Insurance - Waste Management Holdings 2016-04-29CERTIFICATE OF LIABILITY INSURANCE DATE
1/1120174/
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 caNlBcaleholder is an ADDITIONAL INSURED, the pollcy(ias) 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(.).
320
1MRF_R• I
HUMPED Y
.._.._._...._...__... ........=a
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
ADDLUBR
POLICY NUMBER
P CY F
I/L/2016
POLI K
IMMATYPEOFINSURANCE
1/111017
LIMBS
A
X COMMERCIAL GENERAL LIABILITY
Y
Y
HDO.G2740331.1
EACHOCCURRENCE_ S $000000
CLAIMS -HIDED OCCUR
PA MEET Eda urenoel
„$5,000,000
MED EXP (My one' enari r. XXXXXXX
X XC.(I INCLUDED
PERSONAL & ADV INJURY S 51000,000
X I ISO FORM 0000010413
GENE AGGREGATE LIMIT APPLI ES PER
POLICY iECGT [X] LOC
GENERALAGGREGATE s 6,000,000
PRODUCTS-COMPIOPAGG E 6.000 000
OTHER
S
A
AUTOMOBILE
NXANYOoAJEDBODILYINJURY(Perperson)
LIABILITY
ALL -.ED SCHEDULED
Y
Y
A4MT H08866326
1/1/2016
111/2017
O I, IN LEUMITlEaS 1 000,000.
S XXXXXXX
BODILY INJURY (Per acddenl $XXXXXXX
HIREDAUTOS X ANWOOWNED
S
PPROPERTYDAMAGE.g XXXXXXX
MCS -90
S XXXXXXX
C
}{
UMBRELLA LIAR
X
OCCUR
Y
Y
X00027929242001
11112016
11IT2017
EACH.00CURRENCE 51$,000000
EXCESS LIAR
CLAIMS-NLADE
AGGREGATE S 1$000.,000
DEO I I RETENTIONS
S XXXXXXX
B
A
D
WORKERS COMPENSATION
AND EMPLOYERS' UAaIUTY YIN
pNYPROPRiEieRPARIxERIE%ECVIIVE
OFFlCEWMEIABER E%uuDEO'
(MantleCery In NXl
HyY.Cex .1
pESCRIPIION OF OPERAi1DN5 WrpW
NIA
Y
WLR 048596769 (AOS)
WLR 048596800 (A7,CA,&MA
SCFC48596$a3 (\YYYYV111II)
1112016
1)12016
1/1/2016
111(2017
1/1/2017
1/12017
TH.
X: Mane.
ecEueacuDExr sJ/0t0/0�,000
IL OI.EASE-FA EMPLOYEE 3,000,000
�1
EL DISEASE. -POI LAID J000,000
A
EXCESS AUTO
LtABILFTY
Y
Y
XSA 1108866314
1112016
1110017
COMBINEDSrNGLCLIMIT
S9000,000
(EACU ACCIDBNI)
DESCRIPTION OF OPERATIONS LOCATIONS f VEHICLES (Attach AGORD In, Additional Ramerks SCEedaM, may be attached if mote space Is requlretl
THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER. APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S) REFERENCED:
BLANKET WAIVER OF SUBROG V'[ON IS CRANTFD IN FAVOR OF CERTIFICATE HOLDER ON ALL POLICIES WHERE AND TO I HE EXTENT REppUIRED BY
WRITTEN CONTRACT WHERE PCRMISSIBL F BY LAZY_ CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED (F.NCEP'I FOR WORKEkS' COMR'EW
WHERE AND TO THE EXTENT RFQL.Iki D BY WRITTEN CONTRACT. ADDITIONAL INSURED IN FAVOR OF COSTA MESA SANITARY DISTRICT, THEIR
ELECTED AND APPOINTED OFFICIALS, AGFNFS, Orr ICEI S VOLUNTEERS AND EMPLOYEES (ON ALL POLICIES S EYCEPF WORKERS' COMPENSAIION'EL)
WHERE REQUIRED by WRI FFCN CONTRACT THE INSURANCE AFFORDED 10 THE ADDITIONAL INSURED AS DESCRIBED IN .'HIS CERTIFICATE OF
INSURANCE FOR WORK PERFORMED BY T RENAMED INSURED IS PRIMARY AND NON-CONTRIBUTORY TO ANY SIMM AR COVERAGE MAINTAINED By THE
ADDITIONAL INSURED WHERE AND TO THE EXTENT REQUIRED BY CONTRACT. 30 DAYS NOTICE OF CANCELIATION IS tNCLUDED ON THE POLICIES.
11076631
COSTA MESA SANITARY DISTRICT
628 WEST 19TH STREET
COSTA MESA CA 92627
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Ing AOORU name and logo are registered marks of ACORD
reserved
POLICY NUMBER: HDD 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 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
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 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: 14085377