2016-307-E Solid Waste - OE Enterprises for custodial services

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DocuSign Envelope ID:A6FF0664-EFC3-4659-1365B-D0FD3D066032 AC J CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)6/17/2016 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 in lieu of such endorsement(s). PRODUCER ACT Tammy_ Brown NAE: Jennings Bryan-Chappell Insurance Services (A/CNNo,Ext): (336)227-7458 FAX No): (336)343-1000 PO Box 1118 E-MAIL DRE ' SS: y �tamm b@ bcins.com AD INSURER(S)AFFORDING COVERAGE NAIC# Burlington NC 27216 INSURERA:Philadelphia Indeminity Ins. Co. 18058 INSURED INSURER B:United Heartland OE Enterprises, Inc. INSURER C: 348 Elizabeth Brady Road INSURERD: INSURER E: Hillsborough NC 27278 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1562601418 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000 PHPK1358362 6/30/2015 6/30/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED AUTOS AUTOS PHPK1358362 6/30/2015 6/30/2016 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) $ Medical payments $ 5,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 DED X RETENTION$ 10,000 PHUB505354 6/30/2015 6/30/2016 $ WORKERS COMPENSATION X PER 0TH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A B (Mandatory in NH) 2000011130 7/1/2015 7/1/2016 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Professional Liability PHPK1358362 6/30/2015 6/30/2016 1,000,000 2,000,000 A Sexual Abuse/Molestation PHSD1055405 6/30/2015 6/30/2016 1,000,000 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is listed as additional insured per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Solid Waste THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 17177 ACCORDANCE WITH THE POLICY PROVISIONS. 1207 Eubanks Road Chapel Hill, NC 27516 AUTHORIZED REPRESENTATIVE Tammy Brown/TB ( ` Q, v 4 " 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 nmam i