ACOR D
3
I
CERTIFICATE OF LIABILITY INSURANCE
~
DATE (MM/00/YYYY)
6/25/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES N OT 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 cert.l ficate holder Is an ADDITIO NAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certai n policies m ay require an en dorsement. A statement on th is certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
~~~~~CT Layla Smith
PRODUCER
Morgan
Insurance Agency,
s.
3708
I tA/f'.
FAX Nol· (936) 632 · 3862
fr,~N.r~ ~~·· { 9 3 6) 6 3 4 - 7 7 5 5
Ltd.
E:,.M_A.!~--. lsmi th®morganins. com
Medford
INSURERISI AFFORDING COVERAGE
Lufkin
75901-5700
TX
INSURER A :Cincinna t i
INSURED
1NSURERe :The Cincinnati Casual ty
Southern Supply,
Inc.
NAIC #
Special tv
Comoany
INSURER c :TEXAS MUTUAL INSURANCE CO
INSURER D :RSUI Indemnity Co.
2218
Suite F
Atkinson Dr.,
Lu fkin
INSURER E :
75901
TX
13037
28665
22945
22314
INSURER F :
CERTIFICATE NUMBER:CL1562503194
COVERAGES
REVISION NUMBER:
THIS IS TO CERTIFY THAT TH E POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TH E POLICY PERIOD
INDICATED. NOTVVITHSTANDING ANY REQU IREMENT, TERM OR CONDITION OF ANY CONTRACT 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 SHOllllN MAY HAVE BEEN REDUCED BY PAID CLAIMS
' "n~
INSR
TYPE OF INSURANCE
LIMITS
'• ••~n
t~'t~ 1~6~~.
POLICY NUMBER
LTR
GENERAL LIABILITY
1,000,000
EACH OCCURRENCE
$
IJ"M"l.>t: TO
t:IJ
100,000
s
x COMMERCIAL GENERAL LIABILITY
p1>s:u 1c::s:c:; IEa oc:x:urre11Cel
, . .ft<~
-
I-
A
I-
:J
"''""I
CLAIMS-MADE
W OCCUR
7/1/ 2015
~SU00 486 79
7/1/2016
II-
GEN'L AGGREGATE LIMIT APPLIES PER
rxi POLICY n
B
--
n
P,~R,:
MEO EXP (Any one peNon)
$
5,000
PERSONAL & ADV INJURY
$
1,000,000
GENERALAGGREGATE
s
s
s
2,000,000
s
l
PRODUCTS ·COMP/OP AGG
LOC
AUTOMOBILE LIABILITY
)E:'i:MBINED SINGLE LIMIT
x
BODILY INJURY (Per person)
ANY AUTO
ALLOIMllED
AUTOS
x
I-
HIRED AUTOS
--~"-ll
-
SCHEDULED
AUTOS
NON-O'MIED
AUTOS
-x
17 / l /2015
:BPP0199862
7/1/2016
UMBRELLA LIAB
I-
B
c
EXCESS LIAB
000 000
$
BOOILY INJURY (Per ac:adent) $
~ERTY DAMAGE
s
........,._,,,
s
s
s
s
PIP·BaSIC
x
2,000,000
~OCCUR
EACH OCCURRENCE
rt'BD
CLAIMS-MADE
10, 00(
OED I x I RETENTION s
WORKERS COMPENSATION
ANO EMPLOYERS' LIABILITY
YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
NIA
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
AGGREGATE
17 /l/20 15
7/1/2016
x I T~~I~J,~;,I
[!]
r/1/2015
17 / 1/20 16
~~S~i:~~ 'b~PERATIONS belOw
2,000,000
I OJ~-
s
l
000 000
E L DISEASE · EA EMPLOYEI $
l
000 000
E L DISEASE • POLICY LIMIT $
l
000,000
E L EACH ACCIDENT
rt'SF -000 1213669
2 500
2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONSI VEHICLES (Attach ACORD 101, Additional Remart<a Schedule, if more space Is required)
Insurance is primary and
Certificat e holder is listed as additional insured on all l iabi l i t y polic i es.
non cotributory on General Liability when required by contract. Waiver of Subrogation in favor of
Certificate Holder when required by written contract.
CANCELLATION
CERTIFICATE HOLDER
(936) 468 - 4282
purchase@sfasu.edu
Stephen F. Austin State University
Attn: Linda, Purcha sing Dept .
PO Box 6085
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
Terry Morgan/LAYLA
© 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05)
IN~02!'i
"n'"""' n1
~~~
Tho
Ar.:f"'U::)n n:::.mo :::.nrt
lnnn ::aro ron ictorort m::.,."c nf
Ar.:ru:~n