2019-143-E AMS - Boomerang ES remediation design services

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DocuSign Envelope ID: BA5A022E-FF90-4319-A182-3037ClEB7711 page 2 of 3 E... Client#:121479 70BOOMEDES GATE(MM10O/yYYY) ACORD., CERTIFICATE OF LIABILITY INSURANCE 01/15/2019 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(les)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 an Ihis certlfIcate does not confer any rights to the certificate holder In IIou of such endorsement(s), PRODUCER NNA TAIT E! Charlotte Certificate Team McGriff Insurance Services ABC.NE No,E,a;704 954-3000 � No; 888-751-3197 5925 Carnegie Blvd Suite 400 E-MAIL ccertteam0mcgriff Charlotte,NC 29209 INSURER(S)RFFORi71NG COVERAGE NAIC Y 704 954-3004 14990 INSURER A:Panmylwnla Naavrnl hiuival Cae rra co INSURED — - — — -— - INSURER B: Boomerang Design PA INSURER C., PO Box 2285 INSURER D: Shelby, NC 28151 INSURER E INSURER F: 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 CONTRACTOR 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. INS TYPE OF INSURANCE DD UBR pOu Y EFF POLICY EXP LIMBS LTRINSR WVD POLICY NUMBER MMID YYY MMIttO1YVY A X COMMERCIAL GENPRAL LUIBILtTY y 1090670238 2/11/2019 02111/202C EAgCCH OCCURRENCE $1 000 000 CLAIMS-MADE L OCCUR PREM SEs 0occu ence 000,000 MED EXP(Any an person) s 5 ODO PERSONAL&ADV 1N URY $1 000 000 GEN'✓_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2 000,000 PRO- POLICY❑JECT LOG PRODUCTS-COMPIOP AG s2,000,000 OTHER: $ A AUTOMOBILE LIABILITY y AU90670238 2/11/2019 021I t1202 COMBCNmeO SWGLELIMIT 1,000 OQO x ANY AUTO BODILY INJURY(Per person) $ OWNED SCAUTOS HEDULETI AUTOS ONLY BODILY INJURY{Per accidenS] $ HIRED NON-OWNED PROPERTY❑AMAGE $ X. AUTOS ONLY x AUTOS ONLY Per accoen 5 A X UMBRELLA LIAO NCLAiMS-MADE. 00CUR Y UL9067023$ 11/2019 02/11/202 EACH OCCURRENCE s3 000 000 EXCESS LIAB AGGREGATE s3,000,000 DED I I RETENTION$ WORKERS COMPENSATIbN I'ER OTH- AND EMPLOYERS'LIAaILRY CFMCERIMEMSER EXCLUpE ANY E?EIX17NE E.L.EACH ACCIDENT ❑ N 1A $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES IACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Certificate Holder is automatically listed as A Did it Iona I Insured IF required in their written contract with the Insured. Blanket Additional Insured Endorsement applies. (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Orange County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20O S Caiheron St PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORISED REPRESENTATIVE CP 1988-2015 ACORD CORPORATION,All rights reserved. ACORD 25(2016103) 1 of 2 The AC0RD name and logo are registered marks of ACORD 847 #S227486531M22748569 SMWA