03 :45 :20 p.m. 02- 29-2016
rom: Fawn Cowart
I
4
fcowa rt@th relkeld.co
To : 19364684282@rcfax.cc Fax: +19364684282
Fax: (903) 225-1996
ACORD®
Page 4 of 4 0212912016 3:57 PM
~
DATE (MM/DDIYYYY)
I
CERTIFICATE OF LIABILITY INSURANCE
2/29/2016
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(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) 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
~~~~~CT Carrie Claiborne
Threlkeld
&
~~g~~o .Extl : (903)581-0077
~~J'~~ss : cclai.borne@threlkeld. cam
Company Insurance
515 WSW Loop 323
I if~
Nol: (903)306-0652
INSURER!Sl AFFORDING COVERAGE
TX
Tyler
75701
INSURER A :Cincinnati Casualty
NAIC I
Co~anv
28665
INSURED
INSURER B :TEXAS MUTUAL INSURANCE COMPANY
Shanco Insulation , Inc.
INSURERC :
Shanco Sales , LTD
INSURERD :
P.O. Box
INSURERE:
7387
22945
Longview
TX 75607
INSURER F :
CERTIFICATE NUMBER·16-17
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. N01WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WI-IICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUS10NSANDCONDITIONS OF SUCH POLICIES. LIMI TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
~~~~
X
17~~ ~=
TYPE OF INSURANCE
COMMERCIAL GENERAL LIABILITY
POLICY NUMBER
l <&sltlgMYYl
<&Sr6'6~~>
I Q.AJMS-MADE [i] OCOJR
EXP (Arry one person)
$
PERSONAL &AfN INJ ~Y
$
GEIIERAL AGGREGATE
$
PRODUCTS - COli/PlOP AGG
$
$
2,000 , 000
Oll-ER:
AUTOMOBILE LIABILITY
~d~~?NGLE UIIIIT
$
1,000,000
X
BOOILY IN.u:lY (Per person)
$
EPP0065435/EBAD065435
3/1/2016
3/1/2 017
f-GEN"L AGGREGATE UIIIIT APPLIES PER:
~POLICY D ~~
X
B
AN"Y AUTO
ALLOINNED
-
D
LOC
,--
AUTOS
HREDAUTOS
-
A
1,000,000
500,000
10,000
1,000,000
2,000,000
=~~~~i~nce)
X
f--
A
$
OCC~NCE
$
A
-
LIMITS
EACH
SCHECILLED
f-- AUTOS
NQN.OINNED
f-- AUTOS
UMBRELLA LIAB
EXCESS LIAB
P1
EPP0065435/EBAD065435
X
3/1/201 6
3/1/2017
OCOJR
a.AJMS-MADE
I I
BOOILY IN.u:lY (Per accident) $
~~~;~t~M<\GE
$
PIP-Basic
$
2,500
EACH
$
2 000 000
2 000 000
OCC~NCE
$
AGGREGATE
X
OED X RETENllON$
0
WORKERS COMPENSAllON
AND EMPLOYERS' LIABILITY
YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
N/A
OFFICER/MEMBER EXCLUDED?
(Man datory In NH)
D
llfED
EPP0065435/EBAD065435
3/1 /2016
$
3/1/2017
X
I ~~TUTE I
I~H$
E.L. EACH ACODENT
TS!'0001302085
3/1 /2016
3/1/2017
~~~~ri&':. ~~PERAllONS below
E.L. DISEASE- EA EMPLOYE!: $
E.L. DISEASE - POLICY UIIIIT
$
1 000 000
1 000 000
1 000 000
DESCRIPTION OF OPERATIONS /LOCATIONS I VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached If more space Is required)
The general liability and automobile policies include a b lanket automatic additional insured endorsement
provision that provides additional insured status to the certi£icate holder only when there is a written
contract between the insured and the certi£icate holder that requires such status.
The general liability , automobile and workers compensation policies include a blanket automatic waiver of
subrogation endorsement that provides this feature only when there is a written contract between the
named insured and the certi£icate holder that requires i t .
CANCELLATION
CERTIFICATE HOLDER
(936)468-4282
Stephen F. Austin State University
Attn : Purchasing Department
P.O. Box 13030
75962
Nacogdoches, TX
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 REPRESEN"rATIVE
.
Todd Threlkeld/USER23 /~~- _,e_v~.e.
@ 1988-2014 ACORD CORPORATION. All nghts reserved.
ACORD 25 (2014101)
The ACORD name and logo are regi stered marks of ACORD