2018-125-E Planning - Transstate LLC Phase 3+5 Sewer Cleaning

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DocuSign Envelope ID: 6E30952E- 74C9- 4C59- BO50- B1AE415FDFED TRANS -4 OP ID —1 RL�" CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DDYYYY) � 04/03/2018 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 have ADDITIONAL INSURED provisions or 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 704 - 892 -6411 CONTACT Nico lannelli A uesta Insurance - Cornelius NAME: PO Box 189 (A/CC, No, Ext), 704- 892 -6411 [AIc No):704- 892 -3266 Cornelius, NC 28031 E -MAIL Nico lannelli ADDRESS: Auto - Owners Insurance Co 118988 INSURED Transstate LLC PO Box 545 Denver, NC 28037 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 DDL UBR POLICY NUMBER POLICY EFF D YYYY POLICY EXP D YYY LIMITS • X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR Y 35853599 08/28/2017 08/28/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE To RENTED PREMISES Ea occurrence 300,000 $ MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY � PECOT- F7 LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 • AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 5085359900 08/28/2017 08/28/2018 Ea BINEDRSINGLE LIMIT $ 1,000,000 X BODILY INJURY Per person) $ BODILY INJURY Per accident $ PROPERTY DAMAGE $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 5085359901 08/28/2017 08/28/2018 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED X RETENTION $ 10000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER R EXCLUDED? If yes, describe under DESCRIPTION OF OPERATIONS below NIA BNUWC0137911 08128/2017 08/2812018 X IPER H- STATUTE ER E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE 1,000,000 $ E.L. DISEASE - POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is additional insured with regards to general liability 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 ACORD 25 (2016/03) © 1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD