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Insurance - CR&R - 2014-03-24CR &RING -03 SUOS '441.. P CERTIFICATE OF LIABILITY INSURANCE OAT /2412D/YYYY) 3/24/2014 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 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 Solid Waste Insurance Managers 115 N. El Molino Ave -" P.O. Box 7072 S77,,l, yt, Pasadena, CA 91101 t+7 i'T CONTACT NAME: _p HONE FAX AIC No Est: A/c No: E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC4 u RER A:XLSPECIALTYINSURANCECOMPANY Ir T INSURED CR &Rlncorporated "`'" `'I' INSURER a: $ Haulaway Storage Containers, Inc. INSURER C: 11292 Western Avenue Stanton, CA 90680 INSURER D: INSURER E E TO RENTS PREMISES Ea occurrence INSURER F MED EXP (Any one person) $ COVERAGES CERTIFICATE NUMBER: RFvtslr)N NUMBER: 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDD /YYYV 1 POLICY EXP (MMIDDNYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR E TO RENTS PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL &ADV INJURY $ GENERALAGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGO $ POLICY PRO LOG $ AUTOMOBILE LIABILITY EDD SINGLE LIMIT EOa aBI $ BODILY INJURY (Per person) $ ANY AUTO A O SCHEDULED AUTOS AUTOS BODILY INJURY accident (Per J $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ A AND EMPLOYERS' LIAHIL ITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? N N/A RWD943520907 4/1/2014 41112015 X ORV LA I ITS DER E.L. EACH ACCIDENT $ 1,000,06 E.L. DISEASE - EA EMPLOYEE $ 1,000,06 (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,66 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) California Cancelation Endorsement- WC040601A Re: All Operations CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010105) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District ry ,(\ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. �\\ 628 W. 19th Street y�\\ Costa Mesa, CA 92627- AUTHORIZED REPRESENTATIVE ACORD 25 (2010105) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 06 01 A (Ed. 12 -93) CALIFORNIA CANCELATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. The cancelation condition in Part Six (Conditions) of the policy is replaced by these conditions: Cancelation: 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancelation is to take effect. 2. We may cancel this policy for one or more of the following reasons: a. Non - payment of premium; b. Failure to report payroll; C. Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy issued by us; d. Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or any previous policy issued by us; e. Material misrepresentation made by you or your agent; f. Failure to cooperate with us in the investigation of a claim; g. Failure to comply with Federal or State safety orders; h. Failure to comply with written recommendations of our designated loss control representatives, i. The occurrence of a material change in the ownership of your business; j. The occurrence of any change in your business or operations that materially increases the hazard for frequency or severity of loss; k. The occurrence of any change in your business or operation that requires additional or different classification for premium calculation; I. The occurrence of any change in your business or operation which contemplates an activity excluded by our reinsurance treaties. 3. If we cancel your policy for any of the reasons listed in (a) through (f), we will give you 10 days advance written notice, stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. If we cancel your policy for any of the reasons listed in Items (g) through (1), we will give you 30 days advance written notice; however, we agree that in the event of cancelation and reissuance of a policy effective upon a material change in ownership or operations, notice will not be provided. 4. The policy period will end on the day and hour stated in the cancelation notice. Notes: 1. This endorsement, or any other endorsement having the same substantive provisions, must be attached to a policy showing California in Item 3.A. of the Information Page. 2. Cancelation of the policy is governed by California Insurance Code Section 676.8. 3. This endorsement amends the NCCI standard contract by replacing the cancelation condition in Part Six, "Conditions:' This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective April 1, 2014 Policy No. RWD943520907 Endorsement No. Insured CR &R INCORPORATED Insurance Company XL Insurance America, Inc. Countersigned By / 7 C/� © Copyright 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.