Insurance - Costa Mesa Disposal - 1992-04-09 AMMO. 1 CERTIFICATE OF INSURANCE ISSUE DATE(MM/DD/YY)
--- --- __ _ �r{ 4/09/92
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE,HOLDER.THIS CERTIFICATE DOES NOT AMEND,
$O I id Waste Ins Mgrs EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
P 0 Box 7072 COMPANIES AFFORDING COVERAGE
Pasadena, CA 91 Rict. CEIVED
1992 COMPANY
A 13 LETTER A CALIFORNIA INS CO (,IND)
.._
t'UbLIL-SLK.VICES-- COMPANY B
INSURED CALIFORNIA INS CO ( IND ) •
COMPANY C
Costa Mesa Disposal ,Inc
1251 N Jefferson St COMPANY
Anaheim Ca 92807 LETTER D
COMPANY E
LETTER CALIFORNIA INS CO ( IND ) .
COVERAGES _ _T
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.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS
LTR DATE(MM/DD/YY) DATE(MM/DD/YY)
A GENERAL LIABILITY 0R9120090 3/11/92 3/11/93 GENERAL AGGREGATE $ 2000_.
X I COMMERCIAL GENERAL LIABILITY PRODUCTS'COMP/OPS AGGREGATE'$ 1000
1 CLAIMS MADE X (OCCUR. PERSONAL&ADVERTISING INJURY $ 1000
X OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ 1000
I FIRE DAMAGE(Any II e) $ 50_
MEDICAL EXPENSE(Any pe n) $ 5 •
B AUTOMOBILE LIABILITY OR 9120 09 0 3/ 11/92 3/11/9 3 COMBINED
ANY AUTO LIMTLE $ 1000
II ALL OWNED AUTOS BODILY
INJURY $
X SCHEDULED AUTOS
(Per person)
X HIRED AUTOS BODILY
X NON OWNED AUTOS APPROVED TO FORM: INJURY $
(Pe ccident) I
GARAGE LIABILITY I `- PROPERTY '
i DAMAGE • $
EXCESS LIABILITY /.--- _- EACH ' AGGREGATE
ATTORNEY FO' a TRICT'
J OCCURRENCE
$ $
OTHER THAN UMBRELLA FORM •
WORKER'S COMPENSATION STATUTORY , ,I —
$ (EACH ACCIDENT)'
AND --- ,
$ (DISEASE—POLICY LIMIT)
EMPLOYERS'LIABILITY
$ (DISEASE—EACH EMPLOYEE
•
E OTHER 0R9120090 3/ 11/92 3/1.1/93
PHYSICAL DAMAGE I $1 ,000 DED FIRE E
I
SCHEDULED VEHICLES THEFT
, I —_ $1 ,000 DED COLLISION
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
ENDORSEMENT 20101185 ATTACHED 10 DAY NOTICE OF CANCELLATION IN
RE PERMIT – ANNUAL CLEAN–UP FOR RESIDENTIAL PICK–UP THE EVENT OF NON PAYMENT PREMIUM
CERTIFICATE HOLDER __ CANCELLATION CANCELLATION __----- ___ _____
I I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES.BE CANCELLED BEFORE THE
i EXPIRATION DATE THEREOF THE ISSUING COMPANY WILL ENDEAVOR TO
CITY OF COSTA MESA I MAIL 3 DDAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
PUBLIC SERVICE DEPARTMENT LEFT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
P 0 BOX 1200 • LIABILITY OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES.
COSTA MESA, CA 92626 I AUTHORIZED REPRESENTATIVE /�
1
• __ ___ _ —__ _ I ____ _ __ __
ACORD 25-S (11/89) CO ACORD CORPORATION 1989
0– 0
_ = `:• _
OR9120090 COMMERCIAL GENERAL UABIUTY
- POLICY. PLEASE READ IT CAREFULLY
-=- FSSEES OR
_ - ART
SOEDW.E
Name of Perscm or Organ
PERMIT — ANNUAL
CLEAN UP FOR RESIDENTIAL
CITY OF COSTA MESA PICK—UP
PUBLIC SERVICE DEPT
PO BOX 1200
COSTA MESA, CA 92626
(It no entry appears above.mfarmation required to c:molete mis endorsement will be snows in the Oecaraacnc
as applicable to this endorsement.)
WHO IS AN INSURED (Section I!) is amended to inCUCe as an insure^_ arson or organization shown —e
Scneduie. our only with resoect to liaoility arising cu. at your work -or-na insured by or tar you.
APPR U VED AS TO FORM!
ATT RN Y FOO TRICT
CG 20 10 11 35 Copyright. Insurance Services Office. Inc. 1984 =
ACilian. � CERTIFICATE OF INS!%sRA1ICE. H ISSUE DATE(MM/DDTYY)
_ n 4/09/92
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND,
S o l i d Waste Ins Mgrs
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
P 0 Box 7072
Pasadena, CA 91109 COMPANIES AFFORDING COVERAGE
COMPANY
RECEIVED
LETTER A CALIFORNIA INS CO ( IND)
ARR 13-N92 COMPANY
INSURED LETTER B CALIFORNIA INS CO IIND)
rubut, &AVICES COMPANY
Costa Mesa Disposal , Inc LETTER C
1251 N Jefferson St COMPANY
Anaheim Ca 92807 LETTER D
COMPANY E (D.I'
LETTER CALIFORNIA INS CO ( IND )
COVERAGES _ _ ___ _____
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.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE)POLICY EXPIRATION ALL LIMITS IN THOUSANDS
LTR DATE(MM/DD/YY) DATE(MM/DD/YY)
A GENERAL LIABILITY 0R9120090 3/11/92 3/11/93 GENERAL AGGREGATE -II$ 2000
J(1 COMMERCIAL GENERAL LIABILITY `PRODUCTS-COMP/OPS AGGREGATE $ 1000
-`_ CLAIMS MADE X 1 OCCUR. ,PERSONAL 8 ADVERTISING INJURY $ 1000
X OWNER'S&CONTRACTOR'S PROT. F EACH OCCURRENCE ..... 1000
FIRE DAMAGE(Any Ii e) $ 50
MEDICAL EXPENSE(Any pe n) $ 5
B AUTOMOBILE LIABILITY O R 912 00 9 0 3/11/92 3/11/9 3'COMBINED '
ANY AUTO I LIMIT SINGLE $ 1 000
ALL OWNED AUTOS III BODILY
INJURY $
X SCHEDULED AUTOS I(Po pe n)
X_ HIRED AUTOS BODILY
X NON-OWNED AUTOS INJURY $ I
(Pe ciCenl)
GARAGE LIABILITY APPROVED AS TO FORM: III PROPERTY $
S DAMAGE
EXCESS LIABILITY `« /�7 C`/' �p(`/yp\_\)_- � OCCURRENCE $ AGGREGATE
OTHER THAN UMBRELLA FORM __ AT'ORf(1EY F�,/. {JISTRIICT� __ __
WORKER'S COMPENSATION STATUTORY
AND I $ 1 (EACH ACCIDENT)
IS (DISEASE—POLICY LIMIT)
EMPLOYERS'LIABILITY °' --•
$ (DISEASE—EACH EMPLOYEE
E OTHER 089120090 3/11/92 3/11/93
1 PHYSICAL DAMAGE $1 ,000 DEO FIRE E
SCHEDULED VEHICLES THEFT
I I 1 $1 ,000 DED COLLISION
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
ENDORSEMENT CG20101185 ATTACHED 10 DAY.NOTICE OF CANCELLATION IN
RE RUBBISH HAULING THE EVENT OF NON PAYMENT PREMIUM
( REGULAR TRASH — NO MEDICAL TRASH )
CERTIFICATE HOLDER _ CANCELLATION
1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF THE ISSUING COMPANY WILL ENDEAVOR TO
COSTA MESA SANITARY DISTRICT i MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
ATTN FLO I LEFT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
PO BOX 1200 I LIABILITY OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES.
COSTA MESA, CA 92626
AUTHORIZED REPRESENTATIVE /frJ{//�Tr
ACORD 25-S(11/89) (C7ACORD CORPORATION 1989
0— 0
-- -'s _. OR9120090 Y w COMMERCIAL GENERAL UABILfT'y
POLICY. PLEASE READ IT CAREFULLY
" EES OR
ART
SCPBEStULE
Name at Person-or Chiptnizatort
RUBBISH HAULING
REGUALR TRASH - NO
COSTA MESA SANITARY DISTRICT MEDICAL TRASH
PO BOX 1200
COSTA MESA, CA 92626
(If no entry aooears above. information required to ccr. Clete this endorsement will be snown in the Dedaraaons
as applicable to this endorsement.)
W4O IS AN INSURED (Section I!' is amended to induce as an insure --e de-son or orpnuzanon -mown •- --?
Schedule. out only with resoec-to liability arising ou, of you work ror -na- insured oy or for you.
APPROVED AS TO FORM:
AT T QRNEY FO II STRICT'
CG 20101155 Copyright. Insurance Services Office. Inc. 1984
COSTA MESA DISPOSAL, INC.
Named Insured
1) Costa Mesa Disposal Inc
2) J-X Inc
3) R R Investment Account
4) RMS Leasing Inc
5) RR & S Equipment Company, Inc
6) Orco Disposal, Inc
7) Raul 0 Rangel
As respects to the following vehicles only
1985 White Front Loader, #9218
1985 White Front Loader #9219
A ROVED AS TO FORM'
15T
ATTOR BEY FOR
COSTA MESA DISPOSAL, INC.
Named Insured
1) Costa Mesa Disposal Inc
2) J-X, Inc
3) R R Investment Account
4) RMS Leasing, Inc
5) RR & S Equipment Company Inc
6) Orco Disposal Inc
7) Raul 0 Rangel
As respects to the following vehicles only
1985 White Front Loader, #9218
1985 White Front Loader #9219
APPROVED AS TO FORM:
ATTORNEY FOR DISTRICT`