Insurance - Waste Management Holdings Inc.ACORLY CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY)
k4� 1/1/2020
12/19/2018
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 700
HOUSTON TX 77042
866-260-3538
NCONTACT
AME:
A/C, PHONE Ext): FAX
A/C, No
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: ACE American Insurance Company22667
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 Co of North America 43575
INSURER C : 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
POLICY NUMBER
POLICY EFF
MM/DD
POLICY EXP
MM/DD
LIMITS
A
COMMERCIAL GENERAL LIABILITY
Y
Y
HDOG71212993
1/1/2019
1/1/2020
EACH OCCURRENCE 5,000,000
CLAIMS-MADEFX—1 OCCUR
PX1
PREMISES (Ea occurrrence 5,000,000
MED EXP (Any one person)$ XXXXXXX
XCU INCLUDED
PERSONAL & ADV INJURY $ 5,000,000
ISO FORM CG00010413
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY JE0FX] LOC
GENERAL AGGREGATE $ 6,00-0,00- 0
PRODUCTS - COMP/OP AGG $ 6,000,000
$
OTHER:
A
AUTOMOBILE LIABILITY
Y
Y
MMT H2527863A
1/1/2019
1/1/2020
Ea accidentSINGLE LIMIT $ 1,000,000
BODILY INJURY (Per person) $ XXXXXXX
X ANY AUTO
X AAUTOS ONLY AUTODULED
BODILY INJURY (Per accident $ XXXXXXX
X AUTOS ONLY X NON-OWNED
ONLYD
PeraccidenDAMAGE $ XXXXXXX
$ XXXXXXX
x MCS -90
A
X UMBRELLA LIAB
X1-]CLAIMS-MADE
OCCUR
Y
Y
XOO G27929242 004
1/1/2019
1/1/2020
EACH OCCURRENCE $ 15,000,000
AGGREGATE $ 15,000,000
EXCESS LIAR
DED I I RETENTION $
$ XXXXXXX
B
A
C
WORKERS COMPENSATIONPER
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N
OFFICER/MEMBEREXCLUDED? N❑
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
Y
WLR C65435846 (AOS))
WLR C65435809 (CA & MA)
SCF C65435883 (WI)
1/1/2019
1/1/2019
1/1/2019
1/1/2020
1/1/2020
1/1/2020
OTH-
X STATUTE ER
E.L. EACH ACCIDENT $ 3,000,000
E.L. DISEASE - EA EMPLOYEE $ 3,000,000
E.L. DISEASE - POLICY LIMIT 3,000,000
A
EXCESS AUTO
LIABILITY
Y
Y
XSA H25278598
1/1/2019
1/1/2020
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)
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' COMPEL)
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' 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.
CERTIFICATE HOLDER CANCELLATION See Attachment
11076631
COSTA MESA SANITARY DISTRICT
290 PAULARINO AVE.
COSTA MESA CA 92626 '9g;
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.
AUTHORIZED REPRESENTATIVE
Ccs 1988-2015 ACORD CORPORATICN. All rights reserved
The ACORD name and logo are registered marks of ACORD
Attachment Code: D446557 Master ID: 1306000, Certificate ID: 11076631
POLICY NUMBER: HDO G71212993
Endorsement Number: 39
• 1 ii C ► I 4"f
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS LESSEES OR
• •'(Form
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