Orange County NC Website
DocuSign Envelope ID: E53DCC3C-B8E8-410C-BB50-A039C27BD393 Page 1 of 2 <br /> A��0 DATE(MM/ Y) <br /> CERTIFICATE OF LIABILITY INSURANCE 06/19/201/2019 <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 Willis Towers Watson Certificate Center <br /> NAME: <br /> Willis of Illinois, Inc. <br /> c/o 26 Century Blvd WCNNo Ext: 1-877-995-7378 F4IC No: 1-888-467-2378 <br /> E-MAIL cm <br /> P.O. Box 305191 ADDRESS: ertificates@willis.co <br /> Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA: Indian Harbor Insurance Company 36940 <br /> INSURED INSURER B: Zurich American Insurance Company 16535 <br /> Tradebe Environmental Services, LLC <br /> 1433 E 83rd Ave. Suite 200 INSURERC: American Zurich Insurance Company 40142 <br /> Merrillville, IN 46410 INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:W11664816 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 IN SD WVD POLICYNUMBER MM/DD/YYYY MM/DD/YYYY <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 <br /> RENTED <br /> CLAIMS-MADE � OCCUR PREMISES(DAMAGE ToEa occurrence) <br /> ccurrrence) $ 300,000 <br /> A MED EXP(Any one person) $ 10,000 <br /> US00077228LI18A 12/31/2018 12/31/2019 PERSONAL&ADV INJURY $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY PRO JECT ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000 <br /> Ea accident <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> B OWNED SCHEDULED BAP1155419 00 12/31/2018 12/31/2019 BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> A X UMBRELLALIAB I X OCCUR EACH OCCURRENCE $ 14,000,000 <br /> EXCESS LIAB CLAIMS-MADE US00077229LI18A 12/31/2018 12/31/2019 AGGREGATE $ 14,000,000 <br /> DIED X RETENTION$10,000 $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N X STATUTE ER <br /> C ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? NO NIA Y WC 5447991 05 12/31/2018 12/31/2019 1,000,000 <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> B Workers Compensation Y WC 0503182 01 12/31/2018 12/31/2019 E.L. Each Accident $1,000,000 <br /> & Employers Liability E.L. Disease-Each $1,000,000 <br /> Work Comp: Per Statute E.L. Disease-Pol Lmt $1,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <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 North Carolina <br /> AUTHORIZED REPRESENTATIVE <br /> Attn: Cheryl Young <br /> 200 South Cameron Street <br /> Hillsborough, NC 27278 <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: 18134634 BATCH: 1249440 <br />