2018-083-E AMS - Environmental Solutions Group site assessment and sampling BOE

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DocuSign Envelope ID: F08B1D96- 60E5 -45AD- 8055- 70EAF07C320F ACC? " CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD /YYYY) 3/1/2018 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 Phyllis Carter, CIC, CISR PWHCNIN Ext: (336)375 -0600 FAX, No: (336) 375 -7004 Craft Insurance Center E -MAIL ADDRESS:P carter @craftinsurance.com 823 North Elm Street PO Box 14946 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Colony Insurance Company 39993 Greensboro NC 27415 INSURED INSURER B :Selective Ins. Co. Of America 12572 INSURERCAccident Fund National Insurance 12305 ESG Holdings, Inc. INSURER D: ( see attached for named insured) INSURER E: $ 50,000 1000 North Elm Street INSURER F: $ 5,000 Greensboro NC 27401 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM DDYNYYY EXP MM/ DY /YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE FXI OCCUR DA AGE To RETED PRE M ISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,000 PACEP3066171 1/31/2018 1/31/2019 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT F7 LOC X PRODUCTS - COMP /OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY (CEO, accident MBINED SINGLE LIMIT $ 1, 000 , 000 X BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 52194939 1/31/2018 1/31/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peraccident $ NON -OWNED HIRED AUTOS AUTOS X UMBRELLA LIAB I X OCCUR EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 A EXCESS LIAB CLAIMS -MADE DED X RETENTION$ 10,000 $ EXC3045001 1/31/2018 1/31/2019 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N X — 15' ER OTH- STATUTE I ER C ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? � (Mandatory in NH) N / A WCV6122801 1/31/2018 1/31/2019 E.L. EACH ACCIDENT $ 1. 000 , 000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Professional E &O PACEP3066171 1/31/2018 1/31/2019 Occurrence /Aggregate $1M /$2M A Pollution PACEP3066171 1/31/2018 1/31/2019 Occurrence /Aggregate $1M /$2M DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION abarnes @orangecountync.gov Orange County PO Box 8181 306 -F Revere road Hillsborough, NC 27278 ACORD 25 (2014/01) INSn25rgmami SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE P Carter, CIC, CISR /P? ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD