2022-154-E-DEAPR-S&ME, INC-Additional remedial investigation at former Hillsborough landfill

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DocuSign Envelope ID: FC9986C3-F179-4A3D-BACO-D8CA9F8B93A7 AG" 7/1/2022 412/2 CERTIFICATE OF LIABILITY INSURANCE DA/12/2DDIYYYY)022`.� 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(ies)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 on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). ACT PRODUCER Loekton Companies NAME: 444 W.47th Street,Suite 900 PHONE FAX Kansas City MO 64112-1906 EMA IL AIC No): (816)960-9000 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Valley Forge Insurance Company 20508 INSURED S&ME INC. INSURER B:Travelers Property Casualty Co of America 25674 1495227 3201 SPRING FOREST ROAD INSURER C:American Casualty Company of Reading,PA 20427 RALEIGH NC 27616 INSURER D:National Fire Insurance Co of Hartford 20478 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 18415779 REVISION NUMBER: XXXXXXX 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 CONTRACT OR 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. INSR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY POLICY LIMITS EXP LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000 000 D X I' Y 6042844344 7/1/2021 7/1/2022 DAMAGE TO RENTED CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 1,000,000 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 OOO O00 POLICY JECOT- �X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y BUA 7015184548 7/1/2021 7/1/2022 (CEO,accld.DISINGLE LIMIT $ 2,000,000 X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS XXXXXXX X HIRED X NON-OWNED PROPERTY DAMAGE $ XXXXXXX AUTOS ONLY AUTOS ONLY Per accident $ XXXXXXX B X UMBRELLALIAB X OCCUR Y Y CUP-2S937960-21-NF 7/l/2021 7/1/2022 EACH OCCURRENCE $ 5000000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTION$ 10,000 $ XXXXXXX WORKERS COMPENSATION PER OTH- C AND EMPLOYERS'LIABILITY Y/N Y WC7015154143 7/1/2021 7/1/2022 X STATUTE ER ANY OFFICER/MEMBER EXCLUDEDp ECUTIVE N/A E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:PROJECT NUMBER:4305-17-061G,PROJECT NAME:HILLSBOROUGH DUMP/FAIRVIEW PARK.**SEE ATTACHED** CERTIFICATE HOLDER CANCELLATION See Attachments 18415779 ORANGE COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DEPARTMENT OF ENVIRONMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN AGRICULTURE,PARKS AND RECREATION ACCORDANCE WITH THE POLICY PROVISIONS. 1020 US HWY 70 W HILLSBOROUGH NC 27278 AUTHORIZED REPRESENTATI ©198BL2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD