-------------------------------------------------------~

ACORD"' CERTIFICATE OF LIABILITY INSURANCEDATE (:'oL\f/Dl).'YYYY I

5/9/2015

NAICIII

(B8B) 443-6112"•.,(A.'C. flo)

INSURER(SlAFfOROltJO COVERAGE

(866) 467-B730

INSURER!.; Sentir.el Ins Co LTD

corITACT'lAME"PHOtlE(A.'C. No, ut)"

E.~IAILADDRESS.443-6112

INC/PHS

F: (888)

TIllS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTnuTE A CONTRACT BETWEEN TIlE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGA TlON1S WAIVED, subject to theterms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).

'~OOUCER

HIGGINBOTHAN INS AGENCY

504221 P: (866) 467-8730

PO BOX 33015

SAN ANTONIO TX 78265INSURED INSURER B:

INSURER c:

GREG I1ILLIANS DBA WILLIANS ELECTRIC INC INSUf{ER 0:

156 PINE CONE LN INGUHER E:

LUFKIN TX 75901 IrlSURER F:

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUHED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDfTlON OF ANY CONTRACT OR OTHER DOCUMENT WrrH RESPECT TO WHICH THISCERTIFICATE MAY DE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TIlETERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

l~".f: n'PE 01'- t'S['R..I,'iCE ,~~J)JI~:~';; I'oue}" ,'\'VMHER roLlCJ" J::1"F POLlCJ' £Xl' l.l.\flTS,. tl.-;£'1)Jl1}T111 "COMMERCIAL GENERAL LIABIUTY EACHOCCURRENCE ,1,000,000

I CLAIMS-MADE00CCUR ~~:~~J~~~~?ence) 1,000,000

A X General Liab X 46 SBM B833CO 12/29/2014 12/29/2015 MEn EXP (Any 01'18 parson) ,10,000e-

,1, 000, 000PERSONAl & ADV INJURYI-

,2, 000, 000~rAGGREGATE LIMIT APPLIES PERGENERAL AGGREGATE =

POLlCY0 PHO-0 LOC PRODUCTS. COMPIOP AGG ,2, 000, 000 ;::::::JECT

OTHER: , .:=.AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT ,1, 000, 000 ~I- (Ea accident)

ANY AUTO BODilY INJURY (Por person) , -I-ALL OWNED - SCHEDULED =A AUTOS AUTOS 46 SUM EN3300 12/29/2014 12/29/2015 BODILY INJURY (pm accident) $fx HJREDAUTO X NON.QWNED PROPERTYDAMAGE ;;::;AUTOS (Per 3ccldenl) ,

I- - , =X UMBREUAUAB

1~CUREACHOCCURRENCE -5, 000, 000 =

AI-

12/29/2014 12/29/2'J15 ,5, 000, 000 1'==1EXCESS LIAB CLAIMS-MADE 46 SSM B~3300 AGGRC-GATE

DJ X IRETEtmON sl 0 , a 0 a ,WOlal'.Jts ("t).VP£"StTlO." I~TUTE I I~K.","D 1'..\ll'wru!f,. LUBlUlT .ANYPROP~ETO~ARTNE~CUnVEY/N E.L EACH ACCIDENTOFFICERlWEMBER EXCLUDED? 0 ",A - E.L DISEASE-EAEMPLOYEE $(Mandato". in NH)

-E.L DISEASE_POUCY LIMIT SIf yes, describe undet'"

DESCRIPTION OF OPERAnONS below

DESCRIPTION OF OPERATKJNS I LOCATIONS I VEHIqllCDRD 101. AddiUonal Rema,b Schedule, may bll attached if more t;pace is requited)

Those usual to the Insured's Operations. Stephen F. Austin State University

officials, directors, employees, representative and volunteers. Waiver ofits BroadSubrogation applies in favor of the Certificate holder per the Extended

Form Endorsement WC420304 attached to this policy.:Jt'

CANCELLATION11

CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBEDPOLICIES BE CANCELLEDBEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BEDELIVERED IN ACCORDANCEWITH THE POLICY PROVISIONS.

Austin State UniveL'sity AUTHORIZED REPRESE!NTAJ1VE .Stephen F.1936 NORTH ST 7#.rc 7t<-JL~NACOGDOCHES, TX 75965 @1988.2014ACORD CORPORATION. All ri9hts reserved

ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD

I./III/~'

EACH OCCURRENCE

DAMAGE TO RENTEDPREMISES (Ea OCCurrence)

MED EXP (Anyone person)

PERSONAL 8. ADV INJURY :;

GENERAL AGGREGA TE ~

PRODUCTS - COMP/OP AGG ~

BODilY INJURY (Per accfdenl) :;

PROPERTY DAMAGE(Por accident)

COMBINED SINGLE LIMIT(Ea accidem)

BODILY !NJURY (Per person) ~

REVISIONNUMBER.

