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Insurance Certificate P5261w2w102 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 07/30/2019 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(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). x PRODUCER 1-317-844-7759 CONTACT NAME: Lyndsay Myers AssuredPartners of Indiana, LLC PHONEI(A/C,No): > INCA°.E ): 317-595-7392 > E-MAIL 10401 N. Meridian #300 ADDRESS: Lyndsay.Myers@assuredpartaers.com INSURER(S)AFFORDING COVERAGE NAIC k Indianapolis, IN 46290INSURERA: GREENWICH INS CO 22322 INSURED INSURER B: XL INS AMER INC 24554 Heritage Environmental Services, LLC INSURER C: XL SPECIALTY INS CO 37885 J 5400 W 86th Street INSURERD: ZURICH AMER INS CO 16535 INSURERE: TOKIO MARINE PACIFIC INS LTD 11216 Indianapolis, IN 46268 INSURERF: IRONSHORE SPECIALTY INS CO 25445 COVERAGES CERTIFICATE NUMBER:56852296 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 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. INR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMMIDDIYYYYI (MM/DDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY X GEC000304119 08/01/19 08/01/20 EACH OCCURRENCE 1$ 1,000,000 CLAIMS-MADE I X I DAMAGE TO RENTED OCCUR PREMISES{Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 --, (_PERSONAL 8 ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY CX I JECT PROL- _i LOC PRODUCTS-COMP/OPAGG $ 2,000,000 i ------- --- OTHER: $ B AUTOMOBILE LIABILITY X ABC000304319 08/01/19 08/01/20 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) pX ANY AUTO BODILY INJURY(Per person) $ ;OWNED —1 SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED (Per accident) $ —_-. AUTOS ONLY AUTOS ONLY —_----- C X UMeRELLAUAB RIOCCUR UEC00183617 08/01/19 08/01/20 EACH OCCURRENCE $ 10,000,000 --- EXCESS LIABCLAIMS-MADE AGGREGATE $ 10,000,000 DED RETENTIONS 10,000 $ OT - D WORKERS COMPENSATION WC929886319 08/01/19 08/01/20 X STATUTE ERH AND EMPLOYERS'LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT H-;--7,000,000 _ OFFICER/MEMBEREXCLUDED? 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 E CPL/ PROFESSIONAL PPK2017694 08/01/19 08/01/20 EACH 15,000,000 AG 30,000,000 F POLLUTION LEGAL LIABILITY 002855803 08/01/19 08/01/20 EACH 15,000,000 AGI 30,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It more space is required) CITY OF SALINA IS ADDITIONAL INSURED IN REGARD TO GENERAL LIABILITY AND AUTOMOBILE LIABILITY AS REQUIRED BY WRITTEN CONTRACT. A WAIVER OF SUBROGATION IN THEIR FAVOR APPLIES TO THE WORKERS COMPENSATION AND EMPLOYERS LIABILITY AS REQUIRED BY WRITTEN CONTRACT. UMBRELLA FOLLOWS FORM. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SALINA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PUBLIC WORKS DEPARTMENT AUTHORIZED REPRESENTATIVE PO BOX 736 SALINA, KS 67402-0736 I USA ‘.. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD LMYERS 56852296 s ^ IIIIIIIIIIIIIII■ F., ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYIT L /. 08/01/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS rg 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 vm 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. r l 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 1-317-844-7759 CONTACT Lyndaey Myers r NAME: AssuredPartners of Indiana, LLC PHONE FAX Ens 317-595-7392 INC.No): > 10401 N. Meridian 9300 AADD ESS: lmyeregassuredptrin.com INSURER(S)AFFORDING COVERAGE AMC 4 Indianapolis, IN 46290 INSURER A:GREENWICH INS CO 22322 UISURED INSURER B: XL INS A21ER INC 124554 Heritage Tsavlxnnnental Services, LW INSURERC: XL SPECIALTY INS CO 137885 5400 N 86th Street INSURERD: WHICH AMER INS CO 16535 INSURER E: IRONSHORE SPECIALTY INS CO 25445 Indianapolis, IN 46268 INSURERF: TOEIO MARINE PACIFIC INS LTD 111216 COVERAGES CERTIFICATE NUMBER:53578824 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 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�8I POLICY EFF POLICY EXP I LIMITS LTR 'NSD JND POLICY NUMBER (MMIDDIYYYY1 IMWDDIYYY1n A E COMMERCULGENERAL'ABILTY X OBC000306118 08/01/18 08/01/19 EACHMOCCURRENCE DAMASE6If 1,000,000 CIAASMADE I E I OCCUR PRESES(aown n* 15100.000 EX 1 MED P(Any one Forma 1$ 5,000 PERSONAL 8ADV INJURY S 1,000,000 GEN.AGGREGATE LARAPPLIES PER GENERAL AGGREGATE 5 2,000,000 POOCYII IJECT I I LOC PRODUCTS-COMP/OP AGG f 2,000,000 OTHER S B AUTOMOBILELIAEIUTY E ABC00030d31B 08/01/18 08/01/19 COMBINED SINGLE I-11m 1f 1,000,000 E ANY AUTO BOORYINJURY(Perperate) I4 OWNED SCHEDULED BODILY INJURY(Par eaiaan016 — AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE 1 AUTOS ONLY AUTOS ONLY (Per accident) 14 C E UMBRELLA LIAR X OCCUR OEC00183616 08/01/18 08/01/19 EACHOCCURRENCE Is 10,000,000 EXCESS LAB