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DocuSign Envelope ID: 88A54057 -CC31- 4328 - 9012- 2B021842D3E4
<br />County of Orange, NC
<br />INSURANCE CERTIFICATES
<br />RFP #5183
<br />CERTIFICATE OF LIABILITY INSURANCE,.,, 1 of 2 1 10/27/"/201'
<br />THIS CERTIFICATE IS ISSUED AS A MATTEL; 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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: N the certlReate holder Is an ADDITIONAL INSURED, the polfcy(les )must be endorsed. If SUBROGATION IS WAIVED, subject
<br />to the terms and conditions of the policy, corfalh policies may require an endorsement.A statement on this certificate does not confer rights
<br />to the cortlfloate holder In lieu of such endorsamant(s).
<br />PRO13WER
<br />CONrACT
<br />Hillis of Lraesashusetts, Ina.
<br />c/o 26 Century Slvd,
<br />P. o. Box 305191
<br />Hashv111e, TH 37230 -6193.
<br />ft, 8 7 -945 -7378 FAX 8 -467 -2376
<br />A,YS
<br />ongp aert:iEioaEeaRPri111
<br />INsTIRER qND COVFRN3E
<br />NAICH
<br />IMMERk Zurich American Ineuranaa Company
<br />16535 -002
<br />_
<br />WSUREO
<br />clean earbora environmental Seriiaaa, Ina.
<br />iwmERHAmeriaen Guarantee and Liahility Insarana
<br />26297 -003
<br />INSLWRC_Stea4f60t InOUranae Company
<br />26307 -001
<br />and its affiliates
<br />42 LenSHatar Drive
<br />Haruellr NA 02061
<br />INSURER D:
<br />R
<br />INSURER E:
<br />5 2,000,000
<br />EN5lkiER F. '
<br />OENEMAWFIMATE
<br />3 3,000,000
<br />NIIMRER:
<br />THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOWHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONOITION OF ANYCONTRACTOR OTHER DOCUMENT WETH RESPEOTTO WHICH THIS
<br />CERTIFICATE MAYBE ISSUED CR MAY PERTAIN. THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUB150TTO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMIT$ SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />AlER
<br />TYPE OFiH80MHCE
<br />DO'
<br />SUB
<br />POLIOYNUMBER
<br />POUOYEFF
<br />POUGY EXP
<br />LlAR8
<br />•
<br />OEIIERALLIABILrIY
<br />X
<br />CDIAMERCNLGENERN.LIABILITY
<br />CiAiN6•MMEn COGUR
<br />XqL.,,__,- ._,,.u,
<br />Tr
<br />CLO 9681229 -05
<br />1/1/2011
<br />1111/2018
<br />S 2,000,000
<br />pEAACHApO=JRRENCE
<br />R IL ISE3 aEocMc�i erica
<br />9 1 000
<br />MEDEXP ens P?aon
<br />$ 5 000
<br />R
<br />FERSONALa ADV14MY
<br />5 2,000,000
<br />Contractual
<br />OENEMAWFIMATE
<br />3 3,000,000
<br />GENtAGGREOAr6LIMITAPPLESPER;
<br />POLICY - IFS LOC
<br />PRODUCTS•COMPAIPACO
<br />$ 2,000,00
<br />5
<br />•
<br />AVTOMOERELIARILRY
<br />X ANYAUTC
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />x rtlREDAIlr� x �O.s
<br />R NCS -90
<br />Y
<br />BAP 6601231 -05
<br />1/1/2011
<br />11/1/2012
<br />�o
<br />Ira.Wrdrd InvLRULID
<br />$ 5,000,000
<br />BODILY IN.XiRYIFerPenmj
<br />$
<br />1K0).YIiMiYYIURY(I%racddong
<br />5
<br />erao$dm MAC1
<br />$
<br />S
<br />B
<br />%
<br />UMBRELLA LIAG R
<br />e]ICESa LWB
<br />DOWR
<br />C11UM8 -MADE
<br />AUC4275262 -07
<br />111/2011
<br />11 /1 /2012
<br />I
<br />EACHOC"RENCE
<br />$ 101800,000
<br />AGGREGATE
<br />5 1 0 0
<br />DEO I IRETENTION S
<br />$
<br />g
<br />WORKERS COMPENSATION
<br />ANO EMPLOYERS' LIABILIN
<br />ANYTROPRIETOR/PARTNERIEXECUTIvE
<br />OFFICERlMEMSEREXOLUDED''1
<br />IN, Indde
<br />a N
<br />D IWIFn[YuGnFdDr PNATICNSneWn
<br />NIA
<br />TLC 9681332 -05
<br />1/1/2011
<br />11/1 /2012
<br />x -1 TATLI
<br />E.L. EACH ACCIDENT
<br />S 2,000,000_
<br />E.LOESPAS£.EAEUPLOYES5
<br />2,000,000
<br />EL DISEASE- POLICY LIMrr is
<br />2,000,000
<br />c
<br />Contra atora Pollution
<br />Liability
<br />Pgc 3s5ssel -ls CPI.
<br />1 1 toll
<br />11 1 zOlz
<br />$10,000,000 each Claim
<br />$10,000,000 All claims
<br />OEaanlPn0N AF CPERATION$1 LOCATWN8 AV60LES(Atheh A20rd 101,AddRoAll Rennrks SehtduH, If MM spina Is rpulnd)
<br />See Attached:
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2010!051
<br />01908 -2010 ACORD CORPORATION. All rights reserved,
<br />The ACORD name and logo aro registered marks of ACORD
<br />Company Confidential 37 www.cleanharhors.com
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVEREO IN
<br />ACCORDANCE VhTH THE POLICY PROVISIONS.
<br />-- For Referanaa only -�
<br />AlRH0A7G. E0AEPRESENMTtYE
<br />ACORD 25 (2010!051
<br />01908 -2010 ACORD CORPORATION. All rights reserved,
<br />The ACORD name and logo aro registered marks of ACORD
<br />Company Confidential 37 www.cleanharhors.com
<br />
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