WM0100470_Application_20200605 (2)

CONDITIONAL PROPERTY ACCESS AGREEMENT
This CONDITIONAL PROPERTY ACCESS AGREEMENT (the "Agreement") is made
as of the 5th day of_)Mq 2020 by and between SOUTHEAST ENERGY, L.L.C., a
Delaware limited liability company ("Owner") having an address of 701.4 AC Skinner Parkway,
Suite 290, Jacksonville, Florida 32256 and Singleton Environmental, Inc.,
("Contractor") having an address of _PO Box 604, Fletcher, NC 28732 . Contractor's
agreements, undertakings and covenants as set forth in this Agreement are deemed to be
agreed, undertaken and made by Contractor for itself and for each of and all Contractor's
Agents (as defined below).
RECITALS
WHEREAS, Owner owns the certain parcels of real property located
at 1.31 Park Street, Canton, NC (the "Pro erty" , DEP .Facility No. _5444 more completely
described in the attached Exhibit "A" and desires to provide access to Contractor to
perform certain assessment and/or remediation of the Property strictly on the terms and
conditions set forth in this Agreement, but not otherwise; and
WHEREAS, Contractor wishes to perform such assessment and/or remediation.
NOW, THEREFORE, in consideration of the mutual agreements contained in this
Agreement, and other valuable consideration, the receipt and sufficiency of which are
acknowledged, Owner and Contractor agree as follows:
1. Grant of Access. Owner conditionally grants to Contractor, its agents,
employees, consultants, contractors, and subcontractors (collectively, "Contractor's Agents"), a
limited right of access to enter upon the .Property for the sole purpose of assessing and/or
remediating (the "Work") petroleum product contamination existing at the Property (the
"Contamination"). Unless separately authorized by Owner in writing, all Work must relate to
that certain funding eligibility described in the documentation that is attached as Exhibit "B"
issued by the North Carolina Department of Environmental Quality or its predecessor or
authorized delegated unit of government (collectively "the Department").
2. Duration and Termination of Access. The conditional access provided to
Contractor by this Agreement shall be allowed. following the execution of this Agreement and
strictly upon the terms of this Agreement and the access granted by Owner to the Department
pursuant to the Permission to Enter Property, a copy of which is attached hereto as Exhibit "C"
and made a part hereof. This Agreement shall continue for the shorter of sixty (60) months or
the termination of Contractor's task assessment from the Department at which time it will expire
unless extended in writing by Owner. In the event Contractor breaches any covenant or
obligation under this Agreement and such breach is not cured to the reasonable satisfaction of
Owner within five (5) days after receipt of notice of such breach, Owner (i) may terminate this
Agreement and revoke the access granted in this Agreement upon delivery of notice to
Contractor and (ii) may take all other action authorized by .law or pursuant to this Agreement to
remedy such breach.

3. Covenants of Contractor.
a. The cost of the Work and related activities shall not be bo.me by Owner.
Contractor shall obtain all required licenses, approvals, certificates and permits for the
performance of the Work. The Work undertaken at the Property shall be conducted in
accordance with standards customarily employed in the industry and in an expeditious,
safe and diligent manner. The Work shall be performed in accordance with all applicable
federal, state and local laws, ordinances, rules and regulations in force and effect during
the implementation and completion of the Work. By execution of this Agreement,
Owner is not providing any consent or agreement to the Contamination or conditions at
the Property and does not waive any rights or remedies in connection with any
Contamination at the Property.
b. Contractor shall deliver notice to Owner at envirownental ("i
lirstcoasteneray.conn at least seventy-two (72) hours' prior to every entry onto the
Property, which notice shall describe in reasonable detail a statement or scope of the
Work to be performed, its location on the Property, and an estimate of the duration of the
Work, and shall be accompanied by a copy of Contractor's site safety plan. Access shall.
be scheduled by Owner at times convenient to Owner and to Owner's tenants and/or
operators. Owner shall have the right to have a representative present and accompany
Contractor on the Property during access events.
C. Contractor shall control the dust, noise and other effects of the Work and
related activities using appropriate methods customarily utilized in order to control to
Owner's satisfaction the deleterious impacts of the Work and such effects.
d. Contractor shall minimize any disruption or inconvenience caused by the
Work and related activities to Owner and Owner's tenants and/or operators and the
business operations of Owner and Owner's tenants and/or operators, including but not
limited to location of the groundwater monitoring wells and collection of the groundwater
and soil samples. The Work shall not interfere with access, ingress or egress to or from
the Property by Owner or its tenants and/or operators, or the business invitees of Owner
and/or its tenants and/or operators. Contractor shall perform the Work at locations that
do not interfere with business activities of Owner, its tenants, operators vendors and/or
employees during working hours. Owner may prescribe hours during which Work may
not occur at the Property by separate .notice to Contractor.
e. Contractor shall allow Owner or its representatives to observe and monitor
the performance of the Work. Owner shall have the right to obtain split samples to be
provided by Contractor.
f. Contractor shall dispose of soil cuttings, any work and/or investigative
derived wastes, materials and/or water generated during the Work in accordance with all
laws. All such cuttings, wastes, materials and water shall be owned and controlled by
Contractor as the generator of such materials and shall be promptly removed from the
Property, in no event later than thirty (30) days after the generation of such cuttings,
wastes, materials or water.
2

g. Contractor shall repair any damage caused by the Work undertaken on the
Property and restore the Property to the condition existing prior to the Work.
h. As a portion of the Work, Contractor shall at no cost to Owner properly
and permanently abandon the groundwater monitoring wells installed by Contractor on
the Property, or otherwise existing on the Property, in strict conformance with the
requirements of the applicable governmental authority with jurisdiction over the
Property, including, without limitation, the requirements for use of any licensed water
well contractor. Contractor shall provide Owner a copy of a well abandonment report
confirming the proper abandonment of the groundwater monitoring wells.
4. Covenants of the Property Owner. Owner shall notify Contractor in accordance
with this Agreement prior to commencement of any construction or other site work that may
damage or destroy any part of the monitoring well(s) installed at the .Property so that Contractor
has an opportunity to take necessary actions to remove, protect, properly abandon and/or repair
or replace the well(s), as applicable, at no cost to Owner.
5. Information Sharing. Contractor shall provide Owner with all data collected by
Contractor and Contractor's agents, including but not limited to laboratory analysis, chain of
custody records, notes, reports reflecting sampling and analysis and laboratory test results
resulting from the Work promptly upon receipt or upon submittal to the agency of government
reviewing such reports, all at no cost to Owner.
6. Insurance. Prior to commencing and at all times during the performance of the
Work, Contractor shall maintain (and shall cause their subcontractors to maintain) policies of
insurance providing no less than following insurance coverages: Worker's Compensation and
Employer's Liability Insurance at the statutory amount; Commercial General Liability ("CGL")
Insurance with combined single limits of One Million Dollars ($1,000,000.00) per occurrence
and Two Million Dollars ($2,000,000.00) in the aggregate; Comprehensive Automobile Liability
Insurance (owned, non -owned and hired) with a combined single limit of Five Hundred
Thousand Dollars ($500,000.00); and Professional Errors and Omissions Insurance with limits of
One Million Dollars ($1,000,000.00) per incident and in the aggregate. A certificate evidencing
that Contractor holds the above -described coverages and that Owner is an additional insured
under the same is attached as Exhibit "D"; Contractor shall provide to Owner additional or
updated certificates of insurance evidencing the continuous existence of the required insurance
during the term of this Agreement prior to the expiration of any policy of insurance reflected on
the prior such certificate. Contractor agrees that the CGL policy shall be considered primary
insurance without recourse to or contribution from any similar insurance carried by Owner. The
insurance certificate shall contain a provision that coverage afforded under the policy evidenced
by such certificate will not be cancelled or changed without at least thirty (30) days prior written
notice to Owner.
7. Indemnity. Contractor shall indemnify, hold harmless and defend Owner from
and against any and all claims, demands, liabilities, causes of action, losses, costs, damages and
expenses (including reasonable attorneys' fees and expenses and court costs) that may be asserted
against or incurred by Owner in any way related to, caused by or arising out of or in connection
with (i) the acts or omissions of Contractor or any agents of Contractor in connection with the

