ACORD®
CERTIFICATE OF LIABILITY INSURANCE
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DA TE (MM/DDNYYY)
1/26/2016
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 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 endorsementlsl.
CONTACT
PRODUCER
Amy Stranae
NAME:
Arthur J. Gallagher Risk Management Services, Inc.
P~j?N,jn ~-'" 318-629-8124
;:-,~
318-798-5501
9220 Ellerbe Road
~~"AJ~.,.,
.
Amy
Strange@ajg
.com
Suite 700
Shreveport LA 71 106
INSURER( SI AFFORDING COVERAGE
NAIC #
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INSURER A : National Trust Insurance Company
20141
INSURED
INSURER B ,Columbia Casualty Company
31127
Storer Equipment Company, Ltd dba Storer Services
Strorer HVAC Management Corp
504 W67th St
Shreveport LA 71106
INSURER C:
INSURER D:
INSURER E:
INSURER F:
CERTIFICATE NUMBER· 265218688
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. NOTWITHSTAN DING ANY REQUIREME NT, TE RM 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.
"
INSR
,~~)i\g~, ,~~765~1
TYPE OF INSURANCE
LIMITS
POLICY NUMBER
INSD WVD
LTR
CPP0019892-02
2/1/2016
2/1/2017
A
COMMERCIAL GENERAL LIABILITY
$1 ,000,000
EACH OCCURRENCE
-x D
-
w
CLAIMS-MADE
OCCUR
f---
-
GEN'L AGGREGATE LIMIT APPLIES PER:
~
A
A
POLICY D JECT
PR~
OTHER:
AUTOMOBILE LIABILITY
-x
A
-
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
D
CA 0029014 ·02
CA 0029015·02
f--f---
x
UMBRELLA LIAB
EXCESS LIAB
LOC
2/1/2016
2/1/2016
2/1/2017
2/1/2017
SCHEDULED
AUTOS
NON-OWNED
AUTOS
~~~~~UYE~~~,;iencei
$1 00,000
MED EXP (Any one person)
s 15,000
PERSONAL & ADV INJURY
S1 ,000,000
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP/OP AGG
$2,000,000
$
lt)SINGLE LIMI 1
(Ea acciden
BODILy INJURY (Per person)
BODILY INJURY (Per accident) $
PRUPERTY DAMAG~
$
IPer accidentl
$
M
UMB0020481·02
OCCUR
CLAIMS-MADE
2/1 /2016
2/1 /2017
EACH OCCURRENCE
$5,000,000
AGGREGATE
$5,000,000
Ix I
OED
RETENTION $10,000
A WORKERS COMPENSATION
AND EM PLOVERS' LIABILITY
YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
N/A
OFFICER/MEMBER EXCLUDED?
D
(Mandatory in NHI
WC00003066-02
2/1 /2016
2/1 /2017
I
I I
OTHPER
X STATUTE
ER
E.L. EACH ACCIDENT
$
$1 ,000,000
E.L DISEASE - EA EMPLOYEE $1 ,000,000
~~~~~ftfrg~ O~OPERATIONS below
B
A
s1 .ooo.ooo
$
E.L DISEASE - POLICY LIMIT $1,000,000
Contractors Errors & Omissions wi
Contractor Tools & Equipment
5095039932
CPPOO 19892-02
9/4/2015
2/1 /2016
9/4/2016
2/1 /2017
Occurrence/Aggregate
Blanket Jobsite Limit
Scheduled Equipment
$ 1,000,000
$ 100,000
$ 165,018
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Additional Remarl<s Schedule, may be attached if more space is required)
Certificate Holder is an Additional Insured as respects General Liabiltiy, Auto , Umbrella pol icies , pursuant to and subject to the policy's terms ,
definitions , cond itions and exclusions when required by written contract.
Waiver of Subrogation applies to certificate holder, as respects General Liabiltiy, A uto , Umbrella , & Workers Compensation policies , pursuant
to and subject to the policy's terms , definitions, conditions and e xcl usions when requ ired by written contract.
Leased/ Rented Equ ipment From Others Limit: $50 ,000
Craig Storer is e xcluded from Workers Compensation
CANCELLATION
CERTIFICATE HOLDER
Stephen F Austin State University
P .O .BOX 13030
Nacogdoches TX 75962 USA
I
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
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