(,OU(')' ,"o( ',WUH,wmSU1Rl.l.ThJ I

COMMERCIAL GENERAL LIABILITY

J CLAIMS-MADE DOCCUR

ANY AUTO

ALL OWNED - SCHEDULEDAUTOS _ AUTOS

NON-DWNEDHIRED AUTOS AUTOS

-

--

~

GEN;'LAGGR. EGATE LIMn APPLIES PER:

POLICY 0 PRO- 0 LOCJECT

OTHER

AUTOMOBILE UABIUTY-'--r-r-

COVERAGES CERTIFICATENUMBER'

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFtCATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THETERMS.EXClUSIONS AND CONDITIONS OF SUCH POLICIES. liMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS

1'(}I.IlT 1:."1'1" 1'(}I,1lT tXP_f!.IMmlJ/lTn) _ (,'U.&::llUall1L

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~

CERTIFICATE OF LIABILITY INSURANCE D:\n: (MM:llD/YYYYIACORD"

5/9/2015. -THISCERTIFICATEIS ISSUEDASA MATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIESBELOW. THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEA CONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZEDREPRESENTATIVEOR PRODUCER,ANDTHE CERTIFICATEHOLDER.

IMPORTANT:If the certificate holder is an ADDITIONALINSURED,the policy(ies) musl be endorsed. If SUBROGATIONISWAIVED,subjecllo thelerms and conditions of the policy, certain policies may require an endorsemenl. A slalemenl on this certificale does nol confer rights 10 thecertificate holder in lieu of such endorsement(s).

PRODUCER

CONTACTNAME"NORTHEAST AGENCIES INC/PHS PHONE

( 866) 467-8730 ItAX (888) 443-6112(AIC, No, E<I)

(NC,Noj214608 P: (866) 467-8730 F: (888) 443-6112 E.MAILADDRESS301 WOODS PARK DRIVE

INSURER(SJ AFFORDING COVERAGEtlAIe>rCLINTON NY 13323

ItlSURER A. I~a~tford TnM Co of Lhe MiJ"e:>t.INSUR£IJ

INSURER B:

ItlSURER c.GREG WILLIAMS DBA WILLIAMS ELECTRIC INC INSURER 0156 PINE CONE LN

ItlSURER ELUFKIN TX 75901

INSURER F

UMBRELlA LIAS

EXCESS LIAS

OCCUR

- CLAIMS-MADE

EACH OCCURRENCE ~

AGGREGATE

D~ -.fuETENTlOtlSU'OHI:.IJf.\' (¥}Mn:"oS i JWI"o'~,'J) I'.M/'I_OYl"II~' LHllltm

ANY PROPRIETOR/PARTNER/EXECUTIVEYJNOFFICER/MEMBER EXCLUDED? 0

A (Mandatory in NH)

If yes, describe underDESCRIPnON OF OPERA nONS ~

WA r--r- lJS/21/281S O~/21/201r,

'" I 10TH

•X JSTATUTE _lER

ELEACHACCIDENT Sl, 000, 000EL DISEASE- EA EMPLOYEE ~1 , a a 0, 000EL DISEASE - POLlCY LIMIT S1 , 00 0 , 00 0

IONS I VEHIQlft3lRO 101 Additional Remarks Schedule, may bo aUached if more space is requirod)DESCRIPnONOFOPERATIONS/LOC" '. A tin State University

I d's Operatlons. Stephen F. us 'f'Those usual to the nsure t t' e and volunteers. Walver 0_

. . loyees represen a lV i:lits officials, dlrectors, emp , . f' t holder per the Extended Broa 'Subro at ion applies in favor of the Cert~ lca ~

9 . t ~C420304 attached to thls pollcy.Form Endorsemen •

Austin State University

CERTIFICATEHOLDER

Stephen F.1936 NORTH STNACOGDOCHES, TX

ACORD 25 (2014101)

75965

CANCELLATIONSHOULDANYOFTHEABOVEDESCRIBEDPOLiCIESBECANCELLED[JEFORETHEEXPIRATIONDATETH~~~O:6~g~'~~~~g~sDELiVEREDINACCORDANCEWITHAUTHORIZED REPRESENT A11VE

7~982~~~ORATION. All rig hIs reserved.The ACORD name and logo are registered marks of ACORD

AGENCY CUSTOMER 10: _

LOC#:--------

AGENCYADDITIONAL REMARKS SCHEDULE

NAMED INSURED

Page of

HIGGINBOTHAM INS AGENCY INC/PHSPOLICY NUMBER

SEE ACORD 25CARRIER

SEE ACORD 25I NAIC CODE

GREG WILLIAMS DBA WILLIAMS ELECTRIC INC156 PINE CONE LNLUFKIN TX 75901EFFECTIVE DATe SEE ACORD 25

ADDITIONAL REMARKSTHIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM

FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE

Waiver of Subrogation applies in favor of the Certificate holder per the BusinessLiability Coverage Form SS0008 attached to this policy. Certificate Holder is anAdditional Insured per the Business Liability Coverage Form SS0008 attached to thispolicy. Blanket Waiver of Subrogation applies per Waiver of our Right to Recover fromOthers Endorsement WC 42 03 04 attached to this policy.

ACORD 101 (2014/01)@2014 ACORD CORPORATION. All rights reserve,

The ACORD name and logo are registered marks of ACORD