RLIF
CERTIFICATE OF LIABILITY INSURANCE
I
.DATE (MM/DDIYYYY)
10/13/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF
PRODUCER
INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE
RU INSURANCE COMPANY
9025 N LINDBERGH DR
PEORIA, IL
CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT
AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY
THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC#
INSURER A: RLI INSURANCE COMPANY
INSURED
SHARON TOUCHETTE
WINDOW WEAR
7169 CR 302
NACOGDOCHES, TX 75961
13056
INSURERB:
INSURERC:
INSURERD:
INSURERE:
COVERAGES
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 USED OR MAY PERTAIN, THE INSURANCE AFFORDED
BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,.EXCLUSIONS AND CONDITIONS OF SUCH.
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY EFFECTIVE POLICY EXPIRATION
INSR ADD'L
POLICY NUMBER
TYPE OF INSIJRANCE
DATE (MM/DD/YYYY) DATE (MM/DD/YYYY)
LTR INSRD
GENERAL LIABILITY
BOP1010340
0
COMMERCIAL GENERAL LIABILITY
D
D
D
CLAIMS MADE
0
09/24/2015
09/2412016
OCCUR
GENERAL AGGREGATE LIMIT APPLIES PER:
IZJ
POLICY
nPROJECT
ntoc
I
LIMITS
EACH OCCURRENCE
DAMAGE TO PREMISES RENTED
TO YOU (Any one fire or explosion)
$1,000,000
PERSONAL & ADV INJURY
$1,000,000
$50,000
GENERAL~GGREGATE
$2,000,000
MED EXP {Any one person)
$5,000
PRODUCTS COMP/OP AGG
~2,000!000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Proof of Insurance
CERTIFICATE HOLDER
SFASU
CANCELLATION
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
~
c. .
-
f-
....
HBP 202 (12111)
ATIACH TO FORM 20001 TO COMPLETE POLICY
TEXAS PERSONAL AUTO POLICY
Texas Farm Bureau Casualty Insurance Company
Policy Declarations
1.800.772.6535
Mailing Address; PO Box 2689 • W~~o. TX 76702·21569
74.20 Fish Pond Road· Waco, TX 76710-1010
Vis~ us at www.txflriru.eom far Policyl'lold•r in1orma.lion
Renewal
FOR YOUR AUTo-FIRE-Llr;E-HEAL TH INSURANCE NEEDS
CONTACT YOUR LOCAL AGENT AT936-564--7374
NACOGDOCHES COUNTY FARM BUREAU, PO BOX 631664, NACOGDOCHES TX
75963
OR VISIT US AT WWW.TXFB·INS.COM FOR POLICYHOLDE~ INFORMATION
71
Named Insured/Malling Address
SHARON C TOUCHETTE
HENRY TOUCHETTE
PO BOX 633501
NACOGDOCHES TX 75963-3501
1 111111111111111111 11111 111111 1111111•11'1'· ·1'11" 1111 111 ·
AT 1i1'01 AM STANOAAO TIME AT
THli AOORYs CF THii NAMiitl
INS\JltED ~ 6TATEC:> ~Rl!!IN
1 1
' 1111
«r•
\leHICL. ~ F~E r.IU M BEFORE DISCO UNTS: 9
2,42.1..00
POL.IO' ;NCORSEM:NT P~ MI UM ; S
TOTAL POLICY PREMIUM BEFO~ii 0 1SCOUNTS: S
2.00
2,4:;ze.DO
LESS Cl.AiMS ~!e O I KOU~
LESS COMPANION F:Jt.lt;Y OISCOU~
U:s:s VEHICLE Df9COUNTI :
T OTAL POLICY ~F!!f:M I UM :;
l'>UTO TH EFT PR,E\I, ."llJTH. FEE" - Sea NO!IO! on Bad\
The Dec:la.ra.tian' of this policy Indicated Ii ere in
subject to all ether terms and e.Qndltlons cf
the policy and repla.te all previously issued Deciarations and should be attathed to and b~co rne
a pettm1nent part of your policy.
5
S
!It! 00·
.337 00-
S
9
1.435.00
~~ ~
'
3.00
~;4~~~~r~:~~~r~J
<;;OVEREtl DRJVEltS LI ST::
SHAAOf.I C T¢VOIEITTii
P~Ullol AC:>JU:STUENTS 'NILL 86 il.loFLliCTED
HEN~Y TOUC~~!
ON VOUF! !!ILL ACCQUl'IT S TATEME'NT
OIE>COU HTS:
1 =f'ASSM '1.ESTRAJrff 2 •ANTI·THE!FT 3 =CEiFENSIVC ORI Vl ~G 4 =OAIVt; f{ nv.INING 5 •ACADEMIC A::: H l~ Viil\llENT I; •AGE .S0.64 ? =MULTl·t:AA
2013 RAM PICKUI"
zooe JEEP COMMAN DER UMIYEC
4
2000 DODGE RAM F'lc:KUP
lSOO
1aiAA7Wl'SDS'nN14
1JIHG582l6C157481
1IJ S
20
20
10 5
~ ,.
3B6MF366~YM20 1 S37
1Ar5
17
1"
1267
1H7
1 67
'4
SJ4~
500 565.'I
s;ca- 5:10
$107-
~o
COVERED PROVISIONS! Covel'il11e i5 provided wl'w!ira premium, ijmit or deductible Is shown
BDd~loJu ry
Voh
"~~
SI,
,OOC P"'
Pt'IQll/ S.1,000,000
each acadent
Dalll•g•
P1P
51 ,000,000 _,,, SS,000 eoch
occldem
~
othor
F'l'Opt~
~111ag•
IOcllly lrT,JUI)'
SS0,000 per perscn/
9100.000 ~acti
Acddern
n....
Ool l !Slo~
Colllslon
550,000N<tl
ll(dde~2 !5o:l
CE;tl
S1 000ED
5258
Mi".
527
$J7
S2 t
2
$~SCI
NA
S~4
ue
521
4
$195
NA
514
$3e
S2 1
~y11ble u
Interest may app u r tt> the
$143
s100 oeo
S103
S1000 O!o
51(6
51000 DED
~
$93
NA
VEHICLE GARA.GING LOCATIONS:
N.l\COGOOo-IES O>unt;I
EONDOMEMENTS:
500
Uab~ ity Combined Single Limits
S28A LOSS PAYAl3LE CLAUSE. Any lou under Part D Is
551
565
1
OOQ-IES CREDIT UNION 921> N ST,AU.1NI;$ t<ACOGCOCHES TX 75~
2
Fl ~ !IAN K ANP iP-Vsr PO EIQ X 63 11 11 ~OGDOCl1E!S
Princip~I 11t.1m
per pen;on or pert.0n(s) ns.meo below:
iHAAON TOUCHETTE
573A Supplementary Death Benefit
"DOES NOT APPLY TO NISCELI-"NEOUS TYPE VEHICLES
1.000
174
Insured and
-x ?'SQ,;)., 11 1
Mexico Coverage-Limittd
Auto Dea.th indemnity and Total Disabirrty Coverages - $.5,000
HE NR.'f TOUCHETTE
N~med
3'
11780
0008
FR9M
1 02 !201~
NA
NA
$m
NA
NJ\
S53S
Ill...
N,A.
S2M