WI/AS-WADE AGGREGATE Is 10,000,000 I DED I IRETENTION$TIM IS D AND WORKERS COMPENSATION WC929886318 08/01/18 08/01/19 X I;TLFTE I I ER I ANYPROPRIETORPARTNEWEXECUTNE � NIA EL.EACH ACCIDENT $ 1,000,000 OFFICE RM EMBER EXCLUDED' (I/endears • L. NH) EDISEASE-EAEMMOYEEI$ 1,000,000_ If ea desalt*under DESCREMON OF OPERATIONS eddy El.DISEASE-POLICY Lim Is 1,000,000 E 'POLLUTION LEGAL LIABILITY 002855802 08/01/18 08/01/19 EACH 15,000,000 AG 30,000,000 P CPL/ PROFESSIO2AL PPX1858085 08/01/18 08/01/19 EACH 15,000,000 AG 30,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may W'lathed If mom apace Is required) CITY OF SALINA IS ADDITIONAL INSURED IN REGARD TO GffiIERAL LIABILITY AND AUTOMOBILE LIABILITY AS REQUIRED BY WRITTEN CONTRACT. A WAIVER OF SUBROGATION IN THEIR FAVOR APPLIES TO THE MORTISES COMPENSATION AND EMPLOYERS LIABILITY AS REQUIRED BY WRITTEN CONTRACT. UMBRELLA FOLLOWS PORN. • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SALINA THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PUBLIC NORMS DEPARTMENT AUTHOR®REPRESENTATIVE PO BOX 736 SALINA, 145 67402-0736 4�_ 'Z____–.— 1 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 20A NLAP 53578824 tuox,lxxR 10401 N. Meridian St., Suite 300 Indianapolis, IN 46290 AssuredPartners Phone: 317-844-7759 = O. Fax: 317-815-6036 or Fax 317-844-9910 of Indiana c IF YOU ARE THE RECIPIENT OF THIS CERTIFICATE: ANY WORDING TO PROVIDE ADDITIONAL INSURED COVERAGE, PROVIDE COVERAGE ON A PRIMARY AND NON-CONTRIBUTORY BASIS, OR PROVIDE A WAIVER OF SUBROGATION APPLIES ONLY WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT. CONTRACTUAL LIABILITY COVERAGE IS ONLY PROVIDED TO THE EXTENT SET FORTH IN THE POLICIES AND MAY NOT COVER ALL LIABILITY ASSUMED BY THE NAMED INSURED UNDER THE CONTRACT. IF YOU ARE THE REQUESTOR OF THIS CERTIFICATE OF INSURANCE: AssuredPartners of Indiana, LLC has,upon your request, issued the attached Certificate of Insurance. If you have not already done so, we highly recommend that you provide AssuredPartners of Indiana, LLC with a copy of the insurance and indemnification provisions of the contract pertaining to the Certificate of Insurance request so that we may properly ascertain whether the referenced insurance policies address the limits of insurance, terms and types of coverage required by the contract. While most Certificates of Insurance can be issued at no cost, the contract may require the purchase of additional insurance coverage that could be subject to an additional premium charge. In some instances, the coverage identified in the contract may be outside the underwriting guidelines of the insurance carrier and cannot be obtained. Any contract review performed by AssuredPartners of Indiana, LLC should not be construed as the rendering of legal advice or a legal opinion concerning any portion of the contract. AssuredPartners of Indiana, LLC has not endeavored to identify all potential liability issues that might arise under this contract. This review is provided for information purposes only and should not be relied upon by third parties. Any description of insurance coverage is subject to the terms, conditions, exclusions and other provisions of the policies and any applicable regulations, rating rules or plans. This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD forms & Policy Cancellation Requirements Effective September 2009,ACORD revised the ACORD 25 Certificate of Insurance and the Acord 27&28 Evidence of Property forms,the major change being removal of the cancellation notice provision. Per our contract with ACORD,we are not able to alter pre-existing wording on the current form,nor are we able to complete a proprietary form you provide: •Per Indiana House Enrolled Act 1322,effective July 1,2013, Sec.13.(a)A person is not entitled to notice of: (1)cancellation of (2)non-renewal of; or (3)a material change in; a policy of property or casualty insurance unless the person has notice rights under the terms of the policy of property or casualty insurance or an endorsement to the policy. Violation of this statute is considered an unfair and deceptive act or practice under Indiana Law and if an agent is found to be in violation,they can possibly lose their license,and an insured or customer can possibly be fined. We appreciate your understanding of the legal restrictions on our ability to fully comply with your request. P5260323012 5 _ POLICY NUMBER:AEC000304318 COMMERCIAL AUTO S;• CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: HERITAGE ENVIRONMENTAL SERVICES,LLC Endorsement Effective Date: June 1,2017 SCHEDULE Name(s)Of Person(s)Or Organization(s): ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED IN A WRITTEN CONTRACT OR WRITTEN AGREEMENT TO WAIVE ANY RIGHT OF RECOVERY WE MAY HAVE AGAINST THE PERSON OR ORGANIZATION PROVIDED THE'BODILY INJURY"OR'PROPERTY DAMAGE"OCCURS SUBSEQUENT TO THE EXECUTION OF THE WRITTEN CONTRACT OR WRITTEN AGREEMENT. