Insurance - Waste Management Holdings - 2015-12-07ACO/20° CERTIFICATE OF LIABILITY INSURANCE
L� 1112017
DATE (MM/DD YYYY)
12/7/2015
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(les) 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 LOCKTON COMPANIES
5847 SAN FELIPE, SUITE 320
HOUSTON TX 77057
866-260-3538
CONTACT
NAME
PHON FAX
ac No E:r: ac No:
E-MAIL
INSURER(S)AFFORD(S) AFFORDING COVERAGE NAIC#
INSURER A: ACE American Insurance Company -1 22667
INSURED WASTE MANAGEMENT HOLDINGS, INC. & ALL AFFILIATED,
1306000 RELATED& SUBSIDIARY COMPANIES INCLUDING:
WM CURBSIDE, LLC
500 S. JEFFERSON
PLACENTIA CA 92870
INSURER B: Indemnity Insurance Co of'Norlh America 43575
INSURERC: ACE Property &Casua Insurance Coy 20699
INSURER D : ACE Fire Underwriters Insurance Companyi 20702
INSURER E:
INSURER F,
COVERAGES CERTIFICATE NUMBER: 11076631 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
LTR
TYPE OF INSURANCE
ADDL
IH$D
SUBR
1YVD
POLICY NUMBER
POLICY EFF
[MMIDDIYYYY
POLICY EXP
IMMIDD1y)`y`Y
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
Y
Y
HDO G27403311
1/1/2016
1/1/2017
EACH OCCURRENCE 5,000,000
-RENTED
CLAIMS -MADE OCCUR
X
DAMAGE TO
PREMISES fEa occurrence 5,000,000
MED EXP (Any oneperson) XXYY)=
X XCII INCLUDED
PERSONAL & ADV INJURY $ 5,000,000
X ISO FORM 0000010413
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY JERCOT FX LOC
GENERAL AGGREGATE $ 6,000,000
PRODUCTS -COMPIOP AGG $ 6,000,000
$
OTHER
A
AUTOMOBILE
LIABILITY
Y
Y
MMI' H08866326
1/12016
1/I/2017
Ee acceldimtSINGLE LIMIT $ 1,000,000
X
ANYAUTO
BODILY INJURY (Per person) $ y'vvvv)
X
AUTOWNED gUTOSULED
BODILY INJURY (Per accident s XXXXX)a
X
HIRED AUTOS X AUTOSWNED
Per acc de DAMAGE $ XXXXX} x
X
MCS -90
$ XXXXXX7C
C
X
UMBRELLA LIAB
X
OCCUR
Y
Y
XOO G27929242 001
I/I/2016
1/1/2017
EACH OCCURRENCE s 15,000,000
EXCESS LIAB
CLAIMS -MADE
AGGREGATE $ 15,000,000
DEO I I RETENTION $
$ X)O XXXX
B
A
D
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YIN
ANY
NFlCER/MEMBEREXCTNEW ECUTIVE
N❑
NIA
Y
( )
WLR `I 048596700 (COS&MA
SCF 048596848 ( WW11)) )
1/1/2016
I/I/2D16
1/1/2016
1/1/2017
I/I/2017
1/2017
PER OTH-
X STATUTE FR
EL EACH ACMDENT $ 3,000,000
EL. mSEASE-EA EMPLOYEE 3,000,000
(Mandatory in NH)
II yes, dese iEe uMer
DESCRIPTION OF OPERATIONS below
EL DI EE LE -POLICY LIMIT 3,000,000
A
EXCESS AUTO
LIABILITY
Y
Y
XSAH08866314
1/1/2016
1/1/2017
COT.MIN®SINGLE LWT
$9,000,000
(EACH ACCHDENl)
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached H more space is required)
(BLANKET WAIVER OF SUBROGATON IS GRANTED IN FAVOR OF CERTIFICATE HOLDER ON ALL POLICIES WHERE AND TO THE EXTENT
FAVORD AS AN ADDITIONAL
OF COSTA FORADDITIONAL
MESA KERS' CONTRACTD BY WRITTEN MPDIS/EL CW HIE OFANDD TORS, THE
U OYEB (W WRITTEN
ALL CONTRASIBLE BY LAW. CERTIFICATE HOLDER IS CT.
AND ENI P Wp WORKERS'
COMPENSATION/EL) WHERE REQUIRED BY WRITTEN CONTRACT.
11076631
COSTA MESA SANITARY DISTRICT �� t
ATTN: SCOTT CARROLL
628 WEST 19TH STREET
COSTA MESA CA 92627
ACORD 25 (2014/01)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
M
The ACORD name and logo are registered marks of ACORD
All rights reserved
POLICY NUMBER: HDO G27403311 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED — OWNERS, LESSEES OR
CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization: ANY OWNER, LESSEE OR CONTRACTOR WHOM YOU HAVE
AGREED TO INCLUDE AS AN ADDITIONAL INSURED UNDER A WRITTEN CONTRACT, PROVIDED
SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF LOSS.
(If no entry appears above, information required to complete this endorsement would be
shown in the Declarations as applicable to this endorsement.)
WHO IS AN INSURED (Section ll) is amended to include as an insured the person or
organization shown in the Schedule, but only with respect to liability arising out of "your
work" for that insured by or for you.
CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984
RECEIVEr)
Attachment Code: D446557 DEC 14 2015
Master ID: 1306000, Certificate ID: 11076631