ACORD®
I
CERTIFICATE OF LIABILITY INSURANCE
~-
DATE (MMIDD/YYYY)
11 /09/201 5
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND C ONFERS NO RIGHTS UPON T HE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEN D O R ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the polic y (ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the pol icy , certain policies may require an endorsement. A statement on this certif icate does not confer rights to the
certificate holder in lieu of such endorsement(s).
CONTACT
NAME:
PHON E
PRODUCER
Marsh USA, Inc.
Attn : Elvira Bond - dallas.certs@marsh.ccm
4400 Comerica Bank Tower
1717 Main Street
Dallas, TX 75201 -7357
016016-LES-STD-15-16
USLTX
ID. Ir. .. n
I IAJC
FAX
Nol:
l=Ytl·
E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
No
INSURER A :
INSURED
Liquid Environmental Solutions
ofTexas, LLC
7651 Esters Boulevard, Suite 200
Irving, TX 75063
NAI C#
22322
Greenwich Insurance Company
INSURER B :
XL Specialty Insurance Company
37885
INSURER c :
Starr Indemnity & Liability Company
38318
INSURER D :
INSURER E :
INSURER F :
HOU-002458737-05
REVISION NUMBER:1 1
THI S IS TO CERTIFY THAT TH E POLICIES OF INSURANC E LI STED BELOW HAVE BEEN ISSUED TO TH E INSURED NAMED ABOVE FOR THE POLI CY PERI OD
INDICATED. NOTWITHSTANDING ANY REQUIR EMENT, TERM OR CONDITION OF ANY CON TRACT OR OTH ER DOCUMENT WITH RESPECT TO WIHI CH THIS
CERTIFI CATE MAY BE ISSUED OR MAY PERTAIN , THE IN SURANCE AFFORDED BY THE POLICIES DESCRIB ED HEREI N IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLI CIES. LI MITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM S.
COVERAGES
INSR
LTR
A
CERTIFICATE NUMBER:
ADDL SUBR
TYPE OF INSURANCE
x
~
0
CLAIMS-MADE
l " n "'
POLICY NUMBER
GEC3000995
COMMERCIAL GENERAL LIABILITY
D
1--
1 ...., . ,
POLICY EFF
fMMI DDNYYYl
POLICY EXP
fMMIDDNYYYl
11/06/2015
11 /06/2016
LIMITS
OCCUR
~
.___
Fl
GEN'L AGGREGATE LIMIT APPLIES PER:
B
POLICY
0
r;~8-r
0
Loe
I---
ANY AUTO
ALL OVVNED
AUTO S
HIRED AUTOS
UMBRELLA LIAB
~
EXCESS LIAB
c
1,000,000
300,000
MED EXP (Any one person)
$
25,000
PE RSONAL & ADV INJURY
$
1,000,000
GENERAL AGGREGATE
$
2,000,000
PRODUCTS - COMP/OP AG G
$
2,000,000
$
AEC0046891
AUTOMOBILE LIABI LITY
~
$
$
OTHER:
11/06/201 5
11/06/201 6
~
x
.___
EACH OCCURRENCE
DAMAGE TO RENTED
PREMI SES (Ea occurrence I
COMBINED SINGLE LIM IT
!Ea accidentl
$
BOD ILY INJURY (Per person)
$
1,000,000
~
~
.___
SCHEDULED
AUTOS
NON-OVVNED
AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
H
OCC UR
EAC H OCCURRENCE
$
CLAIMS -MADE
AGGRE GATE
$
I I
DED
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABI LI TY
ANY PROPRIETORIPARTNERIEXECUTIVE
OFF ICER/MEMBER EXCLUDED?
(Mandatory in NH )
If yes, describe under
DESCRIPTION OF OPERATIONS below
100 0001 284-02
11/06/201 5
x I ~f~TUTE I I OTHER
11/06/2016
YI N
~ NIA
$
$
1,000,000
E.L. DISEASE - EA EMPLOYEE $
1,000,000
E.L. DISEASE - POLICY LIM IT
1,000,000
E.L. EACH ACCIDENT
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attache d if more spa ce ls required)
CERTIFICATE HOLDER
Stephen F. Austin State University,
its offi cials, directors, employees,
representatives and volunteers.
1936 North St.
Nacogdoches, TX 75962
I
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CANCEL LATION
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
of Marsh USA Inc.
Manashi Mukherjee
...J'wlo."'-"'Oi...A. ~
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25 (2014/01 )
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