2017-233-E Planning - Transstate LLC to clean, video Phase 4 of Efland Sewer System

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DocuSign Envelope ID: 18C4E672-1DB7-4020-9D85-083D0D588F92 TRANS-4 OP ID: ASU1 ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE[MMlDDrIYYY] 0610812017 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 NAME:CT Rebekah Rosko Aquesta Insurance-Cornelius PHONE 704 FAX -892-6411 PO Box 189 (A/C,No,Ext): (A1C,No): 704-892-3266 Cornelius, NC 28031 ADDRESS: Nico lannelli INSURER(S)AFFORDING COVERAGE NAIC p INSURER A:Auto-Owners Insurance Co 18988 INSURED Transstate LLC INSURER B:Carolina Casualty Ins Co PO Box 545 Denver, NC 28037 INSURER C: INSURER D: 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 INSD WVp POLICY NUMBER POLICY EFF POLICY EXP LIMITS {MMlDD1YYYY) (MMlDD1YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X 35853599 08/28/2016 08/28/2017 DAMAGETO RENTED 300,000 PREMISES(Ea occurrence} $ MED EXP(Any one person) $ 10,000 PERSONALS ADS INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT PRODUCTS-COMP/OP AUG $ 2,000,000 JECT OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO 5085359900 08/28/2016 08/28/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION$ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N B ANY PROPRIETOR/PARTNER/EXECUTIVE BN UWC0137911 08/28/2016 08/28/2017 EL.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? Y N!A (Mandatory in NH) E .DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E1_DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Orange County is listed as an additional insured as when required by written contract. CERTIFICATE HOLDER CANCELLATION ORANGEC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County Planning and ACCORDANCE WITH THE POLICY PROVISIONS. Inspections Department 131 W. Margaret Lane AUTHORIZED REPRESENTATIVE PO Box 8181 (Hillsborough, NC 27278 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD