2018-082-E AMS - Environmental Solutions Group site assessment and sampling 129 E King

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DocuSign Envelope ID: E52B8315- AFE6- 4DB3- 8A28- FA045C18AA31 '4�� "® CERTIFICATE OF LIABILITY INSURANCE P�3/1/2018 TE (MM /DD /YYYY) 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 NAME: y Craft Insurance Center HOE (PA/C, N No, Ext: (336) 375 -0600 A/C No: (336)375 -7004 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 INSURER c Accident 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MM /DD/YYW POLICY EXP MM /DD/YYW LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 , 000 , 000 A CLAIMS -MADE � OCCUR PREM SESOEa occurrDen. $ 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 ❑ JECT PRO [::] LOC X PRODUCTS - COMP /OP AGG $ 2 , 000 , 000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1 , 000 , 000 X BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 52194934 1/31/2018 1/31/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE APer accident $ NON -OWNED HIRED AUTOS AUTOS X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 3, 000, 000 AGGREGATE $ 3,000,000 A EXCESS LAB CLAIMS -MADE DED X RETENTION$ 10,000 $ EXC3045001 1/31/2018 1/31/2019 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N X PER OTH- STATUTE ER C ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? [y] (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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 8181 ACCORDANCE WITH THE POLICY PROVISIONS. 306 -F Revere road AUTHORIZED REPRESENTATIVE Hillsborough, NC 27278 ,`. ✓ P Carter, CIC, CISR /P ACORD 25 (2014/01) IN S025 (201401) © 1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD