I
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
5/5/2016
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).
~~~~~CT Janie Smiley
PRODUCER
I r~~ Nol: ( 25~ ) 753 - 1132
r.~.~>N.t c-"· (254) 753-5317
corn
ance.
~~D~~ss : j anie@baileyinsur
Bailey Insurance and Risk Management
1201 Washington Ave.
TX
Waco
76701
INSURER A :Transport a t i on Ins.
INSURED
O.
20494
Co.
Co.
INSURERB :Continental Casualty Ins.
Parsons Commercial Roofing,
P.
NAIC #
INSURER(S) AFFORDING COVERAGE
Box 298
P.O.
Inc.
20443
INSURER c :Texas Mutual Insurance
Box 21835
INSURER D :
INSURER E :
Waco
Tx
INSURERF :
76702-1035
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REVISION NUMBER :
CERTIFICATE NUMBER:CL1655042 16
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES 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 AN Y CO NTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TH IS
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 RED UCED BY PAID CLAIMS.
IAUUL ISUBR
LIMITS
l o.,~n ' ""'n
TYPE OF INSURANCE
I~~~
POLICY NUMBER
1,000,000
$
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
A
1---0
CLAIMS-MADE
W
500,000
OCCUR
C20 7757579 2
,__!__ Excludes Residential
,___ Operations
5/5/2 01 6
5 / 5 / 2017
GEN'L AGGREGATE LIMIT APPLI ES PER:
R
POLICY
0
j~~T
D
LOC
SCHEDULED
AUTOS
NON-OWN ED
AUTOS
HIRED AUTOS
B
C
UMBRELLA LIAB
EXCESS LIAB
PERSONAL & ADV INJURY
$
GEN ERAL AGGREGATE
$
2,000,000
PRODUCTS - COMP/OP AGG
$
2,000,000
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person)
B ~ ANY AUTO
ALL OWN ED
AUTOS
X
15,000
1,000,000
$
OTHER:
AUTOMOBILE LIABILITY
1---
$
MED EXP (Any one person)
Ul0 7 36 32877
5/5/2 016
5 / 5 / 2017
L~J OCC UR
n
CLAIMS-MAD E
1 0, 000
OED I x I RETENTION$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
N/A
O
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH )
C2 0775759 6 8
5/5/ 2016
Uninsured motorist combined
$
EACH OCCURRENCE
$
2,000,000
AGGREGATE
$
2,000,000
5 / 5 / 2 017
$
OTHI ER
$
1,000,000
E.L. DISEASE - EA EMPLOYEE $
1,000,000
E.L. DISEASE - POLICY LIMIT
1,000,000
E.L. EACH ACCIDENT
5/5/20 16
5 / 5 / 2017
~~st~fti[~~ ~~~PERA TIONS below
1,000 , 000
$
BODILY INJURY (Per accidenl) $
PROPERTY DAMAGE
$
IPer accidentl
I
PER
X I STATUTE
TS F0 001156952
$
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 . Additional Remarks Schedule, may be attached if more space is required)
CANCELLATION
CERTIFICATE HOLDER
Stephen F Austin State University, its
officials, directors, employees,
representatives and Volunteers
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.
AUTHORIZED REPRESENTATIVE
Wes Bailey/ J ANIE
~L-:1 rs~--~
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ACORD 25 (2014/01)
INS025 1?014011
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