DATE (MM/ODNYYY)
CERTIFICATE OF LIABILITY INSURANCE
4/30/2016
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
Arthur J. Gallagher Ri sk M anagem e nt S ervices, Inc.
. 318- 798-5507
. 318-798-5550
9220 Ellerbe Road
Suite 700
NAIC #
INSURER(S AFFORDING COVERAGE
Shreveport LA 711 06
15954
INSURED
41297
JETTBUS-01
22945
Jett Data Syste m s
Mr. Tim Jett
1452 Hawn Ave nue
Shreveport LA 71107
INSURER E:
INSUR ER F:
REVISION NUMBER·
CERTIFICATE NUMBER· 9783517 44
COVERAGES
THIS IS TO CERTIFY THAT THE POLIC IES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING AN Y REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESC RIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUS IONS AND CONDITIONS OF SUCH POLICIES . LIMITS SHOWN MAY HAV E BEEN REDUCED BY PAID CLAIM S.
INSR
EXP,)
LIMITS
c~~gM~~) t~)iiCY
TYPEOF INSURANCE
MM DNYYY
POLICY NUMBER
INSD WVD
LTR
11/25/201 6 EACH OCCURRENCE
11/25/2015
TPP1 175613 00
$1,000,000
A x COMMERCIAL GENERAL LIABILITY
5/112017
5/1/2016
CPS2419478
D UAMAGt I; Yi KtN1 iou
$100,000
PREMISES Ea occurrencel
OCCUR
CLAIMS-MADE
$5,000
MED EXP (Any one person)
D
0
c--
-GEN'L AGGREGATE LIMIT APPLIES PER:
~
A
-
PROJECT
POLICY D
OTHER:
AUTOMOBILE LIABILITY
-
x
c--
-x
B
c
-
x
x
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
UMBRELLA LIAB
EXCESS LIAB
LOC
D
TPP1175613 00
11/25/2015
11/25/2016
XBS0062916
5/1/2016
5/1/2017
-
SCHEDULED
AUTOS
NON-OWNED
-- AUTOS
-
x
PERSONAL & ADV INJURY
$1,000,000
GENERALAGGREGATE
$2,000,000
PRODUCTS - COMP/OP AGG
$2,000,000
s
{Ea accide~tl:SI N GLt LIMI I
s1.ooo.ooo
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) s
$
I T gAMAGt
lP~;,""'
ccident
$
H
OCCUR
CLAIMS-MADE
EACH OCCURRENCE
$1,000,000
AGGREGATE
I I
RETENTION $
OED
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE
N/A
OFFICER/MEMBER EXCLUDED?
D
(Mandatory in NH)
If tes. describe under
D SCRIPTION OF OPERATIONS below
SBP0001033743
10/21/2015
10/21/2016
I
$1,000,000
I I
$
OTHPER
ER
X STATUTE
$100,000
E.L. EACH ACC IDENT
E.L. DISEASE · EA EMPLOYEE $100,000
E.L. DISEASE - POLICY LIMIT $500,000
DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
The General Liability policy includes a Blanket additional ins ured endorseme nt that provides additional insured status only when there is a
written contract between the named insured and the certifi cate holder that requires suc h statu s.
The General Lia bility & Workers Compensation policy includes a Blanket wa iver of subrogation endorsement that provides this feature only
when there is a w ritten contract between the named insured and the certifica te holder that requires such statu s.
CANCELLATION
CERTIFICATE HOLDER
Ste phen F. Au stin University Attn : Cry stal
19 36 North St.
Ru sk Building Rm 114
Nacogdoc hes TX 7 5962
USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
TH E EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
IC 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01)
The ACORD name and logo are registered marks of ACORD