2022/01/01 Waste Management Holdings, Inc. and all affiliated Related and Subsidary Companies (3)A,'ORif
12t09t2021
THIS CERTIFICATE IS ISSUEO AS A MATTER OF INFORMATIOT{ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTENO OR ALTER THE COVERAGE AFFORDED BY THE POLICIES AELOW.
THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING IT{SURER(S), AUTHORIZED REPRESENTATIVE
OR PRODUCER, AI{D THE CERTIFICATE HOLDER,
IMPORTANT: lf the certific.te holder is an AODITIOIIAL INSURED, the policy(ies) mult have ADDITIONAL INSURED provisions or be endorsed. lf
SUBROGATION lS WAIVEO, aubiect to the terms and conditioni of the policy, c€rtain polici€3 may require an ondoBement. A 3tatement on thi3
cortilicate does not cohfor righB to the certiticate holcler in lieu of 3uch endoBemenr(3).
PFooucER LOCKTON COMPANTES
3657 BRIARPARK DRIVE SUITE 7OO
HOUSTON TX 77042
866-260-3538
INSU RERISI AFFORDIITIG COVERAGE
rNsuREi a: ACE American lnsurance Company 22667
IiSUREO wAsTE MANAGEMENT HoLDINGS. INC. E ALL AFFILIAT
1306000 RELATED & SUBSIDIARY COMPANIES INCLUDINGT
WASTE MANAGEMENT MORENO VALLEY TRANSFER STATIO
17700 INOIAN STREET
MORENO VALLEY CA 92551
rNsuRER B: lndemn(y lnsurance Co of North America 43575
ttsuiEFc: ACE Fire Underwriters lnsurence Comoenv 2A7 02
rxsuiER o: ACE Prooertv & CasLlaltv lnsurance Co 20699
CERTIFICATE OF LIABILITY INSURANCE
cERTIFIcATE NUMBER: 1 3848309
CANCELLATION
NUMBER
ee ac me
@ 1988-20is ACORO CORPORATION. All rig
1tl12023
COVERAGES
CE TE HOLDER
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 CONOITION 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 10
ALL1HE TERMS EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
tNso SUSR
EACN OCCIJRRENCE s 5 000.000
s 5.000.000
MEO EXP lAnv on€ eBon)s xxxxxxx
PERSONAL A ADV INJURY s 5 000 000
G E NERAL AGGREGATE 5 6,000.000
PROOUCTS. COMP/OP AGG $ 6.000,000
COMIIERCIAL GENERAL LIABILITY
rso FoRM cG00010413
GENL AGGREGAIE LIMIT APPLIES PER
X
X X
X
X
x
CLAIMS,MAOE
LOC
OTHER
JECT
Y Y
HDO G72492365 a1la1t2a22 a1ta1t2a23
5
COMBINEDSINGLE L]MIT s 1,000,000
AOD LY NJURY (Perpersonl e xxxxxxx
BOOILY INJURY (Per a@de.l)5 XXXXXXX
5 XXXXXXX
AI]IOMOBILE LAAILITY
OlM{EO
urREo
SCHEOULEO
NON,OWNEOAUTOS ONLY
X
X
X
X
X
Y Y
MMT H25550328 01t01t2022 01t0112023
$ XXXXXXX
x EACH OCCIJRRENCE $ '15,000,000X
MS MAOE $ 15,000,000
UUARELLA LIAB
EXCESS LIAB
XEUG27929242 007 41to1t2022 01t01t2023
$
D
DED RETENTION $
x 1R5L,,,. I lo#.
r 3,000,000
E L OiSEASE - EA EMPLOYEE $ 3,000,000
01101t2022
911011202201101t2022
01to1t2023
01t01t2023
41t01t2023
r 3 000 000
B
c
woixERs cofPENsaTl0
ANO EMPLOYERS' LIABIIITY N
Y
wLR C68918595wLR C68918558
scF c68918637
(AOS)
(AZ CA & M/(wt)
EXCESS AUTO
LIABILITY Y Y
xsA H25550286 01t0112022 01101t2023 COMBINED SINGLE LIMIT
$9,000,000(EACH ACCIDENT)
SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCOROANCE WTH THE POLICY PROVISIONS.
13848309
OUAIL VALLEY
VOLUNTEER FIRE DEPARTMENT
29714 HAUN ROAD
MENIFEE CA 92586
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
The ACORD name and logo are r€gistered marks of ACORO
ts reserved
XCU INCLUDED
Y Y
N
oEscRtPTroN oF oPERATtoNS / LocATroNs r vEHrcL€s lacoRD 10r, addruon.r F.nark. sch.dur., d.y b..nrch.d Itmore.p.c€ r. r.qulred)
BLANKET WAIVER OF SUBROGATION IS GRANTED IN FAVOR OF CERTIFICATE HOLOER ON ALL POLICIES WHERE ANO TO THE EXTENT REOUIRED BY
WRITTEN CONTRACT WHERE PERMISSIBLE AY LAW CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED (EXCEPT FOR WORKERS' COI\,IPlEL)
WHERE AND IO THE EXTENT REQUIRED BY WRITTEN CONTRACT
>e/4
Attachment Code : D446557 Master lD: 1306000, Certificate lD: 13848309
POLICY NUMBER: HDO G72492365 Endorsement Number: 39
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEIUENT 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 lo include as an
additional insured under a written contract, provided such contract was executed prior to the date of loss.
(lf no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
cG 20 10 11 85 Copyright, Insurance Services Omce, Inc., 1984 Page 1 of 1
WHO lS AN INSURED (Section ll) 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.