SWCAl-1
CERTIFICATE OF LIABILITY INSURANCE
OP ID: LW
DATE (MMIOD/YYYY)
05/09/15
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 th is ce rtificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUC ER
BRADLEYINSURNACEAGENCY
FAX
A1C No :
PO BOX 12215
5210· B SCHUBERT ROAD
KNOXVILLE, TN 37912
INSURED
INSURER(S)AFFOROING COVER_
AG
_E
______
NAIC#
INSURERA : H astlngs Mutual Insurance C_o_ __ _ __ __,14176
SWCAlnc.
1029 N PEACTREE PARKWAY SUITE 102
PEACHTREE, GA 30269
INSURERS :
INSURERC :
INSURERO :
INSURERE :
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 TH E 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.
IN SR
LTR
I'll Dl OUBR
I.SR WVD
TYPE OFINSURANCE
GENERAL LIABlLITY
rl
J L9900095
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE
OCCUR
I
r vL"' oorr
M
v.,,.,
Tfl
05/09/15
05/09/16
Ix I
I
II
GENL AGGREGATE LIMIT APPLIES PER:
I IFrT
POLICY
IAUTOMOBILE
LIABILITY
IX
PRO-
A
I
,__ UMBRELLALIAB
EXCESS UAB
05/09/15
05/09/16
SCHEDULED
AUTOS
NON-OWNED
AUTOS
h1
1,000,000
100,000
I CU
REMISES IEe occurrence\
~ED EXP (Anv one person)
5,000
ERSONAL & ADV INJURY
1,000,000
GENERAL AGGREGATE
2,000,000
PRODUCTS·COMP/OPAGG
2,000,000
If yes, descnbe under
DESCRIPTION Of OPERATIONS below
•s
1,000,000
s
s
s
s
s
(p~';'~~~~l)MOY~V"'
I
YIN
D
IEa aCClclent)
BODILY INJURY (Per person)
BOOILY INJURY (Per accident) $
OCCUR
CLAIMS-MADE
PROPRIETOR.IPA.RTNERIEXECUTIVE
OFFICER/WEMBER EXCLUDED•
I
n1...1'111
$
GL9900095
ANY
(Mandatory in NH)
IV
LDC
OED I I RETENTIONs
WORKERS COMPENSATION
ANDEMPLOYERS"LIABILITY
A
• n1•1nu1...
'::.tNlilt: LIMI I
~ ~'~" Fx1
ALL OWNED
AUTOS
HIRED AUTOS
LIMITS
"'"'"
ACH OCCURRENCE
I
A
POLICYNUMBER
EACH OCCURRENCE
AGGREGATE
NOT INCLUDED
x IT~;TfJ~s I
05/09/15
WC9900121
N/ A
I
I
I I
I
I
05/09/16
OTH·
FR
E.L. EACH ACCIDENT
$
EL DISEASE· EA EMPLOYEE
s
1,000,000
1,000,00(
E L. OISE.ASE· POLICY LIMIT
$
1,000,000
I
DESCRIPTIONOF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101 , Additional Remarks Schedule, if more apace ls required)
Operations-Janitorial
tephen F. Austin State University, its officials, directors, employees,
epresentatives and Volunteers.
936 North St.
acogdoches, TX 75962
ACORD 25 (2010/05)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WI LL BE DELIVERED IN
ACCORDANCE WITH THE PO LICY PROVISIONS.
AUTMORIZEO REPRESENTATIVE
Nancy A . O 'Connell
© 1988-2010 ACORD CORPORATION. All rights reserved.
Th e ACORD name and logo are reg istered marks of ACORD