Orange County NC Website
DocuSign Envelope ID:813A5323-29B6-4DDD-A2B8-22B7F4A4A68C <br /> CLEAHAR-01 GAIKWADSM <br /> ACOREY DATE(MWDD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 10/27/2016 <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 certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT Willis Towers Watson Certificate Center <br /> Willis of Massachusetts,Inc. PHONE 877 FAX (888)467-2378 <br /> c/o 26 Century Blvd (A/C,No,Ext):(877)945-7378 (A/c,No): ) <br /> P.O.Box 305191 E-MAIL certificates @willis.com <br /> Nashville,TN 37230-5191 ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:ACE American Insurance Company 22667 <br /> INSURED INSURER B:American Guarantee and Liability Insurance Company 26247 <br /> Clean Harbors Environmental Services,Inc. INSURER C:Indemnity Insurance Company of North America 43575 <br /> and its affiliates <br /> 42 Longwater Drive INSURER D: <br /> Norwell,MA 02061 INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 <br /> CLAIMS-MADE X OCCUR HDOG27858478 11/01/2016 11/01/2017 DAMAGE TO RENTED 500,000 <br /> PREMISES(Ea occurrence) $ � <br /> X XCU MED EXP(Any one person) $ 5,000 <br /> X Contractual PERSONAL&ADV INJURY $ 2,000,000 <br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 <br /> POLICY X JEROOT- LOC PRODUCTS-COMP/OP AGG $ 4,000,000 <br /> OTHER: • $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 5,000,000 <br /> (Ea accident) <br /> A X ANY AUTO ISAH09051107 11/01/2016 11/01/2017 BODILY INJURY(Per person) $ <br /> X AUTOS OWNED MI SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS <br /> X HIRED AUTOS © AUTOSWNED Per a cidentDAMAGE <br /> X MCS-90 $ <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 "b <br /> B EXCESS LIAB CLAIMS-MADE AUC 4275262-12 11/01/2016 11/01/2017 AGGREGATE $ 10,000,000 <br /> DED X RETENTION$ 0 $ <br /> WORKERS COMPENSATION X <br /> AND EMPLOYERS'LIABILITY STATUTE OTH- <br /> ER <br /> Y <br /> C ANY PROPRIETOR/PARTNER/EXECUTIVE N N <br /> N/A WLRC49103554(AOS) 11/01/2016 11/01/2017 E.L.EACH ACCIDENT $ 2,000,000 <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000 <br /> A Work Comp&Emp Liab WLRC49103530(AZ,CA,MA) 11/01/2016 11/01/2017 See Attached <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Scope of Work:Permanent Household Hazardous Waste Collection Program. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> is <br /> Orange County Solid Waste AUTHORIZED REPRESENTATIVE <br /> Attn: Kristina Witosky <br /> 1207 Eubanks Road,PO Box 17177 <br /> 'Chapel Hill,NC 27516 O �` <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />