ACORD®
CERTIFICATE OF LIABILITY INSURANCE
~
DA TE (MMIDD/YYYY)
I
4/25/2016
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
~2~~~CT Mandy Manuel
FAX Nol: (903) 753-0782
GANS & SMITH INSURANCE AGENCY INC
fA~J?NJn c .., . (903) 7 57-4601
IAIC
I
~DMDA~~ 55 . mmanuel@gans-smi th. com
P.O Box 2869
Longview
TX
INSURER(Sl AFFORDING COVERAGE
NAIC#
(CNA)
20508C
75606
INSURER A :Vallev Forae Ins Co
INC.
INSURER c :Continental Casualty Co
INSURED
INSURER e :Continental Insurance Company
THEDFORD CONSTRUCTION CO.
5117 STEEL RD
35289C
(CNA)
20443C
INSURER D :Service Lloyds Insurance Co
INSURER E :Evanston Ins Co
TYLER
TX
75703-3041
INSURER F:
CERTIFICATE NUMBER:CL1642503486
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 DOCU MENT IMTH RESPECT TO WH ICH 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.
ADDL SUBR
INSR
POLICY EFF
POLICY EXP
TYPE OF INSURANCE
LIMITS
IM<:n 1wvn
LTR
POLICY NUMBER
IMM/DD/YYYYl IMM/DD/YYYYl
COMMERCIAL GENERAL LIABILITY
1,000,000
EACH OCCURRENCE
$
x
~
A
~
CLAIMS-MADE
LJLJ OCCUR
6017 115 624
,_____
,_____
M
4/28/2016
4/28/2017
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY D
PROJECT
D
LOC
OTHER:
AUTOMOBILE LIABILITY
B
c
D
---
ANY AUTO
ALL O'MIED
AUTOS
HIRED AUTOS
x
,_____
UMBRELLA LIAS
x
EXCESS LIAB
-
SCHEDULED
AUTOS
NON-O'MIED
AUTOS
-
6017115610
4/28/ 2016
4/28/2017
HOCCUR
CLAIMS-MADE
I I
OED
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE
N/A
OFFICER/MEMBER EXCLUDED?
D
(Mandatory In NH)
6017115638
SRZE25965-16
4/28/2 016
4/28/2 016
4/28/2017
4/ 2 8/2017
~~~~~f~ir8~ 'b~'6PERATIONS below
E
Pollution Liability
16 CPL CMS 80144
4/28/ 2016
4/28/2017
Deductible $5,000
~~~~~~JYE~~E~ncel
$
MED EXP (Any one person)
$
5,000
PERSONAL & ADV INJURY
$
1 , 000 ,0 00
GENERALAGGREGATE
$
2,000,000
PRODUCTS - COMP/OP AGG
Pollution Liability
COMBINED SINGLE LIMIT
IEa accident11
BODILY INJURY (Per person)
$
2,000,000
$
2,000,000
$
1,000,000
100,000
$
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
$
IPer accidentl
PIP-Basic
$
2,500
EACH OCCURRENCE
$
5,000,000
AGGREGATE
$
5,000,000
x I ~f~TUTE I IOTHER
$
E.L. EACH ACCIDENT
$
1,000,000
E.L. DISEASE - EA EMPLOYEE
$
1 , 000,000
E.L. DISEASE - POLICY LIMIT
$
1 000,000
Each CPL Condition Limit
3,000,000
Shared General Aggregate
3 ,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Additional Remarl<s Schedule, may be attached If more space Is required)
The general liability & automobile policies includes a blanket automatic additional insured endorsement
provision that provides additional insured status to the certificate holder only when there is a written
The general
contract between the named insured and the certificate holder that requires such status.
liability, automobile, & workers compensation policies inc lude s a blanket automatic waiver of subrogation
endorsement that provides this feature only when there is a written contract between the named insured
and the certificate holder that requires i t .
CERTIFICATE HOLDER
(936)468-4282
CANCELLATION
purchase@sfasu.edu
Stephen F Austin State University, i t s of
directors, employees, representatives &
Procurement & Property Servi
Volunteers;
P
Box 13030
75692
Nacogdoches, TX
o
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
David Hughes/DMD
~~~~
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ACORD 25 (2014101)
INS025 1701401 1
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