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1 The University of Texas at Austin 2014/2015 Vehicle Insurance Packet VEHICLE INSURANCE PACKET CONTENTS: 1. Auto Accident Reporting Procedures 2. ACORD Automobile Loss Notice - To Report Auto Accidents use electronic form at 3. ACORD Certificate of Liability Insurance 4. Memorandum 5. Excerpt from Chapter 601. Motor Vehicle Safety Responsibility Act PLEASE KEEP THIS PACKET IN ALL UNIVERSITY OF TEXAS VEHICLES Risk Management/Office of Accounting (512)

2 UT AUSTIN AUTO ACCIDENT REPORTING PROCEDURE Know What to Say and Not Say o Do not admit fault. o Do not discuss specifics with anyone other than the police, UT Risk Management, or UT s insurance carrier. o Do not accept any monetary compensation from the other driver. Procedure to Report accident involving UT-owned vehicles: 1. Immediately following the accident, contact police to come to the scene: If off campus, contact local police at 911 and file and obtain a copy of the report. If on campus, contact UTPD at (512) and file and obtain a copy of the report. 2. At the scene: Gather information needed to complete the ACORD Automobile Loss notice. Loss: Date Time Location Description of Accident Property Damage: Other driver name Driver phone / contact information Insurance information (company, agent name, phone number, policy number) Car or damaged property information (year, make, model, license plate number). Injured: Name Phone number Description of injury Witness/Passengers: Name Phone / contact information 3. Within 24 hours, inform your supervisor and/or UTDRIVERS delegate. You or your department contact [whomever is responsible for reporting automobile accidents for your department] must go online to and follow instructions in section III to complete electronic ACORD form. 4. the completed ACORD along with the police report, photos, repair estimates and any other available documentation to the Office of Accounting, Risk Management at 5. Risk Management will forward the information to UT s insurance company for processing. 6. A claims adjuster from UT s insurance carrier will contact the parties involved and attempt to settle the claim. Questions? Call (512) or see Physical Damage Auto Policy Claims - Vehicles covered under UT Austin Physical Damage Policy: 1. Office of Accounting, Risk Management at for appropriate ACORD form to report the potential claim. 2. UT s insurance company will dispatch a claims adjuster to assess the damage to the insured vehicle. 3. The claims adjuster will provide the insurance company with a written repair estimate. a. The insurance company will mail the department a check for the amount of the estimate. b. The UT driver or department contact should call the University of Texas at Austin Automotive Shop at (512) or (512) to assist in coordinating necessary repair work. c. If the repair cost exceeds the amount of the estimate, the body shop completing the repairs will send the insurance company a supplemental bill for the difference.

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4 CLAIMS-MADE GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY JECT LOC AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB CERTIFICATE OF LIABILITY INSURANCE OCCUR OCCUR CLAIMS-MADE MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG EACH OCCURRENCE AGGREGATE 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 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 Tara Bolmey PRODUCER Arthur J. Gallagher Risk Management Services, Inc. PO Box 1749 Spring, TX Kevin Gregory INSURED The Board of Regents of the University of Texas System 210 West 6th Street Room B.140E Austin, TX COVERAGES CERTIFICATE NUMBER: 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 ADDL SUBR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) A X X ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON-OWNED AUTOS DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below PK NAME: PHONE (A/C, No, Ext): ADDRESS: INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : /08/14 INSURER(S) AFFORDING COVERAGE 09/08/15 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) WC STATU- TORY LIMITS E.L. EACH ACCIDENT FAX (A/C, No): Lloyds Synd 2987 (Brit Synd Ltd)AA OTH- ER E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT 09/05/ ,000 NAIC # DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) As per fleet schedule on file with the insurance company. *Named Insured Schedule attached. Named Insured Claims Contact: John Santos; PH CERTIFICATE HOLDER Evidence of Insurance 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 (2010/05) tbolmey ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD

5 SUPPLEMENT TO CERTIFICATE OF INSURANCE DATE 09/05/2014 NAME OF INSURED: The Board of Regents of the University of Texas System Additional Description of Operations/Remarks from Page 1: Named Insured Schedule: The University of Texas System Board of Regents The University of Texas System The University of Texas at Arlington The University of Texas at Austin The University of Texas at Brownsville The University of Texas at Dallas The University of Texas at El Paso The University of Texas - Pan American The University of Texas of the Permian Basin The University of Texas at San Antonio The University of Texas at Tyler The University of Texas Southwestern Medical Center The University of Texas Medical Branch at Galveston The University of Texas Health Science Center at Houston The University of Texas Health Science Center at San Antonio The University of Texas M.D. Anderson Cancer Center The University of Texas Health Science Center at Tyler Additional Information: SUPP (05/04)

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