I
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
01/29/2016
THIS CERTIFICATE IS ISSUED AS A MATIER OF INFORMATION ONLY ANO 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 pollcy(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).
~2~~~CT Betty Barnes
PRODUCER
·rn~-Nr:~,. 936-564-7000
Jamie Rodrigues
1-
I r~ No1:936=56o-9224 "" --- --·-
104 W College St
i~D~~ss: b;ttY~ba-,:;;es~iipl@~~~E'.!~':r:ll:~~-~ ---··--- ·- - - - - · - -·- · Nacogdoches, TX 75965
,________1N_s_uR_E_R~<·s_L~~~~D!~.Ci.-~~Y.f:'~_G_E____ _ _ _ _f--_N_A1_c_1_--l
·--·-·------~-----· ----------·---------------·- .INSUR~~ -= ~!Bte Fann Mutual Automobile Insurance Company
---- -~s_11_s_ __
INSURED
INSURER B ,State Farm Lloyds
.. - .... -- -- .. - ·-·--43419
·· - .... ·I
JOHN R HIBBARD CO INC
_INSURER c ,State Farm Fire and C~~a~!r _<:_;omp~~~- ------+--2_5_143
_ __,
I
2208 N STALLINGS DR
~2.\!!.l~.!!.Q_: _____ _ _ _ _ _ _ _ _ _ _ _ _ ______-· -- .... -- ······· ··--I
NACOGDOCHES TX 75964-1258
INSURERE :
·-·--........ ··--··- - ·- - - - - - -- - - - -- - + - - - --!
Sfafzfarm
£
!
f
~'~~~~---------- -··-· --- ----
'
INSURER F :
!
!
i
THIS IS TO CERTIFY THAT THE POLICIES OF INSURAN CE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTVVITHSTANDING ANY 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
' LTR
i
REVISION NUMBER: 1
CERTIFICATE NUMBER:
COVERAGES
TYPE OF INSURANCE
1t.,<:n ; wvn
B ~ COMMERCIAL GENERAL LIABILITY
•
1
I
I
CLAIM5-MADE
y
POLICY NUMBER
9J-8M-C025-6
POLICY EFF ···rot·~1c=Y~E=x=p-.,.----------------~
IMM/DD/YYYYI IMll/ODNYYY\
UNITS
05127/2015
05/27/2016
[Kl OCCUR
~N' L AGGREGATELIMIT APPLIES PER:
~ POLICY D '::~8-r
D
$
1,000,000
PRE;;IBE~ YE~~ElfJ<;.~L. -~ .. -··-·---··- !.~?.:.o~
I
1-·-·-[ .....---····-············... -..·-·--·--···..._
1
EACH OCCURRENCE
LDC
-~E-~~.£'.!Any one person)
$
PERSONAL & ADV INJURY
$
5,000
1,000,000
GENERAL AGGREGATE
$
2,000,000
PRODUCTS • COMP/OP AGG
$
2,000,000
$
I OTHER:
y
c
187 8779-F06-43
12/06/2015
06/06/2016
187 8780-F06-43
12/06/2015
06/06/2016
06/06/2016
187 8782-F06-43
12106/2015
342 6360-806-43
08/06/2015
93-BJ-X828·1
11/16/2015
COMBINED SINGLE LIMIT
S
ili..~i@:rl!L •.- ------- - + - - - - - - - - <
BODILY INJURY (Per person) . _$ • • '' ··-·· _ _:o?,. o~~
BODIL y INJURY (Pe.'. ':."~"'11!+$ ----s_o_
o._
ooo__,
PROPERTY DAMAGE
$
100,000
02/06/2016 ~~de'\\) __ ______ ' -- . ··- 1-··· - - - - - -·- --l
$
11/16/2016 1-EA
_ C_
H _OC
_C
_U_RR
_E
_N_C_E_ ___ -~ -- ---- -~ ..~~o. ooo
AGGREGATE
$
$
C WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
YIN
93-CU-F119-9
os1241201 s
0512412016
O N/A
g~~c~rps.ri~ ~gPERATIONS below
__
. .. L~J~.nrre
_l X_\~~~~~H_-_,__ _ _ _ _ __,
500,000
E.L. EACH ACCIDENT
$
500,000
E.L DISEASE - EA EMPLOYEE $
E.L. DISEASE · POLICY LIMIT $
500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
Additional Auto Policy #2117637-803-43 effective 08/03/2015 - 02/03/2016 has same liability coverage as listed above
CANCELLATION
CERTIFICATE HOLDER
Stephen F Austin State University, Its Officials, Directors,
Employees, Representatives, & Voluntee.rs
1936 North St
Nacogdoches, 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.
© 1988-2014 ACORD COR
ACORD 25 (2014/01)
The ACORD name and logo ar registered
iyia~ A;o-'.'R.' ~
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RATION. All rights reserved . :
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