Work undertaken on the Property, (ii) violations or liens that may be filed against the Property as
a result of the performance of the Work, (iii) personal injury, wrongful death, costs, expenses or
property damage resulting :from the performance of the Work at the Property, and (iv) injunctive
relief or other claims sought by any governmental authorities or third parties as a result of the
Work at the Property. Contractor shall not be required to indemnify Owner for claims, liabilities,
damages, losses or expenses caused by wrongful acts or omission of Owner. The provisions of
this paragraph shall survive the termination of this Agreement.
8. No Admission. The granting of the limited right of access herein by Owner is not
intended, and shall not be construed, as an admission of liability on the part of Owner or
Owner's successors and assigns for any Contamination that may now exist or may be discovered
in, on or under the Property or any adjoining property.
9. Miscellaneous.
(a) Entire Agreement. This Agreement shall constitute the entire agreement
between the parties regarding the conditional grant of access to Contractor for the
purposes of this Agreement, except in the event that Contractor and Owner execute a
document granting Contractor access to enter the property using a form prescribed by the
North Carolina Department of Environmental Quality or any other agency or unit of
government, in which event this Agreement shall govern in the further event of any
conflict between such document and this Agreement. No modification, amendment or
waiver of the terns and conditions of this Agreement shall be binding upon Owner or
Contractor unless approved in writing by an authorized representative of Owner and
Contractor.
(b) Governing Law: Venue. This Agreement shall be governed by and
construed in accordance with the laws of the State of North Carolina. Venue for any
action or proceeding arising from or relating to this Agreement shall be in the appropriate
North Carolina court having jurisdiction located in Mecklenburg County, North Carolina.
(c) No Severability_ Any provision of this Agreement that is prohibited or
unenforceable shall render this Agreement terminated as of the date on which such
prohibition or unenforceability is determined or asserted by any unit of government;
provided that Owner and Contractor by written supplement to this Agreement may
reinstate the remaining provisions of this Agreement.
(d) No Third Party Beneficiaries. This Agreement is solely for the benefit of
the parties to this Agreement and their respective successors and assigns and shall not be
deemed to confer upon third parties any remedy, claim, liability, or reimbursement, claim
of action or other right.
(e) Representations. Each of the parties to this Agreement represents and
warrants to the other that the party executing this Agreement has the authority to do so
knowing that each of the other parties to this Agreement are acting in reliance upon such
representation. The provisions of this Section shall survive the termination of this
Agreement.

(f) Notices. Any notice, demand, request, payment or other communication
which any party to this Agreement may be required or may desire to give under this
Agreement shall be in writing and shall be deemed to have been properly given (a) if
hand received, (b) if received via United. States mail service or other reliable express
courier service, or (c) if sent via confirmed facsimile or e-mail to the addresses set forth
in the preamble to this agreement, or other confirmed addresses of the parties other than
the Property address, and to the attention of the persons indicated below:
Notice to Owner:
Kevin J. Kusmirek
Director, Environmental
Southeast Energy, L.L.C.
7014 A. C. Skinner Parkway, Suite 290
Jacksonville, Florida 32256
Telephone: [phone]
Facsimile: [phone]
E-mail: kkusmirek�firstco�istenerL,,v.com
With a copy to:
Andrew Keith Daw
General Counsel
Southeast Energy, L.L.C.
7014 A. C. Skinner Parkway, Suite 290
Jacksonville, Florida 32256
Telephone: [phone]
Facsimile: [phone]
E-mail: kdaw ufirstcoasteneray.com
Notice to Contractor:
(balance of page intentionally left blank. -
signatures appear onfollowingpagel

