Insurance - CR&R Haulaway Storage Containers, Inc. 2019-01-07-� CR&RINC-01 MG91408E
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)01/07/2019
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 License # OE77964 CONTACT
NAME:
Solid Waste Insurance Marketing
P.O. Box 7072 (AtCNNo, Ext): (626) 795-9000 (A//c, No):(626) 577-8940
Pasadena, CA 91109 AD AIL
INSURED
CR&R, Inc. Haulaway Storage Containers, Inc.
11292 Western Avenue
Stanton, CA 90680
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: XL Insurance America _ 24554
INSURER B:
INSURER C :
INSURER D:
INSURER E
INSURER F:
nr%1kI=MA9±G@ /%CE21r1C11%ATC K11IRAQC0- 0=11ICIr%Kl Ail11UR1:R-
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.
Costa Mesa Sanitary District
�Y
INSR TYPE OF INSURANCE ADDL;SUBR POLICY NUMBER POLICY EFF POLICY EXP
LTR INSD WVD MM/DD/YYYY MM/DD/YWY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $
CLAIMS -MADE OCCUR
DAMAGE TO RENTED
PREMISES (Ea occurrence)_ $
AUTHORIZED REPRESENTATIVE
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE $
POLICY JECT LOC
PRODUCTS -COMP/OP AGG $
OTHER:
$
COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY
(Ea accident) $
ANY AUTO
BODILY INJURY (Per person) $
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident) . $
HIRED NON -AWNED
PROPERTY DAMAGE
(Per accident) $
AUTOS ONLY AUTOS ONLY
UMBRELLA LIAB OCCUR
EACH OCCURRENCE $
EXCESS LIAB CLAIMS -MADE
AGGREGATE $
DED RETENTION $
$
A WORKERS COMPENSATION
PER
X STATUTE EERH
AND EMPLOYERS' LIABILITY YIN
N RWD943620911 04/01/2018 04/01/2019
1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? N / A
E.L. EACH ACCIDENT $
9,000,000
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
1,000,000
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Earlier Notice of Cancellation Provided by Us WC990110 (Ed. 1/08)
A Tr 111 r%r-M !-A k1f%M1 1 ATIAAI
ACORD 25 (2016/03) W 19ss-ZU15 AL;UKU c:UKrUKA I IUN. Ali rlgnis reserves.
The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Costa Mesa Sanitary District
�Y
ACCORDANCE WITH THE POLICY PROVISIONS.
290 Paularino Ave.
Costa Mesa, CA 92626
t
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03) W 19ss-ZU15 AL;UKU c:UKrUKA I IUN. Ali rlgnis reserves.
The ACORD name and logo are registered marks of ACORD
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
EARLIER NOTICE OF CANCELLATION PROVIDED BY US ENDORSEMENT
This endorsement modifies insurance provided under the following:
WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY
Number of Days Notice: 60
WC.99 01 10
(Ed. 1/08)
(If no entry appears above, information required to complete this Schedule will be shown in the Declarations as
applicable to this endorsement.)
For any statutorily permitted reason other than nonpayment of premium, the number of days required for notice of
cancellation, as provided in PART SIX — CONDITIONS, D. Cancelation of the Workers' Compensation and
Employers' Liability Insurance Policy or as amended by an applicable state cancellation endorsement, is increased to
the number of days shown in the Schedule above.
All other terms and conditions remain the same.
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
04-01-2018 to 04-01-2019
Insured
CR&R Incorporated
Insurance Company
XL Insurance America, Inc.
WC 99 01 10
Ed. 1/08
Policy No.
RWD9435209-11
Countersigned by
0 2007 XL America, Inc.
Endorsement No.