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DocuSign Envelope ID:OB6A4D70-3138-422C-98BF-EA253C4BCA84 Page 1 of 2
<br /> A �9 DATE(MM/DDIYYYY)
<br /> �JA CERTIFICATE OF LIABILITY INSURANCE 10/23/2018
<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), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME:
<br /> Willis of Massachusetts, Inc.
<br /> c/o 26 Century Blvd PHO AI NE 1-877-995-7378 FAX 1-888-467-2378
<br /> C N Ext:o (A/C No
<br /> E-MAIL certificates@willis.com
<br /> P.O. Box 305191 ADDRESS:
<br /> Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA: ACE American Insurance Company 22667
<br /> INSURED INSURERB: ACE Property & Casualty Insurance Company 20699
<br /> Clean Harbors Environmental Services, Inc.
<br /> and its affiliates INSURERC: Indemnity Insurance Company of North Ameri 43575
<br /> 42 Longwater Drive INSURERD: Indian Harbor Insurance Company 36940
<br /> Norwell, MA 02061 USA
<br /> INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:W8597802 REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED 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 /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICY NUMBER MM/DDIYYYY MM/DDIYYYY
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> 5v] DAMAGE TO CLAIMS-MADE OCCUR PREM SES('a
<br /> a o'RENTED
<br /> ) $ 500,000
<br /> A X XCU MED EXP(Any one person) $ 5,000
<br /> X Contractual HDOG71209581 11/01/2018 11/01/2019 PERSONAL&ADV INJURY $ 2,000,000
<br /> GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> POLICY L jE LOC PRODUCTS-COMP/OPAGG $ 4,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COEaMBINED accident SINGLE LIMIT $ 5,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> A X OWNED SCHEDULED ISAH25271865 11/01/2018 11/01/2019 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE $
<br /> k(T�OS ONLY AUTOS ONLY Per accident
<br /> X $
<br /> B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000
<br /> EXCESS LIAB CLAIMS-MADE G4682586A 002 11/01/2018 11/01/2019 AGGREGATE $ 10,000,000
<br /> DED X RETENTION$ 0 $
<br /> WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> 2,000,000
<br /> C ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? No NIA WLRC65228610 (ADS) 11/01/2018 11/01/2019 2,000,000
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under 2,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> A Workers Compensation WLRC65228658 (AZ, CA, MA) 11/01/2018 11/01/2019 E.L. EACH ACCIDENT $2,000,000
<br /> & Employers Liability E.L. DISEASE - EA EM $2,000,000
<br /> Per Statute E.L. DISEASE-POL LMT $2,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> Scope of Work: Permanent Household Hazardous Waste Collection Program.
<br /> SEE ATTACHED
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Orange County Solid Waste
<br /> AUTHORIZED REPRESENTATIVE
<br /> Attn: Kristina Witosky
<br /> 1207 Eubanks Road, PO Box 17177 /�,-/,- � _
<br /> Chapel Hill, NC 27516 �"
<br /> ©1988-2016 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br /> SR ID: 16932852 BATCH: 923985
<br />
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