IN WITNESS WHEREOF, the parties have executed this Property Access Agreement
under the sea] of the date first above written.
"OWNER"
SOUTHEAST .ENERGY, L.L.C., a
DelawarAlijiited liabcompany
L.
"CONTRACTOR"
_Singleton Environmental., .Inc.
By-
�--
Print Name: I
As its: Manager

EXFIIBIT "A"
LEGAL DESCRIPTION OF PROPERTY

Instrument# 2016011238 Book 920 Page 766
PENDING REVIEW FOR TAX LISTING
DATE 2016-12-22 BY KH
HAYWOOD COUNTY TAX CERTIFICATION
Mike E, Matthews, Haywood County Tax Collector
Date:2016.12-22 By: ssheitiil
There are no deliquent taxes due that are a lien ag2inst parcel(s)
Parcel Identifier Nc��8657-60-2189 and 8657-60-1243
Excise Tax: -
2016011238
HAYWOOD COUNTY NC FEE 526.00
NO TAXABLE CONSIDERATION
PRESENTED & RECORDED
12/22/2016 03,30:40 PM
SHERRI C. ROGERS
REGISTER OF DEEDS
BY: STACY C. MOORE
ASSISTANT
BK: RB 920
PG: 766 - 771
This instrument was G. Grey Littlewood.
prepared by: Nclsori Mullins Riley & Scarborough LLP
4140 Parklake ?Rve.
Raleigh, NC 2761.2
After recording.retum to: Grantee
Brief description for the Index:
131 Park Sweet I
NORTF1 CAROLINA SPECIAL WARRANTY DEED
TI-ITS DEED made this day of 2016 by and betwoen
7
:`TTEE
NORTH CA.ROLINA SEVEN, LLC ; SOLTT13EAST REAL, PROPERTY, LJ-.C.
a. Colorado limited liability company � a ,Delaware limited liability company
c/o hwestrnent Property Exchange Services, Tnc. 1 7014 A.C: Skinner Parkway, STE 290
675 Noi tll_ First Street, Suite 900 I Jacksonville, FL 322-56
San :lose, CA 95.112 1
Submitted electronically by "Nelson Mullins LLP"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Haywood County RegisLer of Deeds.

Instrument# 2016011238 Book 920 Page 767
`Me designation Grantor and. Grantee as used. herein. shall include said parties, their heirs,
successors, and assigns, and shall include s'ngrilar, plural, masculine, -feminine or neuter as
required by context.
ti'VI I.'NESSETH, that the Grantor, for a valuable consideration -paid by the Grantee, the
receipt of wltrcl3 hereby is acknowledged, has and by these presents does grant, bargain, still and
convey to the Grantee in fee simple, all that certain lot or parcel of land and the improVements
thereon situated in Haywood County, North. Carolina. and more particularly described in Exhibit
A (collectively, the "Property'), which is attached hereto and incorporated herein by.reference.
The :P'ropetty was acgctired by Grantor by .instrument recorded in Book 76 Pagee U77.
Haywood County, North Carolina Register of Deeds.
TO I-LkVE AND TO HOLD the aforesaid Property and all privileges and appurtenances.
thereto belonging to the Grantee in fee simple.
.And Grantor covenants with the. Grantee that Grantor has done nothing to impair such
title as. Grantor received, and Grantor will warrant and defend the title against the lawful claims
of all persons claiming by, under, or through Grantor, except for t
staled_ he exceptions hereinafter
Title to the Property is subject only to the exceptions as set forth in Fxh%bit B attached
hereto and incorporated herein by reference and none ()thers.
THE PROPERTY BEREIN' CONVEYED DOES NOT INCLUDE THE PRAIARY
RkSMEINtCE OF GRANTOR.
[REMAINDER OFPAGEINTENTIONALLY LEFT BLANK.
S IGNATURE PAGE. FOLLOWS]

