ACORd"
CERTIFICATE OF LIABILITY INSURANCE
1,......---
DATE (MMIOOJYYYY)
I
5/13/2015
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).
CONTACT
NAME:
PHONE
(AIC, No, Ext]:
E.MAIL
.ADDRESS:
PRODUCER
CBH Insurance Agency,lnc.
P,O. Box 630630
Nacogdoches
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INSURED
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TX
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75963
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936-56+ 1735 ...
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INSURER~_: Allied
936-564-6759
{AIC,No]:
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2311 North 51.
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INSURERE;
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INSURERF .
COVERAGES
CERTIFICATE
..
NUMBER:
REVISION
NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED,
N01WITHSTANDING
ANY REQUIREMENT,
TERM OR CONDITJON OF ANY CONTRACT OR OTHER DOCUMENT Vv1TH 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.
INSF!
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POLICYEFF
POLICYEXP :
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TYPEOF INSURANCE
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POLICYNUMBER
MMIDDiYYYV MMiDDlYYYV i
LIMITS
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GENERA.LLIABILITY
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CO"'~V.ERCIAL
GErlERALLIABIlITY
[~JOCCUR
Cl'IMSMADE
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peliCY
LIMIT APPLIES
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AHYIIUTO
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UMBRELLAL1AB
(Ea occurrence)
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100,000
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ACP BAPC7205704048
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5/7/16
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NIA
)OOJii.yItJJURY
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(Pt'! i1ocldenl: .• 50
P:iROPERfyr5.6J,lAGE~---,-------
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(Per accident)
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WORKERSCOMPENSATION
AND EMPLOYERS'LIABILITY
YIN
t,NY P~OPRIETCRIP",nNERIEXECUTIVE
S 1,000,000
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GO~ll"; IWURY(Per ~~' ••O>'l)-_.-s
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OCCUR
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EXCESS LIAS
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PER
AUTOMOBilE LIABILITY
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LEACHOCCUR~ENCE
~ $ 500 000
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DESCRIPTIONOF OPERATIONSI LOCATIONS!VEHICLES (Att.1Ch ACORO101,Addition'll Remafk~SChedule.if more sp,lce ISrequired)
Certificate
holder
CERTIFICATE
is Additional
insured
on the general
liability
HOLDER
Stephen
F. Austin
per
form CG2026
CANCELLATION
Stale
University
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
DATE THEREOF,
NOTICE WILL BE DELIVERED
IN
ACCORDANCE WITH THE POLICY PROVISIONS.
THE EXPIRATION
Procurement
Services
Dept.
P.O. Box 13030
AUTHORIZEDREPRESENTATIVE
Nacogdoches
ACORD
25 (2010105)
TX
75962
The ACORD name and logo are registered
--d..J)~
@ 1988-2010 ACORD CORPORATION.
marks of ACORD
All rig hIs reserved.