TEAMM-1
OP ID: ZE
DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
10/13/2015
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 this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER
Zoann Elliott
JMS Insurance Agency, LLC
Ext.= 832-886-4601
ADDRESS:zelliott^mslns.net
10701 Corporate Dr., Suite 103
Stafford,1^77477-4018
„o,: 281-194-0040
INSURER(S)AFFORDING COVERAGE
INSURED
Team Marathon Fitness, Inc.
P.0. Box 17705
Sugar Land,TX 77496
NAIC0
INSURER A:Travelers Indemnity Company
25658
iNsuRERB:Travelers Ind Co of Conn
25682
iNsuRERC:Travelers Cas & Surety Co
19038
INSURER D:
INSURERS:
INSURER F:
CERTIFICATE NUMBER:
COVERAGES
REVISION NUMBER:
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.
\DDL 3UBR
INSR
LTR
B
TYPE OF INSURANCE
X
POUCYNUMBER
INSD WVP
POLICY EFF
POUCY EXP
(MM/DD/YYYYl (MM/DDfYYYYI
COMMERCIAL GE NERAL LIABIUTY
CLAIMS-MAC
E 1 X 1 OCCUR
680-8080M95A-1542
10/29/2015 10/29/2016
GEN-L AGGREGATE LIMIT APPLIES PER:
POLICY[2^ ® 1
1 LOG
UMITS
EACH OCCURRENCE
s
1,000,000
DAMAGE fUKENIED
PREMISES(Ea occurrencal
S
500,000
MEO EXP (Any one person)
S
5,000
PERSONAL & ADV INJURY
$
1,000,000
GENERAL AGGREGATE
s
2,000,000
PRODUCTS ■ C0MP/6p AGO S
2,000,000
s
OTHER:
AUTOMOBILE LIABILITY
B
X
BA8081M24A-15-SEL
ANY AUTO
sc HEDULEO
A! rros
NC}N-0WNED
Al rros
ALL OWNED
AUTOS
X
HIRED AUTOS
X
UMBRELLA UAB
10/29/2015 10/29/2016
X
COMBINED SINGLE LIMIT
(Ea accident!
S
BODILY INJURY(Per person)
s
1,000,000
BODILY INJURY(Per accident) $
PROPERTY DAMAGE
(Per accident!
$
s
A
X
EXCESS LIAB
DED
OCCUR
CUP-1551T367-1542
CLAIMS-MADE
X RETENTIONS
10/29/2015 10/29/2016
AND EMPLOYERS'LIABIUTY
OFFICER/MEMBER EXCLUDED?
5,000,000
$
5,000,000
$
Y 1 PER
IA-UB-8085M20-1-15
»
1
A 1 STATUTE 1
y/N
ANY PROPRIETOR/PARTNER^XECUTIVE
(Mandatory in NH)
S
AGGREGATE
10000
WORKERS COMPENSATION
C
EACH OCCURRENCE
10/29/2015 10/29/2016
OTH-
ER
E.L. EACH ACCIDENT
$
1,000,000
E.L. DISEASE - EA EMPLOYEE
$
1,000,000
E.L DISEASE - POLICY LIMIT
s
1,000,000
N/A
' '
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES {ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Fax Number: 936-468-4282; HendrySL@sfasu.edu
EMAIL: purchase@sfasu.edu
CANCELLATION
CERTIFICATE HOLDER
STEPH-2
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION
DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Stephen F Austin State
University
(see compi cert name pg 3)
AUTHORIZED REPRESENTATIVE
1936 North Street
,Nacogdoches,TX 75962
ACORD 25(2014/01)
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks:of ACORD
MnTCDAH
NUltrAU
iNsuREDS NAME Team MarathoH FItness, Ipc.
TEAMM-1
OP
ID: ZE
The General Liability Policy includes endorsements that provide a blanket
automatic additional insured, primary and non-contributory status, per
project aggregate limit, to the certificate holder only when there is a
written contract between the named insured and the certificate holder that
requires such stataus.
The General Liability Policy provides an
endorsement with a Blanket Waiver of S\ibrogation to the certificate holder
that is required by written contract of agreement.
Auto policy includes an endorsement that provides the certificate holder
an additional insured status as required by written contract or agreement.
The Auto policy includes an endorsement of a waiver of subrogation to the
certificate holder as required by written contract or agreement.
Workers Compensation policy provides an endorsement including waiver of
subrogation to the certificate holder as required by a written contract.
Excess/Umbrella Liability Policy follows form over all coverages General Liability, Business Auto Liability and Workers Compensation/
Employer's Liability policies.
PAGE 2
Date 10/13/2015
l^^ypnArv.
nvJICrMU.
HOLDERCODE STEPH-2
iNSURED'SNAME Team MarathoR Fitness, Inc.
TEAMM-1
OP ID: ZE
Certificate Holder name: Stephen F Austin State University, its officials,
directors, employees, representatives and volunteers
page 3
Date 10/13/2015