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 Rom® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `e� 7/l/2022 4/12/2022 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). PRODUCER Lockton Companies CONTACT 444 W.47th Street,Suite 900 PHONE FAX Kansas City MO 64112-1906 E-MAIL AIc No): (816)960-9000 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Lexington Insurance Company 19437 INSURED S&ME INC. INSURER B: 1495229 3201 SPRING FOREST ROAD INSURER C: RALEIGH NC 27616 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 18415793 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR YYY POLICY NUMBER MMIDDIY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX DAMAGE TO RENTED CLAIMS-MADE 1:1OCCUR PREMISES (Ea occurrence) $ XXXXXXX MED EXP(Any one person) $ XXXXXXX PERSONAL&ADV INJURY $ XXXXXXX GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ XXXXXXX POLICY X JECT �X LOC PRODUCTS-COMP/OP AGG $ XXXXXXX OTHER: $ AUTOMOBILE LIABILITY NOT APPLICABLE COMBINED SINGLE LIMIT Ea accident $ XXXXXXX ANY AUTO BODILY INJURY(Per person) $ XXXXXXX OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ XXXXXXX HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ XXXXXXX $ XXXXXXX UMBRELLA LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX EXCESS LIAB HCLAIMS-MADE AGGREGATE $ XXXXXXX DED I I RETENTION$ $ }{xxxxXX WORKERS COMPENSATION NOT APPLICABLE R PER O H- AND EMPLOYERS'LIABILITY Y/NANY STATUTE E OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNERJEAECUTIVE ❑ NIA E.L.EACH ACCIDENT $ XXXXXXX (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ XXXXXXX If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ XXXXXXX A PROFESSIONAL N N 031565551 7/1/2021 7/1/2022 $5,000,000 PER CLAIM/$5,000,000 LIABILITY AGGREGATE DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) RE:PROJECT NUMBER:4305-17-061G,PROJECT NAME:HILLSBOROUGH DUMP/FAIRVIEW PARK;NOTICE OF CANCELLATION APPLIES PER THE ATTACHED ENDORSEMENT. CERTIFICATE HOLDER CANCELLATION See Attachment 18415793 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 HILL.SBOROUGH NC 27278 AUTHORIZED REPRESENTATIV rF All n� 198819015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD