R DPRO- D Loc PRODUCTS COMP/OP AGG $ 2,000,000
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1 ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) ~ 07/16/2018 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 have ADDITIONAL INSURED provisions or 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). CONTACT PRODUCER Earline \Nardlow NAME: Affiliated Insurance Agents r:,g N~o Extl: (832) I FAX (888) IA/C Nol: Katy Freeway ADDRESS: ewardlow@aimins.net Suite 800 INSURER(S) AFFORDING COVERAGE NAIC# Houston TX INSURER A : Certain Lloyds INSURED INSURERS : Progressive County Mutual Richard Davis, OBA: Americlean INSURERC : Twin City Fire Ins. Co La Salle Lane INSURERD : INSURER E : Friendswood TX INSURER F : COVERAGES CERTIFICATE NUMBER: 18/19 WC Master 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. INSR POLICYEFF POLICY EXP LTR TYPE OF INSURANCE INSD I/ND POLICY NUMBER (MM/DDIYYYYI (MM/DDIYYYYI LIMITS COMMERCIAL GENERAL LIABILITY x EACH D CLAIMSMADE L8I OCCUR OCCURRENCE $ 2,000,000 Ul\Ml\l.oC: TO """I c:u PREMISES IEa occurrence! $ 100,000 MED EXP (Any one person) $ 5,000 A OlWA /09/ /09/2019 PERSONAL & ADV INJURY $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2, 000,000 R DPRO D Loc PRODUCTS COMP/OP AGG $ 2,000,000 POLICY JECT OTHER: Employee Benefits $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 IEa accident! > ANY AUTO BODILY INJURY (Per person) $ B OIM'IED x SCHEDULED /04/ /04/2019 BODILY INJURY (Per accident) $ AUTOS ONLY _AUTOS 2$ HIRED NONOWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY tper accident\ Hired/borrowed $ 1,000,000 UMBRELLA LIAB EACH OCCURRENCE H $ OCCUR EXCESS LIAB CLAIMSMADE AGGREGATE $ OED I I RETENTION $ $ XI mtute I I OTH ER WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y /N ANY PROPRIETOR/PARTN ER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 c OFFICERIMEMBER EXCLUDED? NIA 61 WBCAA5LPR 07/23/ /23/ (Mandatory in NH) E.L. DISEASE EA EMPLOYEE $ 1,000,000 If yes, describe under E.L. DISEASE POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarl<s Schedule, may be attached if more space Is required) CERTIFICATE HOLDER Stephen F. Austin State University POB CANCELLATION 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 Nacogdoches I TX /}~JJ~ ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
2 COMMENTS/REMARKS Certificate Holders continued to read: Stephen F. Austin State University, its officials, directors, employees, representatives and Volunteers SENATE BILL 425 was enacted and became law effective January 1, In part, the new law restricts the type and manner of information that what was historically presented on a certificate of insurance. This certificate of insur ance has been issued in compliance with Senate Bill 425. Most coverage extensions for certificate holders are provided on a blanket basis and are effective only when there is a written contract between the Named Insured and certificate holder requiring coverage. The following forms and endorsement have been attached to and made a part of the referenced policies. They are provided here for your information only. OF REMARK COPYRIGHT 2000, AMS SERVICES INC.
3 Additional Named Insureds Other Named Insureds Americlean Doing Business As OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC
4 ADDITIONAL COVERAGES Uninsured motorist combined single limit UM CSL 500,000 Uninsured motorist property damage UMPD 500, PKG PKG Theft Prevention Authority Charge TPAC $2.00 PIPBasic PIP 2,500 BED BED Policy Fee POLFE $ Adjst. to reconcileexp mod. premium AREM $75.00 Increased employer's liability INEL $26.00 Expense constant EXCNT $ Waiver of Subrogation WVSUB $36.00 OFADTLCV Copyright 2001, AMS Services, Inc.
5 COMMENTS/REMARKS SENATE BILL 425 was enacted and became law effective January 1, In part, the new law restricts the type and manner of information that what was historically presented on a certificate of insurance. This certificate of insurance has been issued in compliance with Senate Bill 425. Most coverage extensions for certificate holders are provided on a blanket basis and are effective only when there is a written contract between the Named Insured and certificate holder requiring coverage. The following forms and endorsement have been attached to and made a part of the referenced policies. They are provided here for your information only. OF REMARK COPYRIGHT 2000, AMS SERVICES INC.
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