Insurance - Waste Management - 2017-12-11ACOOR"' CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DDNYYY)
L� I/l/2019
1 12/11/2017
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).
PRODUCER LOCKTON COMPANIES
3657 BRIARPARK DRIVE, SUITE 700AIC,
HOUSTON TX 77042
866-260-3538
CONTACT
NAME:
PHONE EXt : AIC, No
E-MAIL
ADDRESS:
INSURER(SlAFFORDING COVERAGE IC It
INSURERA: ACE American Insurance Companyl 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 Cc of North America/ 43575
INSURERC: ACE Fire Underwriters Insurance Company/ 20702
INSURER D:
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
INSD
SUBR
WVD
POLICYNUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MMIDD/YYYY
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
Y
Y
HDO 627873091
1/I/2018
1/1/2019
EACH OCCURRENCE 5,000,000
CLAIMS -MADE � OCCUR
PREM,SES Ea RENTED 5,000,000
MED EXP (Any oneperson) XXXXXXX
X XCU INCLUDED
X ISO FORM CG00010413
PERSONAL & ADV INJURY $ 5,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY JECT rX7 LOC
GENERAL AGGREGATE $ 6,000,000
PRODUCTS - COMP/OP AGG $ 6,000,000
$
OTHER:
A
AUTOMOBILE
LIABILITY
Y
Y
MMT H25097890
I/I/2018
(/1/2019
EeeoclEDISINGLE LIMIT $ 1,000,000
BODILY INJURY (Per person) $ XXXXXXX
X
ANY AUTO
X
AUTOS OWNEDSCHEDULED
BODILY INJURY (Per accident $
XXXXXXONLV
XU
X OSONE
ONLY AUUT
PROPERTY
(Per accident) $XXXXXXX
$ XXXXXXX
X
MCS -90
A
X
UMBRELLALIAB
X
OCCUR
Y
Y
X00 027929242 003
1/1/2018
1/1/2019
EACH OCCURRENCE $ 15,000,000
AGGREGATE $ 15 000 000
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$ XXXXXXx
B
C•
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXECUTNE YIN
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH)
N/A
Y
WLR C64622778 (AOS)
WI'R064622778(AZ,CA,RCMA1/1/2018
SCF C64622791(WI)
1/1/2018
1/1/2018
1/1/2019
1/1/2019
1/1/2019
PER OTH-
X STATUTE Eft
ELEACHACCI�ENT s3000000
E.L. DISEASE - EA EMPLOYEE 3,000,000
u yes, descne, under
DESCRIPTION OF OPERATIONS Wre
E.L. DISEASE -POLICY LIMIT 3,000,000
A
EXCESSAUTO
LIABILITY
Y
Y
XSA H25097889
1/1/2018
1/1/2019
COMBINED SINGLE LIMIT
$9,000,000
(EACH ACCIDENT)
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
BLANKET WAIVER OF SUBROGATION IS GRANTED IN FAVOR OF CERTIFICATE. HOLDER ON ALL POLICIES WHERE AND TO THE EXTENT RE HIRED BY
WRITTEN CONTRACT WHERE PERMISSIBLE BY LAW. CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED (EXCEPT FOR WORKERS' COMPILE)
WHERE AND TO THE EXTENT REQUIRED BY WRITTEN CONTRACT. ADDITIONAL INSURED IN FAVOR OF COSTA MESA SANITARY DISTRICT, THEIR
ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS, VOLUNTEERS AND EMPLOYEES (ON ALL POLICIES EXCEPT WORKERS' COMPENSATIONEL)
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.
11076631
COSTA MESA SANITARY DISTRICT
COSTA MESA CA 92627
ACORD 25 (2016/031
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
C5)—,:;
n1988-2015 ACORD CORPORATIOW. All rights
The ACORD name and logo are registered marks of ACORD
Attachment Code : D446557 Master ID: 1306000, Certificate ID: 11076631
POLICY NUMBER: HDO G27873091 Endorsement Number: 37
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 will 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 1185 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1