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 4410 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 P5211)1 2 1111111111111 POLICY NUMBER:GEC000304118 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. e ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s)Of Covered Operations ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED IN A VARIOUS WRITTEN CONTRACT OR WRITTEN AGREEMENT TO INCLUDE AS AN ADDITIONAL INSURED PROVIDED THE"BODILY INJURY"OR "PROPERTY DAMAGE"OCCURS SUBSEQUENT TO THE EXECUTION OF THE WRITTEN CONTRACT OR WRITTEN AGREEMENT. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for"bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: • caused, in whole or in part,by: 1. All work, including materials, parts or 1. Your acts or omissions;or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs)to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed;or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured principal as a part of the same project. is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 2010 0413 ©Insurance Services Office, Inc.,2012 Page 1 C. With respect to the insurance afforded to these 1. Required by the contract or agreement;or additional insureds, the following is added to2. Available under the applicable Limits of Section III—Limits Of Insurance: Insurance shown in the Declarations; If coverage provided to the additional insured is whichever is less. required by a contract or agreement, the most we will pay on behalf of the additional insured is the This endorsement shall not increase the applicable amount of insurance: Limits of Insurance shown in the Declarations. CG 2010 0413 ©Insurance Services Office, Inc.,2012 Page 2 P£26001NUE POLICY NUMBER: GEC000304118 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. c a ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s)Or Organization(s) ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED IN A WRITTEN CONTRACT OR WRITTEN AGREEMENT TO INCLUDE AS AN ADDITIONAL INSURED PROVIDED THE"BODILY INJURY"OR "PROPERTY DAMAGE"OCCURS SUBSEQUENT TO THE EXECUTION OF THE WRITTEN CONTRACT OR WRITTEN AGREEMENT. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to 2. If coverage provided to the additional insured include as an additional insured the person(s) or is required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured with respect to liability for"bodily injury", "property will not be broader than that which you are damage" or "personal and advertising injury" required by the contract or agreement to caused, in whole or in part, by your acts or provide for such additional insured. omissions or the acts or omissions of those acting B. With respect to the insurance afforded to these on your behalf: additional insureds, the following is added to 1. In the performance of your ongoing operations; Section III—Limits Of Insurance: or If coverage provided to the additional insured is 2. In connection with your premises owned by or required by a contract or agreement, the most we rented to you. will pay on behalf of the additional insured is the However: amount of insurance: 1. The insurance afforded to such additional 1. Required by the contract or agreement;or insured only applies to the extent permitted by 2. Available under the applicable Limits of law;and Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 0413 ©Insurance Services Office, Inc.,2012 Page 1 of 1 rssuoamz L AssuredPartners AssuredPartners of Indiana,LLC 10401 N.Meridian Street I Suite 300 of Indiana Indianapolis,IN 46290 Phone:317-844-7759 I Fax:317-815-6036 v � x ADDITIONAL NAMED INSUREDS: (Applies to all locations of the named insured) Heritage Environmental Services, LLC 6510 Telecom Drive Suite 400 Indianapolis, IN 46278 I Heritage Environmental Services, LLC 7901 West Morris Street Indianapolis, IN 46231 Heritage Interactive Services, LLC 6510 Telecom Drive Suite 400 Indianapolis, IN 46278 • Heritage Transport, LLC 7901 West Morris Street Indianapolis, IN 46231 Heritage Environmental Services PR, LLC • Carr 682 Km 13.5 Bo Cercadillo Arecibo, PR 00613 • Rineco Chemical Industries, LLC P.O. Box 729 Benton, AR 72015 • Rineco Environmental Services, LLC P.O. Box 729 Benton, AR 72015 Rineco Transportation, LLC P.O. Box 729 Benton, AR 72015 PR61n2M 112 8 3 DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE 08/01/2018 NAME OF INSURED: Heritage Environmental Services, LW G Z SUPP(10/00)