2019/01/01 Waste Management Holdings, Inc. and all affiliated Related and Subsidary Companies Certificate of Liability Insurance (5)'4CCJR►7 CERTIFICATE OF LIABILITY INSURANCE
1/1/2020
DATE(MM/DD/YYYY)
12/4/2018
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:
AIC. NE FAX
o. Ext : AIC No):
E-MAIL
ADDRESS:
SU AFFORDING COVERAGE
INSURER A: ACE American Insurance Company
22667
INSURED WASTE MANAGEMENT HOLDINGS, INC. & ALL AFFILIATED,
1306000 RELATED & SUBSIDIARY COMPANIES INCLUDING:
WASTE MANAGEMENT MORENO VALLEY TRANSFER STATION
INSURER B : Indemni Insurance Co of North America
43575
INSURER C : ACE Fire Underwriters Insurance Company
20702
INSURER D :
17700 INDIAN STREET
INSURER E :
MORENO VALLEY CA 92551
INSURER F :
COVERAGES CIERTWICATE NUMBER: 1384R10Q RFVISION NiIMRFR- YYYYYYY
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
TR
TYPE OF INSURANCE
ADDL
INSD
ilR
POLICY NUMBER
POLICY EFF
MMIDDIYYYY
POLICY EXP
fMWODNYYYI
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
Y
Y
HDO G71212993
1/1/2019
1/1/2020
EACHOCCURRENCE
s 5,000,000
CLAIMS -MADE OCCUR
PRENFISETENTED
occurrence)
5,000,000
IMED EXP An oneperson)
XLKXXXXX
XCU INCLUDED
X i
ISO FORM CG00010413
(PERSONAL & ADV INJURY
$ 5,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY JECT � LOC
GENERAL AGGREGATE
$ 6,000,000
(PRODUCTS-COMP/OPAGG
$ 6,000,000
$
OTHER:
A
AUTOMOBILE LIABILITY
Y
Y
MMT H2527863A
1/1/2019
1/1/2020
& a81 NEeDISINGLE LIMIT
$ 1000000
130DILY INJURY (Per person)
$ XXXXXXX
X ANY AUTO
X AUTOS ONLY AUTODULED
BODILY INJURY (Per accident
$ XXXXXXX
X AUTOS ONLY X AUUTOS ONLYY
per.r Id DAMAGE
$ XXxxXXX
$ XXXXxxx
X MCS-90
A
X
UMBRELLA LIAB
X
OCCUR
Y
Y
XOO G27929242 004
1/1/2019
1/1/2020
EACH OCCURRENCE
$ 15,000,000
.AGGREGATE
$ 15 000 000
EXCESS LIAB
CLAIMS -MADE
DED I I RETENTION $
1
$ XXXXXXX
B
A
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICEoryInNEREXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA`
Y
WLR C65435809 ((AOS
WI,R C65435809 (CA MA)
SCFC65435883(WI)
1/1/2019
1/1/2Ol I
1/1/2019
1/1/2020
1/1/2020
1/1/2020
OTH-
X STATUTE ER
IE L EACH ACCIDENT
$ 3000,000
IE L DISEASE- EA EMPLOYEE
$ 3,000,000
IE L DISEASE- POLICY LIMIT is
3,000 000
A
EXCESS AUTO
LIABILITY
Y
Y
XSAH25278598
1/1/2019
1/1/2020
COMBINED SINGLE LIMIT
$9,000,000
(EACH ACCIDENT)
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
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.
CERTIFICATE HOLDER CANCELLATION See Attachment
13848309
QUAIL VALLEY
VOLUNTEER FIRE DEPARTMENT
29714 HAUN ROAD
MENIFEE CA 92586
City of Men ifee
City Clerk
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
JAN 07 2019
AUTHORIZED REPRESENTATIVE
Received
ACORD 25 (2016/031
n1ARR-2015 ACORD CORPORATIt-M All rinhfs rasarvarl
The ACORD name and logo are registered marks of ACORD
Attachment Code: D446557 Master ID: 1306000, Certificate ID: 13848309
POLICY NUMBER: HDO G71212993
Endorsement Number: 39
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 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 i of 1