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Insurance - Waste Management Holdings Inc. 2016-12-07AC"R& CERTIFICATE OF LIABILITY INSURANCE 141 1/1/2018 IDATE(MM/OOIY(YY) 12/7/2016 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. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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). TYPE OF INSURANCE PRODUCER LOCKTON COMPANIES 5847 SAN FELIPE, SUITE 320 HOUSTON TX 77057 866-260-3538 CONTACT POLICY NUMBER PHONE INC,No, Ext): MC No): POLICY EXP M DO/YYYY E-MAIL ADDRESS: A INSURER(SI AFFORDING COVERAGE NAICN INSURER A: ACE American Insurance Company 22667 INSURED WASTE MANAGEMENT HOLDINGS, I NC. & ALL AFFILIATED, 1306000 RELATED& SUBSIDIARY COMPANIES INCLUDING: AIM CURBSIDE, LLC 500 S. JEFFERSON PLACENTIA CA 92870 INSURER B: Indemnity Insurance Co of North America 43575 INSURER C: ACE Pro a &Casual Insurance Co 20699 INSURER D: ACE Fire Underwriters Insurance Company 20702 INSURER E ,SURER F: DAMAGE TO RENTED j OOO OOO PREMISES Ea occurrence COVERAGES CERTIFICATE NUMBER- 11076631-RFVISION NHMRFR- 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 AODL INSD SUBR VIVD POLICY NUMBER POLICY EFF MM/DDNYYY POLICY EXP M DO/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y HDO G27860825 1/1/2017 1/1/2018 EACH OCCURRENCE 5,000,000 CLAIMS-MADEFx] OCCUR DAMAGE TO RENTED j OOO OOO PREMISES Ea occurrence MED EXP (Any one erson XXXYMX X XCU INCLUDED - PERSONAL 8 ADV INJURY $ 5,000,000 X ISO FORM 0000010413 GEN'L AGGREGATE LIMIT APPLIES PER. POLICY JECT � LOG GENERAL AGGREGATE $ 6 000 000 PRODUCTS - COMP/OP AGO $ 6 000 000 $ OTHER: A AUTOMOBILE LIABILITY Y Y MMT H09052884 I/I/2017 1/1/2018 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ Y i[ ;X X ANY AUTO X AUTOS ONLY SCHEDULED BODILY INJURY (Per aDad.nt $ ){XXX�;X X AUTOS ONLY X AUTOS ONLOY Per arE. ide DAMAGE $ xy {j{X�{j{ $ X){X Mx X MCS -90 C X UMBRELLA LIAB X OCCUR Y Y XOO 627929242002 1/1/2017 1/1/2018 EACH OCCURRENCE $ 1$000000 AGGREGATE $ 15,000,000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ )XXXX){X H A D WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETORPARTNER/EXECUUVE YIN OFFICERIMEMSER E CWDEDi N❑ IMandamry in NH) If yes, descrim under DESCRIPTION OF OPERATIONS Mi. N/A Y WLR 049106944 (AO$) WLR 049106907 AZ,CA,&MA SCF C49106981 ( 1/1/2017 1/1/2017 1/1/2017 1/1/2018 1/1/2018 1/1/2018 PER OTH- X STATUTE ER E.L. EACH gCCIDENT $ 3000 �00 E.L. DISEASE - EA EMPLOYEE 3,000,000 E.L. DISEASE -POLICY LIMIT 1,3,000,000 00000 A EXCESS AUTO LIABILITY Y Y XSA H09052872 1/1/2017 1/1/2018 COMBINED SINGLE LIMIT $9,000,000 (EACH ACCIDENT) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be aftached if more space is required) BLANKET WAIVER OF SUBROGATION IS GRANTED M FAVOR OF CERTIFICATE HOLDER ON ALL POLICIES WHERE AND TO THE EXTENT REQUIRED BY WRITTEN CONTRACT WHERE PERMISSIBLE BYLAW CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED(EXCEPT FOR WORKERS' COMPEL) WHERE AND TO THE EXTENT REQUIRED BY WRITTEN CONTRACT. ADDITIONAL INSURED M FAVOR OF COSTA MESA SANITARY DISTRICT, THEIR ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS, VOLUNTEERS AND EMPLOYEES (ON ALL POLICIES EXCEPT WORKERS' COMPENSATION/EL) WHERE REQUIRED BY WRITTEN CONTRACT. THE INSURANCE AFFORDED TO THE ADDITIONAL INSURED AS DESCRIBED IN THIS CERTIFICATE OF INSURANCE FOR WORK PERFORMED BY THE NAMED INSURED IS PRIMARY AND NON-CONTRIBUTORY TO ANY SIMILAR COVERAGE MAINTAINED BY THE ADDITIONAL INSURED WHERE AND TO THE EXTENT REQUIRED BY CONTRACT. 30 DAYS NOTICE OF CANCELLATION IS INCLUDED ON THE POLICIES. 1 �I ^ - /I 1 • 11076631 ` Y 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 COSTA MESA SANITARY DISTRICT 628 WEST 19TH STREET COSTA MESA CA 92627 C5 — ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATIC119. All rights reserved The ACORD name and logo are registered marks of ACORD POLICY NUMBER: HDO G27860825 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 II) 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 Attachment Code: D446557 Master ID: 1306000, Certificate fD: 11076631