OP ID: Pl
DATE (MM/OOIYYVY)
HILLBE1
ACOR D .
I
CERTIFICATE OF LIABILITY INSURANCE
~
06/22/2015
THIS CERTIFICATE IS ISSUED AS A MATIER 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($), 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
~O:i~cT James R. Mc Donald
Stanley McDonald Agency IL Inc
r.&N~o Ext): 608-788-6160
No): 608-788-7012
2018 State Road P.O. Box 1446
E-MAIL
La Crosse, WI 54602-1446
ADDRESS:
James R. Mc Donald
INSURER(S) AFFORDINGCOVERAGE
NA1C#
INSURER A: Tudor Ins urance Company
37982
INSURED
BSRK, Inc., dba
INSURER B : The Fed eral Ins urance Co.
ServiceMaster Services
1NsuRERc : Commerce and Industry
19410
Texas Environmental
Consultants, Inc.
INSURER o : Rockhill Insurance Company
28053
PO Box 7464
INSURERE
:
Tyler, TX 75711
INSURER F :
Ifffc.
CERTIFICATE NUMBER:
REVISION NUMBER:
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 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.
ADDL SUBt<
INSR
TYPE OF INSURANCE
,&S}J~, ,&S:-6~1
LIMITS
IM<:n wvn
POLICY NUMBER
LTR
COMMERCIAL GENERAL LIABILITY
A
1,000,000
EACH OCCURRENCE
$
TO r<cr<Tl:O
PGP0834572
06/23/2015 06/23/2016 UAMR\>C
300,000
CLAIMS-MADE
OCCUR
$
PREMISES IEa occurrence\
-D
x
0
-
x
-
R
$
5,00C
$
1,000,00C
GEN'LAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
2,000,00C
POLICY
OTHER
AUTOMOBILE LIABILITY
PRODUCTS · COMP/OP AGG
$
2,000,00C
-
-
c
MEOEXP (Any one person)
PERSONAL & ADV INJURY
-
c
~G~ [ l LOC
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
$
COMBINED SINGLE LIMIT
$
BODILY INJURY (Per person)
$
.J];a accklentl
~ AUTOS
""'""""
NON-OWNED
AUTOS
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
$
IP&r...,.,1dentl
$
UMBRELLA UAB
EXCESSUAB
H
Ix I
EACH OCCURRENCE
OCCUR
CLAIMS-MADE
10000
OED
RETENTION $
WORKERS COMPENSATION
ANO EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(M•ndatory in NH)
EBU033517280
06/23/2015 06/23/2016 AGGREGATE
I PER
STATUTE I I fJH·
YIN
D
E.L. EACH ACCIDENT
N/A
Pollution Liab
B
EmployeeDishonesty
2,000,000
$
2,000,000
s
$
EL DISEASE - EA EMPLOY~~
glsM:'tfto~ ~PERATIONS below
D
$
ENVP012718-00
I
ITBD
E L DISEASE -POLICY LIMIT
03/07/2015 03/07/2016 Pollution
06/23/2015 06/23/2016 C rime
$
$1mil/$2mi
25,00C
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
Stephen F. Austin State University, its officials{ directors, e~l oyees ,
representatives and volunteers are Additional nsured A .T.I. .A .
Policy#PGP0834572. Policy includes 30days notice of cancellation 10days for
non-payment of premium.
CERTIFICATE HOLDER
CANCELLATION
STEVAU1
Stephen F. Austin State
University
Procuremn t & Property Services
P .O. B ox 13030, SFA Station
1Nacoadoches TX 75962-3050
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AlJTHORIZED REPRESENTATIVE
~1\
© 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01)
Th e ACORD name and logo are registered marks of ACORD
'
-
Th is Endorsement Modifies Your Policy
(Effective At Inception Unless Another Date Shown Bel ow)
ADDITIONAL INSURED ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
The insurance afforded by this policy for "bodily injury,• "property damage" and/or "personal and advertising
injury" shall also apply to the "additional insured" listed below for claims, suits, and/or damages made
against the "additional insured," but only to the extent the "additional insured" is being held responsible for
the acts, omissions and/or negligence of the "named insured."
This insurance afforded shall not apply to claims, suits and/or damages arising out of the acts, omissions
and/or negligence of the "additional insured(s)."
The inclusion of the "additional insured(s)" shall not operate to increase the Limits of Insurance.
To the extent, if any, that this policy affords coverage to an "additional insured," the "additional insured" is
subject to all of the terms of the policy.
Our obligation to provide coverage to an "additional insured" is further limited by the interest of the
"additional insured" as defined below.
Interest of the Additional lnsured(s) Defined:
PER CONTRACT, AGREEMENT OR PERMIT FOR CLEANING SERVICES.
THE INSURANCE AFFORDED BY THIS POLICY FOR THE BENEFIT OF THE ADDITIONAL INSURED
SHALL BE PRIMARY AND NON-CONTRIBUTORY BUT ONLY WITH RESPECT TO CLAIMS, SUITS
AND/OR DAMAGES ARISING OUT OF THE NEGLIGENCE OF THE NAMED INSURED.
For the purpose of this endorsement, the "named insured" is the person(s) and/or party(ies) designated on
the Declarations Page of the policy or on any endorsement. The "additional insured" is the person(s) and/or
party(ies) identified below.
Identity of Additional lnsured(s):
STEPHEN F. AUSTIN STATE UNIVERSITY, ITS OFFICIALS, DIRECTORS, EMPLOYEES,
REPRESENTATIVES AND VOLUNTEERS
P.O. BOX 13030, SFA STATION
NACOGDOCHES, TX 75962-3030
(Complete this section if endorsement is added after policy is issued.)
Policy Number
Endorsement Number
Signature of Authorized Representative
Endorsement Effective Date
Producer Number
WW180 (03110)
INSURED