Instrument# 2016011230 Book 920 Page 768
IN WITNESS WHEREOF, the Grantor has caused. this instrunjent to be sighted its its
corporate zrame try its duly authorized officers and its seal to be hereunto affixed by authority of
its Board ofDirectorsy the day and year first above written,
GRANTOR:
NORTH CrAROL•1N.4,. SEVEN, L11-C,
a 'Colorado lianited liability company
BY: N4onal. Safe Harbor Exchanges
a California corporation, its Sole. Member
--'Paulo Sanchez, Assistant Vice Preside t\
STATE. OF
COUNT TY OF
I certify that the following person(s) personally appeared before zne this day, each.
acknowledging to me that :be or she voluntarily signed the foregoing document: PALTLQ
SANCI=IEZ
Sworn to -(or affirmed) and subscribed before me, this clay. of 2016.
Notary Public
Print Name-
%1Vate: 1' otai y Public. inus't sign exizctly as notarl, sea1J
My Commission Expires:.
[NOTARY .SEAL]

Instrmmtent# 2016011238 Book 920 Page 769
CALIFORNIA ALL-PURPOSE CERTIFICATE OF A CKNtiWLEi3CMCENT
knotat-ypubiic or other of cct completing this certificare.vCbfiesctnlythe identih ofthe individual who -signed le.
doctiment to
v kh this certificate isattached, anal not the trLthfitlness;.accumLj,, or• va`:idity of that docutt eat,
State of California
County of Santa Clara
Cl) 92/10/16 before me C N___ is _ Notat'y Public,
{Fiore insatt.narne and title ofthe ofFi—)
personally appeared ---'_- ----- Pau.3:o Sanchez ___ ----------- _------
who proved to me .on the basis of satisfactory evidence to iiy the person(s) �vlra;e nanie(s) is/are subscribed to
.tile within .instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized
capacity.(ies),-and that by his/her/their signatures) .on the instrument the person(s), or the .entity upon behalf of
Which thepersont(s) acted, executed the instrument.
I certify under PENALTY dF PERJURY under the laws of the State of California that the foregoing paragraph
is true and correct.
WFI`NI SS my Nuid and official seat.
Signaaird ofNotary Public
%ot<iry f'utmiic - iFr.«nia
t
,3
n
$t!til i iar;l vLtrffly
a
Ny Corrin. tlir S Jan 26, ?q(
(1.4otaty Seal)
AI3IJMONAL. OPTIONAL INFORIMATIO.N,
j DESCRIPTION OP T14E ATTACHED DOCUMENT
North Carolina Special Warranty Deed
v {'i'itle or r,'es;,riptiiiti ot'attnchetl document)
{Tit; orde's. criptio;r ot';tit!nched document contirruet!?
Nxiniber of Pages _____ Document Date
I
t
(Additional information)
.CAPACITY CLAIMED BY THE SIGNER
Individual (s)
❑ Corporate Officer
❑ Partner(5)
Attorney -in -Fact.
Trustea(s)
❑ Other _
INSTRUCTIONS FOR COM- PLETING THIS FORM
;illy aclarawlgdgjnent contplered in Caftfornia ti»tstcontain verbsrge exactly as
appears above in the notary section or a separate; uck nowlidgm. dtir.fona must be
properly complered and attached to that doetuiwa. TTur tali etespdwt is if a
document is to be reemded outride gfCafilornia. ln.rnrh instances; atty alreniatire
acAnowledgment :verbiage as +nay be,prinred on such a docteeant so long as the
wrbiago does not rerpdt,c the itoiakV to fast nothing ihar is illegal far a itntary in
raVamia (Le. cortlying tine ataborized capacity of the sYgrret). Please chec}; the
document careftd tvfor propernuweW wondfngmidatrach thi.rfarin ifregtdred.
• State and County information ntu.,Lbe-the State and County where thedocument
sig lens) personally a appaarcd.before ilte notan- public for acknowledgment.
• Date or noWrimlion must be the date that the signer(s) personally appeawd syhicit
must also be the same date the acknowledginent is domplemd
• The notnty public most. print his .other name as it, appear-, within his or het
commission fatlaived by a comma and then your title (notary public).
• ;piiut the notne(S) of d0ou5tmeril slgher(5) who personally appear at the time of
notarization.
. Indicate the coirect:singular or pluralforms by crossing off incorrect forms (i.e.
helsheltite; ;, is Iwo.) or circling the correct forms. Failure to correctly indicate this
information may lead to retention of document teeording.
The notary seal impression must lio clear anal pbotographicaPy reproducible.
Impression must not cover text orlines. If seal impression smudges, to-seol if a
sufficientarcm permits, otherwise catrtplcte a different acknowledgment form.
• Signature of the notary public _oust match the signature on file with the officeof
the county cleric.
C• ilddi6cnal information is not nmuired bet could help to ensure this
acknowledgment is not tnisuscd or attached to a diff' rent document
indicate title or type nfattached document, numi5er of pages and date.
indicate.the.capacity claimed by the sign,-. Ifihc Claimed capacity is a
corporata.off icer, indicais the title (i,c. CEO, C.10
; Secretary).
• Securely attach this document to the signed document
C10114-:015 Pr_U.k Sty,hgSm4,r. Int.-All R1g&t Ren. tdu—Y.Ta,Nrot:rk:ton-9P,?or.,4& vbiarlSer4ce

Instrument# 2016011238 Book 920 page 770
Store No. --- 131 Park Street
Lying -and being in Haywood County, North Carolina, and more particularly described as follows;
BEING all of that 0.405 acre parcel and that 0.soq.. acre parcel as shown an plat recorded in Plat Cabinet
C, Slide 5528.

Inst—ment# 2016011238 Book 920 Page 771
.Bi..1Al<IIBIT B
Permitter) .KxL-e-ptions
1- Taxes and assessinetits for the year 2016 and subsequent.years, not yet due anti payable.
2. Terms, Provisions, covenants, conditions, restrictions, easements, chat'ges, assessinents
and liens provided in The Covenant`s, Conditions and R-estnQtions recorded in Deed Book
60; Page. 3 Haywood Cmm Registry, b
restriction, ut omitting any covenant, condition or
restriction, if any; based orn race, color, .religion, sex, handicap, familial status, or rnational
origin unless and. only to the extent that the covenant, condition or restriction (a) is.
exempt under 'title 42 Of the United States Code, or (b). z'elates to handicap, .but does not -
discriminate against handicapped persons..
3. Easement(s) to Carolina Po1v_ et- and Light Company recorded in Book.196, Page 223;
Haywood County Registry.
4. Matters as shown on survey dated April 15, 2016, last revised July 28., 2016, by Jimmy F.
Cain, P.L.S. as follow:
a. Frame, building with.. metal siding .lies within approximate flood line and vvithin
both Flood Zo-no X and Zone AE.
131 PARK STREET

EXHIBIT "B"
PROPERTY ELIGIBILITY LETTER
(attaclied)

EXHIBIT "C"
PERMISSION TO ENTER PROPERTY
(attached)
�roL�stt"tL
CAP-c,�e3 ci�-C(eck lDccjAi'CW\ 0A, &OC-�� -slVe
MG
E

