2015-187-E Solid Waste - Central Carolina Tire - Contract Amendment to 1-21-2010 Agreement for tire recycling

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DocuSign Envelope ID:48321305-FO88-48E2-AA76-9A9CD2256599 73/20/2015(MM/DD/YYYY) AC40R"� CERTIFICATE OF LIABILITY INSURANCE 8/1/2015 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). CONTACT PRODUCER LOckton Companies NAME: 3280 Peachtree Road NE,Suite#250 PHONE FAX Atlanta GA 30305 (A/C,AIL ext: A/c No (404)460-3600 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 4 INSURER A:Navi ators Insurance Company 42307 INSURED Liberty Tire Recycling Holdco,LLC INSURER B:Libert Mutual Fire Insurance Coml2anj 23035 1383905 1251 Waterfront Place 4th Floor INSURER C:Starr Indemnity&Liability Company 38318 Pittsburgh PA 15222-4261 INSURER D:LM Insurance Corporation 33600 INSURER E:Great American Insurance Company 16691 INSURER F COVERAGES 1188499 CERTIFICATE NUMBER: 13407643 REVISION NUMBER: XXXXXXX 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY N N GAI4CGL118263iC 11/1/2014 11/1/2015 EACH OCCURRENCE DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 50,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000,000 X POLICY ❑ PRO JECT 1:1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY N N AS2-651-291424-034 8/1/2014 8/1/2015 UUMBIident) $ 2,000,000 X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX ALL OWNED SCHEDULED BODILY INJURY Per accident $ XXXXXXX AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ XXXXXXX AUTOS AUTOS P X Comp:5000 X Coll:5000 $ XXXXXXX C X UMBRELLA LIAB OCCUR N N 1000010754 11/1/2014 11/1/2015 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I I RETENTION$ $ XXXXXXX WORKERS COMPENSATION N D WAS-65D-291424-024(A OS)EMPLOYERS'LIABILITY ( OS) 8/1/2014 8/1/2015 X STATUTE ER D ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC5-651-291424-014(WI) 8/1/2014 8/1/2015 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N❑ N/A 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 11000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 E Excess Liability N N TUE062953901 11/1/2014 1 I/l/2015 Liinit:$5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION See Attachment 13407643 Orange County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO BOX 17177 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Chapel Hill NC 27516 ACCORDANCE WITH THE POLICY PROVISIONS. E AUTHORIZED REPRESENTV ©1'986-2014 ACORD CORPO ATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD