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Insurance - WM Curbside - 2013-01-07 AWi De CERTIFICATE OF LIABILITY INSURANCE 1,1,2014 DATE(M2013�) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 0 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 LOCKTON COMPANIES,LLC CONTACT 5847 SAN FELIPE,SUITE 320 pHOE FAX HOUSTON TX 77057 (A/C,No,Eat): (A/C,No): E-MAIL 866-260-3538 ADDRESS: INSURER'S)AFFORDING COVERAGE NAIL# INSURER A: ACE American Insurance Company 22667 INSURED WASTE MANAGEMENT HOLDINGS,INC.&ALL AFFILIATED, INSURER B: Indemnity Insurance Co of North America 43575 1306000 RELATED&SUBSIDIARY COMPANIES INCLUDING: INSURER c: ACE Property&Casualty Insurance Co 20699 WM CURBSIDE,LLC • 500 S.JEFFERSON INSURER D: PLACENTIA CA 92870 INSURER S: INSURER F: COVERAGES CERTIFICATE NUMBER: 1 107663 1 • 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. MR TYPE OF INSURANCE ADDL SUBR POUCY NUMBER IMM/DD/YYYYL(MM/DDY/YYYYI LIMITS A GENERAL UABIUTY y y HDO G27015189 1/1/2013 1/1/2014 EACH OCCURRENCE $ 5,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(a RENTED $ 5.000,000 CLAIMS-MADE©OCCUR MED EXP(Any one person) $ XXXX? �X X XCU INCLUDED PERSONAL&ADV INJURY $ 5.000,000 X ISO FORM CG 00011207 GENERAL AGGREGATE $ 6,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 6,000,000 7 POLICY n GA128,-- I PI LOC $ A AUTOMOBILE LIABILITY Y y MM'fH08712293 • 1/1/2013 1/1/2014 COMacciBINEDSINGLELIMIT (Ea dent) $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX 0 —sf ALL OWNED —SCHEDULED BODILY INJURY(Per accident $ XXXXXXX AUTOS AUTOS NON OWNED PROPERTY DAMAGE $ XXXXXXX X HIRED AUTOS X AUTOS .(Per accident( X MCS-90 $ C X UMBRELLA UAB X OCCUR - Y y XOO G27048201 1/1/2013 1/1/2014 EACH OCCURRENCE $ 15,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 15,000,000 DED I RETENTION$ $ XXXXXXX B WORKERS COMPENSATION y WLR 047128249(AOS 1/1/2013 1/1/2014 X TORY UMITS OFR A AND EMPLOYERS'LIABILITY Y/N WLR 047128250 CA&MA) 1/1/2013 1/1/2014 A OFFICER/MEMBER PROPRIETOR/PARTNER/EXECUTIVE © N/A SCF C47128262(WI) ) 1/1/2013 1/1/2014 E.L EACH ACCIDENT $ 3.000,000 (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 3,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 3,000,000 A EXCESS AUTO y y XTR H0871230A 1/1/2013 1/1/2014 COMBINED SINGLE LIMIT LIABILITY $9,000,000 (EACH ACCIDENT) DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES((Attach ACORD 101,Additional Remarks•Schedule,if more space is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER,APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S)REFERENCED. BLANKET WAIVER OF SUBROGATION IS GRANTED IN FAVOR OF CERTIFICATE HOLDER ON ALL POLICIES WHERE AND TO THE EXTENT REQUIRED BY WRITTEN CONTRACT WHERE PERMISSIBLE BY LAW. CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED (EXCEPT FOR WORKERS'COMP/EL)WHERE AND TO THE EXTENT REQUIRED BY WRITTEN CONTRACT.ADDITIONAL INSURED IN FAVOR OF COSTA MESA SANITARY DISTRICT,ITS OFFICERS,AGENTS AND EMPLOYEES(ON ALL POLICIES EXCEPT WORKERS' COMPENSATION/EL)WHERE REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION See Attachment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE \1\ :3'-) THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 11076631 J AUTHORIZED REPRESENTATIVE COSTA MESA SANITARY DISTRICT s ATTN: TOM FAUTH 628 WEST 19TH STREET • COSTA MESA CA 926277 • ACORD 25(2010/05) ©198872010 ACORD-CORPORATI :'All rights reserved The ACORD name and logo are registered marks of ACORD • POLICY NUMBER: HDO G27015189 ENDT. #38 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 ID: 11076631