ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 12/23/2015 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 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 CONTACT WAUC Sam J. Lamoreaux Bent Tree Ins Agency, Inc PHONE ta/f" t.a- "'" -, (972) 466-0084 I ff;~ Nft\ (000) 000-0000 PO Box 118394 E-MAIL Ann.,~ btiasam@verizon.net Carrollton TX 75011 INSURERIS\ AFFORDING COVERAGE NAIC# 1w~"RER A.Capitol Specialty Ins. Corp. 10328 INSURED owc""er e.hallmark County Mutual 29408 Arrow Services, Inc. 1wc11"c" c.texas Mutual Ins. Co. 22945 10202 Airline Dr. Ste. A llj~lldcd n Houston TX 77037-0000 INCll"C" ~ IN~lll>CI> F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER THI S 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 DOCUMEN T WITH RESPECT TO WHICH THIS CERTIFI CATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIC IES 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 I Tl> TYPE OF INSURANCE "'"ft "'" ICY NllUOC" LIMITS.... ft A GENERAL LIABILITY EV20150742-01 12/31/2015 12/31 /2 016 EACH OCCURRENCE s 1,000,000 -x DAMAGE TO RENTED COMMERCIAL GENERAL LI ABILITY $5000 deductible OOC:Ul~J= _C::::. I C... s 50,000 D 0 CLAIMS-MADE OCCUR MED EXP IAnv one oersonl $ 5.000 x Asbestos/Lead/Pollut PERSONAL & ADV INJURY $ 1,000,000 - GENERAL AGGREGATE s 2,000,000 ḠEN'L AGGREn E LIMIT APn S PER: PRODUCTS - COMP/OP AGG $ 2,000,000 :xi POLICY ~f,q.; LOC $ ANY AUTO BODILY IN JURY (Per person) s ALL OWNED X SCHEDULED BODILY INJURY (Per accident) $ AUTOS - AUTOS x HIRED AUTOS x NON-OWNED PROPERTY DAMAGE $ - AUTOS ' - '" " B AUTOMOBILE LIABILITY A42507570-13 12/31/2015 12/31 /2016 COMBINED SINGLE LIMIT 1,000,000 IC.-.,...,,..;,.,,.._.\ < A UMBRELLA LIAB M - OCCUR EVOOO 15154-01 12/31 /2015 12/31 /2016 EACH OCCURRENCE $ 5,000,000 x EXCESS LIAB CLAIMS-MADE Follow Form AGGREGATE $ 5,000,000 mon I X I K" "N " N < 10,000 $ c WORKERS COMPENSATION TSF0012881200-2015 12/31/2015 12/3 112016 x I T~-~T~Y.~~ I 1 Jbl- AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE ~ E.L. EACH ACCIDENT s 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe ~~er holft.., E.L. DISEASE - POLICY LIMIT $ 1,000,000 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLESJAttach ACORD 101, Additional Remarks Schedule, If more si;ace ls required) Policy form #CG 20100413, CG20370413, EN 010361013, CA9901T & WC420304B are attac ed. Please read carefully. A 30 day notice of cancellation endorsement is added. CERTIFICATE HOLDER Stephen F. Austin State University, its officials, directors, employees, representatives & volunteers purchase@sfasu.edu 1936 North Street Nacogdoches TX 75962- CANCELLATION Al 001457 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 (2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved.
POLICY NUMBER: EV20150742-01 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following : COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Any person or organization when you have agreed in writing in a contract or agreement that such person or organization be added as an Additional Insured. Location(s) Of Covered Operations As required by written contract that is executed on or after the policy inception. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: Th is insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed ; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 04 13 Insurance Services Office, Inc., 2012 Page 1 of 2
C. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 Insurance Services Office, Inc., 2012 CG 20 10 04 13
POLICYNUMBER: EV20150742-01 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization when you have agreed in As required by written contract that is executed on or writing in a contract or agreement that such person or after the policy inception. organization be added as an Additional Insured for Completed Operations Coverage. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG20370413 Insurance Services Office, Inc., 2012 Page 1 of 1
Policy Number: EV20150742-01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ENV 010361113 PRIMARY NON-CONTRIBUTORY INSURANCE ENDORSEMENT FOR SPECIFIED PROJECT This Endorsement shall not serve to increase our limits of insurance, as described in the LIMITS OF INSURANCE Section of the policy. In consideration of the payment of premiums, it is hereby agreed as follows: Solely with respect to the specified project listed below and subject to all terms, conditions and exclusions of the policy, this insurance shall be considered primary to the Additional Insured listed below if other valid and collectible insurance is available to the Additional Insured for a loss we cover for the Additional Insured. It is also agreed that any other insurance maintained by the Additional Insured shall be non-contributory. Additional lnsured(s) Any person or organization with whom the Named Insured enters into a written contract that requires them to be named as an Additional Insured on a primary and non contributory basis and the contract is executed prior to the start of the project. Specified Project Where specified by written contract. All other terms, conditions and exclusions under the policy are applicable to this Endorsement and remain unchanged. ENV 01 036 11 13 Page 1 of 1
CA 99 on (Ed. Effective 08/09) ADDITIONAL INSURED This endorsement modifies insurance provided unde r the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below: Endorsement Effective Policy Number A42507570-13 12-31-2015 Named Insured ARROW SERVICES, INC. Countersigned by The provisions and exclusions that apply to LIABILITY COVERAGE also apply to this endorsement Stephen F. Austin State University (Owner) PO Box 13030; Nacogdoches, TX 75962 (Enter Name and Address of Additional Insured) (Authorized Representative) is an insured, but only with respect to legal responsibility for acts or omissions of a person for whom Liability Coverage is afforded under this policy. The additional insured is not required to pay for any premiums stated in the policy or earned from the policy. Any return premium and any dividend, if applicable, declared by us shall be paid to you. You are authorized to act for the additional insured in all matters pertaining to this insurance. We will mail the additional insured notice of any cancellation of this policy. If the cancellation is by us, we will give ten days notice to the additional insured. The additional insured will retain any right of recovery as a claimant under this policy. Additional Premium $ INCLUDED this endorsement. will be reta ined by us regardless of any early termination of Endorsement:
1exasMuruaI Insurance Company WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 42 03 04 B TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. 1. ( Specific Waiver Name of person or organization Schedule ( X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL TEXAS OPERATIONS 3. Premium The premium charge for this endorsement shall be 2, O O percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Advance Premium INCLUDED, SEE INFORMATION PAGE. This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on PolicyNo. TSF-0012881200 20151231 ofthetexasmutuallnsurance Company at 12:01 A.M. standard time, forms a part of Issued to Premium$ ARROW SERVICES I NC Endorsement No. NCCI Carrier Code 29939 Authorized Representative WC420304B (ED. 6--01-2014) AGENT'S COPY GUS ER 12-16-2015