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DocuSign Envelope ID: DC12lC12-DFF2-4E9C-BB37-6988OF6CFBC4 <br /> . -.��� DATa(MrAmanYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 11n112Q14 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER 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(S),AUTHORISED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT, If the certificate holder Is an ADDITIONAL INSURED,the polloy(les)must be andarsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement A statement on Ihls certificate does not confer rights to the <br /> oBHifiaate holder In lieu of such endorsements. <br /> coNT r Urxia Paulsen <br /> PRacucsR Van WykRiskSclutions PHONE 6,6 942-507Q ) (818)-942 8199 <br /> 2237 Weal Street SE• r. o E ( AIC,NG <br /> Suite 200 E-MAR. lindap@vanwkorp.com <br /> Grand Rapids,MI 49508 INSURER 8 AFFORDING COVERAGE Mc# <br /> INSu ERA• National Union Firs Ina 19445 <br /> INsu iED Fleet Staff,Inc. INSURER S; Granite State insurenco Company 23809 <br /> 118 W,Fifth Street INSURER c: Commerce and Industry Ins Cc 1900 <br /> Ste 201 <br /> OWngton,KY 41011 INsuRER n <br /> INSURER E r <br /> INSURER F. <br /> COVERAGES CERTIFICATE NUMBER, 2013.2014 REVISION NUMBER: <br /> THIS is TO CERIIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSERTED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br /> INBR TYPE OF INSURANCE POLICYNUISBER POLICYEFF POLIppRyp lJMITB <br /> A 09NP.RA UMILITY EACHOCCURRTENCE <br /> CONWRCIN.OIDERALLIABLITY PK041884868 1111l2014 11110% ° ere RE ED ; Worm: <br /> CLAMS-MADE M OCCUR MEDEXP(Any oneperson) $ KO <br /> PERSONALbAGYINMRY $ 1,000,0M <br /> _ GENERAL AGGREGATE $ 2,000,000 <br /> GENLAGGREGATELLWT APPLIES PER: PRODUCTS•COMNOPAGG $ $000,000 <br /> POLICY 0 <br /> PRO• LOCI I ; <br /> AUTOMOBILRUABIUff Ma9VEDSINGLE IM 1 <br /> e d <br /> NWAVTO 02 CA•019048508 11/112014 11/112015 eoDLY@LIURY(Perpersan) ; <br /> AALL <br /> OVOEa' SCHEDULED, <br /> BODILY WVRY(PoraWdonl) $ <br /> AUrOS <br /> HIRFDAVrOS V.NUN-O"NEO ,.r o DAMAGE $ <br /> _ AUf03 er eoclldd nF <br /> 10 <br /> A UMBRELIALIAB pCCLFi EACHOCOU4{REtiCE ; 500,000 <br /> EXCESS LIA6.- ' ', cLAwLgrMwnE 01�t1D-01198512&0 11/112014 11/112016 AGGREGATn <br /> DED RURMION $ <br /> C WORKERS COMPENOAIiOH A wC STATU- 0", <br /> - ANDEMPLOYERs`UABILITY YIN "R <br /> ANY PROPMETOMPARTNEIVElECUENE ❑ NIA W04321602 12/26/2013 1212612014 RL,EACHAcc DENT $ 1,0DD,000 <br /> Mind EaoryMNHj I.VDE+D? E, 1.{)w000 <br /> L.DIBFJL9E-FA EASPLOYEE <br /> r aeddasIONOFOPERATIONSb w 1,t100,000 <br /> E.L.Dl3EA9E•PGLICYLWIR' $ <br /> A Staffing Professional PK641864 8 111112(114 11111201E Per OcoUrranceLimit $1,000,000 <br /> A Crime 875913736 717M14 7/19/2016 Limit ofCGwrage $501000 <br /> DESCRIPTION OF OPERATIONS ILOOATIMI VERICLE8(AltRohAGORP 101,AddlUoual Remarks 8ahedule,II more epaoo to required) <br /> Cow age ls etdended to Fleet Staff amp!Gyws assigned tovxKkat Orange County Solid Waste Management by Spec Personnel,Inc. <br /> CERTIFICATE HOLDER CANCI=LLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> i Orange CounlySClld Waste Management THE EXPIRATION DATE THEREOF:, NOTICE WILL BE DELNERED IN <br /> Orange County,North Carolina <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough,NO 27278 AUTHORIZED REPR989MTATNR <br /> : <br /> Ire <br /> Q 19BO•2010 ACORD CORPORATION, All rights reserved. <br /> AQORID 75,(2010105)' The ACORD name and logo are registered marks of ACORD <br /> dt <br />