DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
9/22/2015
10/ 1/2016
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 i n lieu of such endorsement(s).
PRODUCER
LOCKTON COMPANIES
2100 ROSS AVENUE, SUITE 1400
DALLAS TX 75201
214-969-6700
INSURED
UNITED RENTALS (NORTH AMERICA), INC.
1352196 3120 SPUR 482
25038
43575
20702
42757
SUITE B
IRVING TX 75062
A ri General Insurance Com an
CERTIFICATE NUMBER·
COVERAGES *
11758893
REVISION NUMBER·
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSU ED 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 REDU CED BY PAID CLAIMS.
POLICY EFF
POLICY EXP
INSR
TYPE OF INSURANCE
POLICY NUMBER
LIMITS
~9Pk I~
LTR
llMM/DD/YYYYl IIMM/DDIYYYYl
COMMERCIAL
GENERAL
LIABILITY
y
XSL G27400978
$ 3 000 000
I 0/ 1/2015
10/1/20 16 EACH OCCURRENCE
A
x
N
ICLAIMS-MADE [X] OCCUR
,.x_ $2 QQQ QQQ SIR
Fl
GEN'L AGGREGATE LIMIT APPLIES PER:
A
POLICYD
~~T
D LOC
AUTOMOBILE LIABILITY
N
>-----
ANY AUTO
ALL8WNED
>----- AUT S
HIRED AUTOS
~
B
x
UMBRELLA LIAB
N
I 01112015
ISA H08865097
10/1/2016
SCHEDULED
AUTOS
NON-OWNED
AUTOS
-
A
c
~
PERSONAL & ADV INJURY
$
GENERALAGGREGATE
$
$
COMBINED SINGLE LIMIT
$
IEa accident\
BODILY INJURY (Per person) $
2 000 000
3 000 000
6 000 000
6 000 000
5 000 000
BODILY INJURY (Per accident $
fp~?~~~de':.t~AMAGE
$
$
~OCCUR
EXCESS LIAB
N
N
10/ 1/20 15
G27905997 001
10/ 1/20 16
CLAIMS-MADE
I I
D
A
E
F
$
PRODUCTS - COMP/OP AGG $
OTHER
x
>-----
~~~ff;H9E~~Jlence\
MED EXP IAnv one oersonl
RETENTION $
OED
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPR IETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
{Mandatory In NH)
y
Y/N
IBJ
N/A
WLR C485934 l 0 ~OS~
WLR C48593434 AZ,
)
SCF C48593458 ( )
WLR C48593422 (TN)
I 01112015
I 01112015
I 01112015
I 01112015
10/ 1/20 16
10/ 1/2016
10/1/20 16
10/1/20 16
WCU C4859346A (CA, WA)
EEG0000367-0l
I 01112015
I 01112015
10/ 1/20 16
101112016
g~~~~~ir~ Q1~'gPERATIONS below
Excess Workers Compensation
Tx Non-Subscriber
N
N
EACH OCCURRENCE
$
AGGREGATE
$
x I STATUTE
PER
I
25 000,000
25 000,000
$
1 0:~-
E.L. EACH ACCIDENT
$
E.L. DISEASE · EA EMPLOYEE
$
E.L. DISEASE · POLICY LIMIT
~
2 000 000
2 000 000
2 000 000
S2M Each ACC/EMP/AGG
S5MM CSUfOT/IND/OCC
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
ADDITIONAL INFORMATION ATTACHED. CERTIFICATE HOLDER INCLUDES : STEPHEN F. AUSTIN STATE UNIVERSITY, ITS OFFICIALS,
DrRECTORS, EMPLOYEES, REPRESENTATIVES AND VOLUNTEERS.
CANCELLATION
CERTIFICATE HOLDER
See Attachment
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
11758893
STEPHEN F. AUSTIN STATE UNIVERSITY
PROCUREMENT & PROPERTY SERVICES
PO BOX 13030
NACOGDOCHES TX 75962-3030
ACORD 25 (2014/01)
©1 988-2014 ACORD CORPORATION . All rights reserved
The ACORD name and logo are registered marks of ACORD
UNITED RENTALS, INC. AND ALL SUBSIDIARIES CERTIFICATE CONTINUATION
DESCRIPTION OF OPERATIONS/LOCA TIONSNEHICLES/EXCLUSIONS ADDED BY
ENDORSEMENT/SPECIAL PROVISIONS CONT.
RE: ALL OPERATIONS PERFORMED FOR THE CERTIFICATE HOLDER.
BLANKET ADDITIONAL INSURED - ANY PARTY, WHERE REQUIRED BY WRITTEN CONTRACT.
APPLIES TO GENERAL LIABILITY FORM XS-21164a (04/13) AND AUTO LIABILITY FORM
DA-9U74a (04/ 11).
BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US -ANY
PERSON OR ORGANIZATION, WHERE REQUIRED BY WRITTEN CONTRACT. APPLIES TO
GENERAL LIABILITY, AUTO LIABILITY AND WORKERS' COMPENSATION POLICIES. PER STATE
LAWS, WAIVER OF SUBROGATION DOES NOT APPLY IN NEW JERSEY, NEW HAMPSHIRE AND
KENTUCKY FOR WORKERS COMPENSATION.
COVERAGE IS PRIMARY AND NON-CONTRIBUTORY PER TERMS OF ENDORSEMENT XS-20288.
GENERAL LIABILITY POLICY INCLUDES:
ADDITIONAL INSURED WHERE REQUIRED BY WRITTEN CONTRACT FORM XS-21164 (04/ 13);
ADDITIONAL INSURED - OWNERS, LESSEES , OR CONTRACTORS - COMPLETED OPERATIONS .
CONTRACTUAL LIABILITY
"XCU" HAZARDS
BROAD FORM PROPERTY DAMAGE COVERAGE
INDEPENDENT CONTRACTORS COVERAGE
WORKERS' COMPENSATION SELF INSURED/ST ATE FUND POLICIES:
STATE OF CALIFORNIA- SELF INSURED CA-SI 2142-C
STATE OF WASHINGTON - SELF INSURED CERTIFICATE# 601 , 908, 516
STATE OF NORTH DAKOTA - STATE FUND EMPLOYER ACCT # 821330
STATE OF OHIO - STATE FUND POLICY # 1303683
STA TE OF WEST VIRGINIA - STA TE FUND POLICY # 20302489-101
STATE OF WYOMING- STATE FUND POLICY # 00134808
Standard Attachment : NIRE12att
Master ID: 1352196, Certificate ID : 11758893