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DocuSign Envelope ID:813A5323-29B6-4DDD-A2B8-22B7F4A4A68C <br /> County of Orange, NC RFP#5183 <br /> INSURANCE CERTIFICATES <br /> ` ° CERTIFICATE OF LIABILITY INSURANCEkage i of 2 10/i7 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the eeltifleate holder fs an ADDITIONAL INSURED,the policy(ies}must be endorsed. If SUBROGATION IS WAIVED,subject <br /> to the terms and conditions of the policy.certain policies may require an endorsement.A statement on this certificate does not confer rights <br /> to the certificate holder In lieu of such endorsomont(s). <br /> P5000055 CONLA& <br /> Billie et Haeseshueette. Ins. NAME <br /> a/o 26 Century Blvd. 1e_xialexml-xnTS77-945-7378 J ra fan) 988-457-2378 <br /> S. o. Box 305191 enn.erCg certificateaSwlllis,nom <br /> Nashville, 130 37730-5191 INa1RER(SIAFFOREENG COVERAGE NA10I <br /> RtSURERk Burtch American Insurance Company 16535-002 <br /> INURED - INSURERS American Guarantee and Liability Insurana 26247-003 <br /> clean Harbors Enna recimentel. Services, Ina. <br /> and its affiliates INSU4ERc_S teadfast Insurance Company 26307-001 <br /> 42 Lnngwater Drive <br /> NorwelL, HA 02061 INSURER b; <br /> INSURER E <br /> fNEMER E <br /> COVERAGES REVISION NUMBER: <br /> THIS 18 TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELO W HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED,NOTWITHSTANDING A NY REQUIREMENT,TERM OR CONDITIONOF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAYBE ISSUED CR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DES011500 HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOriTt MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> jN TTYPE OF INSURANCE ZI Mn <br /> POLICY NURSER rNotYTVY) DOCEIn ErrtY) LUIS <br /> A GENERAL LIABILITY Y GLO 9651229-05 11/1/2011 11/1/2012 EEEpACHpo�OCURpRE14cE 0 2,000,000 <br /> X COMMERCIAL GENERAL LIABILITY FRE fLI5E3 rEeEorMi,,ierke) 0 100,000 <br /> CLAiM6•1,7RDE1111 ODOUR MED E7P(Auy one pamop) $ 5,000 <br /> X XCu .,_.�„_... PERSONAL&AOv30JURY 0 <br /> X contractual 00E31CRPLAG0REOATE 3 <br /> °G.&AGGREGATE LIMITABRls PER PRODUCTS•COMP/OPAOO 0 2,000,000 <br /> { —I POLICY 1 3 I,IErr 7 Loc 5 <br /> A AUTOMOSILELIABILITY Y PAP 6601231-05 11/1/2011 11/1/2012 OO ¢BLVGLELILUT $ 5,000,000 <br /> X ANY AUTO BODILY IKUlRY(Perpenal $ <br /> ALL OA?EEb 'Sciiseetn0 — <br /> _ ULRI <br /> AUTOS ALTas BODILY RY(Per eccldorJ) $ <br /> X HREDAU u <br /> r05 X � eraaA YOAMAOE $ <br /> X Kra-SO ) 0 <br /> B % UMBRELLA LIAR OCCUR AQC.9275252-07 11/1/2011 11/1/2012 EACHOCCURPENCE S 10.000.000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE 5 10,000,000 <br /> DEC I IRETENnON$ $ <br /> A WORKERS COMPENSATION t€C 9661232-05 11/1/2011 1.1/1/2012 X IT enfirirCrFI �OFR <br /> Ann EMPLOYERS'LIABILITY <br /> AFNPROFSISTOEIRARnr0203ECUTlVE €Nm EL EACH ACCIDENT $ 2.000,000_ <br /> OaFFICEWMEM08/I MCTUDEEV? f•,r <br /> flafyyandSHO NN) EL DLSEASE.EA EMPLOYEE 5 2,000,000 <br /> DEesGRIPTIONOF OPFRATIONSWon EL OFSEASE•POLICY LIMN 5 2,000,000 <br /> C PSC 3656681-16 CPL 11/1/2011 11/1/2012 <br /> Con trec tore Pollution 910,000,000 Bach Claim <br /> Liability $10,000,000 All Claims <br /> DESCRIPTION OR OPERATION 51 LOCATIONS/VEHICLES(Attach Aced 101,Additonal Rerrurks SEMEN,N mom spice Is wished) <br /> See Attached: <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE NALL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> -- For Reference Only -- AIRHOR)GE`ORE�PPEESENMTNE <br /> C! <br /> 01988-2010 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD <br /> Company Confidential 37 www.cleanharbors.com <br />