2017-221-E SW - Clean Harbors for household hazardous waste collection and disposal

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DocuSign Envelope ID:813A5323-29B6-4DDD-A2B8-22B7F4A4A68C CLEAHAR-01 GAIKWADSM ACOREY DATE(MWDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/27/2016 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 CONTACT Willis Towers Watson Certificate Center Willis of Massachusetts,Inc. PHONE 877 FAX (888)467-2378 c/o 26 Century Blvd (A/C,No,Ext):(877)945-7378 (A/c,No): ) P.O.Box 305191 E-MAIL certificates @willis.com Nashville,TN 37230-5191 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:ACE American Insurance Company 22667 INSURED INSURER B:American Guarantee and Liability Insurance Company 26247 Clean Harbors Environmental Services,Inc. INSURER C:Indemnity Insurance Company of North America 43575 and its affiliates 42 Longwater Drive INSURER D: Norwell,MA 02061 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR HDOG27858478 11/01/2016 11/01/2017 DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ � X XCU MED EXP(Any one person) $ 5,000 X Contractual PERSONAL&ADV INJURY $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY X JEROOT- LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: • $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 5,000,000 (Ea accident) A X ANY AUTO ISAH09051107 11/01/2016 11/01/2017 BODILY INJURY(Per person) $ X AUTOS OWNED MI SCHEDULED BODILY INJURY(Per accident) $ AUTOS X HIRED AUTOS © AUTOSWNED Per a cidentDAMAGE X MCS-90 $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 "b B EXCESS LIAB CLAIMS-MADE AUC 4275262-12 11/01/2016 11/01/2017 AGGREGATE $ 10,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE OTH- ER Y C ANY PROPRIETOR/PARTNER/EXECUTIVE N N N/A WLRC49103554(AOS) 11/01/2016 11/01/2017 E.L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000 A Work Comp&Emp Liab WLRC49103530(AZ,CA,MA) 11/01/2016 11/01/2017 See Attached DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Scope of Work:Permanent Household Hazardous Waste Collection Program. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. is Orange County Solid Waste AUTHORIZED REPRESENTATIVE Attn: Kristina Witosky 1207 Eubanks Road,PO Box 17177 'Chapel Hill,NC 27516 O �` ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD