F . Austi n State University
its officials , directors , employees ,
representatives and Volunteers
1936 NORTH ST
NACOGDOCHES , TX 75965
ACORD 25 (2014/01)
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF , NOTICE WILL BE
DELI VERED IN ACCORDANCE WITH THE POLICY PROVISIONS .
AUTHORIZED REPRESENTATIVE
7~
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