ACORDTM INSURED INSURER A : Travelers Property Cas Co of America INSURER B : Travelers Indemnity Company INSURER C : Berkley Insurance Company INSURER D : Travelers Indemnity Company of CT INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: DATE (MM/DD/YYYY) 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Shelly Brandman PHONE FAX (A/C, No, Ext): 713 490-4600 (A/C, No): 713 490-4700 E-MAIL ADDRESS: shelly.brandman@usi.com USI Southwest 9811 Katy Freeway, Suite 500 Houston, TX 77024 713 490-4600 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 6806H05746A 01/01/2018 01/01/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) $ 1,000,000 D OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY B X UMBRELLA LIAB X A C X EXCESS LIAB CERTIFICATE OF LIABILITY INSURANCE Kirksey Architects, Inc. dba Kirksey 6909 Portwest Drive Houston, TX 77024 SCHEDULED AUTOS NON-OWNED AUTOS ONLY INSURER(S) AFFORDING COVERAGE NAIC # MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO- X POLICY X JECT X LOC DED RETENTION $ $ WORKERS COMPENSATION PER OTH- UB9J123652 01/01/2018 01/01/2019 X AND EMPLOYERS' LIABILITY STATUTE ER Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Professional Liability X 10,000 Client#: 169127 $ $ $ $ 12/28/2017 25674 25658 32603 25682 5,000 1,000,000 2,000,000 2,000,000 BA7347L562 01/01/2018 01/01/2019 1,000,000 CUP8127Y510 01/01/2018 01/01/2019 5,000,000 5,000,000 AEC901761502 KIRKSEY 11/11/2017 11/11/2018 $5,000,000 per claim $5,000,000 annl aggr. 1,000,000 1,000,000 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Blanket Additional Insured (all policies except Workers Compensation and Professional Liability) is provided if required by written contract executed prior to a loss, but limited to the operations of the Named Insured per policy forms CGD381 09 15 & CGD379 01 16 (GL); CAT437 08 08 (Auto); Umbrella Follows Form. Coverage provided on the General Liability is primary and non-contributory if required by written contract executed prior to a loss per policy form CGD381 09 15. Blanket Waiver of Subrogation is provided (See Attached Descriptions) CERTIFICATE HOLDER Stephen F. Austin State University* P.O. Box 13030 Nacogdoches, TX 75962-3030 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 ACORD 25 (2016/03) 1 of 2 #S22224039/M22215214 The ACORD name and logo are registered marks of ACORD 1988-2015 ACORD CORPORATION. All rights reserved. DVPZP
DESCRIPTIONS (Continued from Page 1) on GL, Auto, Umbrella, and Workers Compensation policies as required by written contract executed prior to a loss, except as prohibited by law, per policy forms CGD379 01 16 (GL); CAT340 08 08 (Auto); Umbrella Follows Form; WC420304 (B) (WC). Policies include an endorsement providing that 30 days notice of cancellation for reasons other than non payment of premium and 10 days notice of cancellation for non payment of premium will be given to the Certificate Holder by the Insurance Carrier, if required by written contract. *Certificate Holder completed to read as: Stephen F. Austin State University, its officials, directors, employees, representatives and Volunteers SAGITTA 25.3 (2016/03) 2 of 2 #S22224039/M22215214