REGIN-5
ACORD.
I
CERTIFICATE OF LIABILITY INSURANCE
~
OP ID: C7
DATE (MM/DD/YYYY)
11/18/2015
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 tenns 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 Rodger Sumicek
Securance Corporation Agency
r~gN:o Extl: 713-977-6606
Nol: 713-785-6722
P.O. Box 420390
Houston, TX 77242-0390
~oMDA~~ss : Texhipa~swbell.net
Rodger Sumicek
INSURER($) AFFORDING COVERAGE
NAIC#
INSURER A: Sentinel Insurance Company
11000
INSURED
Regina Gust Designs, LLC
INSURER B: Trumbull Insurance Company
27120
Twins Design Christmas
INSURER
C:
5005 Larkin St
INSURER D:
/'"\
Houston, TX 77007
1 tt ti.. SStJK... l~ '::je,('
ef.Atl, e.r·~ ]f .{:»ff\
INSURER E:
I
INSURER F:
CERTIFICATE NUMBER:
REVISION NUMBER:
COVERAGES
I rffc
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D
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THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTVv'ITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 'NITH 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 REDUC ED BY PAID CLAIMS.
INSR
LTR
A
x
-
TYPE OF INSURANCE
COMMERCIAL GENERAL LIABILITY
I
CLAIMS-MADE
0
~..°c°nL ~~~
OCCUR
POLICY NUMBER
1 1&~1-JgM~~i 11&~r~EM-Vv1
x x
61 SBAUl9303
-
11/12/2015 11/12/2016 PREMISESIUIEal'<Cr<ICU
ocrurrencel
MEO EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS · COMP/OP AGG
-
GEN'l AGGREGATE LIMIT APPLIES PER:
PRO- D
POLICY D
JECT
Loc
~
A
-
-
A
x
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS f - -
x
UMBRELLA LIAS
EXCESS LtAB
SCHEDULED
AUTOS
NON-OWNED
AUTOS
x x
H
x
B
OCCUR
CLAIMS-MADE
10,000
61SBAUl9303
COMBINED SINGLE LIMIT
(Ea accident)
11/12/2015 11/12/2016 BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE
IPer accident\
$
$
$
$
$
1,000,000
1,000,000
10,000
1,000,000
2,000,000
2,000,000
61SBAU19303
OED I I RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
Y/N
ANYPROPRIETOR/PARTNER/EXECUTIVE
NIA
OFFICER/MEMBER EXCLUDED?
D
(Mandatory In NH)
Property Section
$
1,000,000
$
$
$
$
EACH OCCURRENCE
11/12/2015 11/12/2016 AGGREGATE
I
61WBCAQ5947
11/12/2015 11/12/2016
OTHX I ~!ffTuTE I
ER
E.L. EACH ACCIDENT
DISEASE · EA EMPLOYEE
E.L. DISEASE · POLICY LIMIT
E.L.
g~s6~ft.W8N 0~0PERAT10Ns below
A
$
$
OTHER:
AUTOMOBILE LIABILITY
x
-
LIMITS
EACH OCCURRENCE
61SBAUl9303
$
$
5,000,000
5,000,000
$
$
1,000,000
$
1,000,000
1,000,000
$
11/12/2015 11/12/2016
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Additional Remar1<s Schedule, may be attached If more space Is required)
SEE ADDENDUM.
CANCELLATION
CERTIFICATE HOLDER
STEPH-7
Stephen F. Austin State
University.
1936 North St
Nacogdochestx, TX 75962
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
~~- ~~
© 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01)
The ACORD name and logo are registered marks of ACORD
NOTEPAD:
HOLDER CODE
INSURED'S NAME
STEPH-7
Regina Gust Designs, LLC
REGIN-5
OP ID: C7
Stephen F. Austin State University, its officials, directors, employees,
representatives and Volunteers are listed as additional insured with
respects to general liability & auto liability where required by written
contract .
Date
PAGE 2
11 /18/2015