I
Source: 2015 Digital Orthoimagery obtained from NC OneMap GeoSpatial Portal.
g �r ya 4
% xv,i Si I
1 pqR APPROXIMATEAREAOF
FORMER LIST. BASIN
i TMWS d
# MEHAFFEY yqr
d �AUTO+SALES `• ; Nsr
MW-Z
— �*RESIDENTIAL
a Vc
" Thcirdo f:on includ (his g:aphk rep/esonlatiIXl has been compiled /rums 1 venely a/sowcea enJ bt .f ro change wahoot rr..'lce. KiaM ider makes no i
-� reprasentatwns or vranaMa; erp-e,:-or rmpGad ns ro xcuncy, canp.Waxsx _
L limaliners ornglJs to the a:o of such in(on^aton Thu dac:pp g a no! arterdod
e . for use as a rand suR V product nor's 2 desgnod or i;fan,s d ea a ccn:rructon
dasjn docu d the use ormisuae a'Iho i� rmar.'Jn mmained on thiz graphic
-- rep'e Malion is at fhe sole risk o/ ere paey _xg ar rnsu-ing tha w—ation.
PROJECT NO. 20170275.001A
DRAWN: 602016
KL E/NF,EL DER DRAWN BY: JP
Bright People. RightSolutions. CHECKED BY: RCB
FILE NAME: 16-0601-131
wvrw.kleinfelderc°m ParkStPhase2-Aerial.mxd
Y SS-1/TM 1
MW-1 RW_1 .
a�
7 �
b
TAN
(HEATING OIL -AST"
"
PROXIMATE FORMER AST: BASIN
Leaend
APPROXIMATE LOCATION OF PRE-EXISTING
Y MONITORING WELL
APPROXIMATE LOCATION OFSOILSAMPLE
AND TEMPORARY MONITORING WELL
APPROXIMATE LOCATION OFTEMPORARY
°& MONITORING WELL
Aerial Photograph
131 Park Street
Canton, Haywood County, North Carolina
FIGURE
2

EXHIBIT "D"
INSURANCE CERTIFICATE
S
(attached)
10

ACORN® CERTIFICATE OF LIABILITY INSURANCE
DATE (MWDD/YYYII)
6/5/2020
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 ternTs 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
CONTACT
NAnF Tina Young
Bankers Insurance, LLC
77 Central Avenue
Suite C
PHONE
a 828-253-2371 AFA7C/ No•828-252-4174
bankersinsurance.net
[e-mail]
INSURERS AFFGRDING COVERAGE
NAIL#
Asheville NC 28801
INSURERA: Owners Insurance Company
32700
INSURED SINGENV-01
INSURER B. Homeland Insurance Company of New York
34452
Singleton Environmental, Inc.
PO Box 2012
lNsuRERc: Employers Preferred Insurance Company
10346
INSURER D.-
Enka NC 28728
INSURER E :
INSURER F :
CnVFRAr.11 CERTIFN;OTE NUMBER! 7I1551Fi..if415 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.
MR
LTR
TYPE OF INSURANCE
ADDL
POLICY NUIMER
POLICY EFF
POLICYEXP
LMTS
B
X
C0MVERCWLGENERAL LIABILITY
Y
793-00-79-18-0001
4/21/2020
4/21/2021
EACH OCCURRENCE
$1,000,000
� OCCUR
_7
DAMAGE TO
RENTECLAIMS-MADE
PREMISESEa occu D r,.
s 50,000
MED EXP (Anyone person)
$ 5,000
PERSONAL 8 ADV INJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
51,000,000
POLICY ❑ PO -JET LOC
PRODUCTS - COMP/OP AGG
$1,000,000
$
OTHER:
A
AUTOMOBILE LIABILITY
5172934600
4/21/2020
4/21/2021
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
I
BODILY INJURY (Per accident)
$1,000,000
PROPERTY DAMAGE
Per accident
$
X HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
UFABRELLJILJAR
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LWB
CLAIMS -MADE
DED RETENTION $
s
C
WORICERSCONPENSA71ON
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE Y/ I
EIG453778000
4/21/2020
4/21/2021
X STATUTE ERH
E.L. EACH ACCIDENT
$ 100,000
OFFICER/MEMBEREXCLUDED? ❑
N/A
(Mandatory In I"
E.L. DISEASE - EA EMPLOYEE
$100,000
E.L. DISEASE - POLICY LIMIT
s 500,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
B
Professional Liability
793-00-79-18-0001
4/21/2020
4/21/2021
Ocwrrence
Aggregate
1,000.000
1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 1D1, Additional Remarks Schedule, may be attached if more spare is required)
Certificate holder is an Additional Insured with respect to General Liability where required by written contract.
Southeast Energy, LLC
Southeast Energy, L.L.P. and
First Coast Energy, L.L.P.
7014 A.C. Skinner Pkwy, Ste. 29
Jacksonville FL 32256
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE IIVrT}t THE POLICY PROVISIONS.
11
IT»
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