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PROOF OF INSURANCE (2022) CLOSEDACCORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 7/8/2021 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 CONTACT NAME: Machelle McKenzie Crystal & Company Alliant Insurance Services PHONE FAX A/C No Ext : 713-624-6338 A/C, No): E-M2000 ADDRESS: machelle.mckenzie@alliant.com West Loop South, Suite 2150 INSURER(S) AFFORDING COVERAGE NAIC# Houston TX 77027 INSURERA: Starr Surplus Lines Insurance 13604 INSURED TRILME INSURER B: Starr Indemnity & Liability Co 38318 Trilogy Medwaste West LLC 8554 Katy Freeway, Suite 200 INSURERC: Endurance Assurance Corporatio 11551 INSURERD: Houston, TX 77024 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER:524083079 REVISION NUMBER: 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 X COMMERCIAL GENERAL LIABILITY 1000067348211 1/1/2021 1/1/2022 EACH OCCURRENCE $1,000,000 CLAIMS -MADE � OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 X MED EXP (Any one person) $ 25,000 Pollution (see Notes Below) PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑PRO � JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 Pollution $ 1,000,000 OTHER: Capped at $5 Mil B AUTOMOBILE LIABILITY 1000636688211 1/1/2021 1/1/2022 COMBINED SINGLE LIMIT Ea accident $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY A UMBRELLALIAB OCCUR 1000337603211 1/1/2021 1/1/2022 EACH OCCURRENCE $ 7,000,000 X AGGREGATE $ 7,000,000 EXCESS LAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE 1000004033 1/1/2021 1/1/2022 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 OFFICE R/M EMBER EXCLUDED? FN] N/A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Network Security, Privacy and PRV10012901603 1/1/2021 1/1/2022 Each Claim/Occurrence 1,000,000 Media Liability Aggregate 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) All policies, except the Cyber and Workers' Compensation, include the certificate holder as an additional insured with a waiver of subrogation as required by written contract and as per the terms of the policies. Underlying policies on the Excess Liability are General Liability and Automobile Liability. The Excess Liability follows form to the underlying (i.e. occurrence, claims made, etc.). Pollution includes Contractors Pollution, Site and Transportation. Site Pollution is on a claims made with a retroactive date of 4/3/2019. Workers' Compensation includes a blanket waiver of subrogation as required by written contract and as permitted by law. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo Dept AHIMT 350 Main St AUTHORIZED REPRESENTATIVE El Segundo CA 90245 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD *Starr Surplus Lines Insurance Company Primary and Non-contributory, Additional Insured and Waiver of Subrogation Policy Number: 1000067348211 Effective Date: 01/01/2021 at 12.01 AM Named Insured: Trilogy Medwaste, Inc. This endorsement modifies the insurance coverage form(s) fisted below that have been purchased by you and evidenced as such on the Declarations page. Please read the endorsement and respective policy(ies) carefully. Commercial General Liability Coverage Form Owners and Contractors Protective Liability Coverage Form Products/Completed Operations Liability Coverage Form Contractors Pollution Liability Coverage Form Professional Liability Coverage Form Site Pollution Liability Coverage Form SCHEDULE Where Required By Written Contract A. SECTION II - WHO IS AN INSURED is amended to include as an insured the person or organization shown in the schedule of this endorsement, but only with respect to liability arising out of "your work" for that insured by or for you. B. As respects additional insureds as defined above, this insurance also applies to "bodily injury" or "property damage" arising out of your negligence when the following written contract requirements are applicable: 1. Coverage available under this coverage part shall apply as primary insurance. Any other insurance available to these additional insured's shall apply as excess and not contribute as primary to the insurance afforded by this endorsement. 2. We waive any right of recovery we may have against these additional insured's because of payments we make for injury or damage arising out of "your work" done under a written contract with the additional insured. 3. The term insured is used separately and not collectively, but the inclusion of more than one insured shall not increase the limits or coverage provided by this insurance. Insureds and Agents are advised that certificates of insurance should be used only to provide evidence of insurance in lieu of an actual copy of the applicable insurance policy. Certificates should not be used to amend, expand or otherwise alter the terms of the actual policy. All other terms and conditions of this Policy remain unchanged. Signed for STARR SURPLUS LINES INSURANCE COMPANY Steve Blakey, Preside Nehemiah E. Ginsburg, GenerajjCounsel SL 023 (06/11) Page 1 of 1 Copyright 0 C. V. Starr 3 Company and Starr Surplus Lines Insurance Company. All rights reserved Includes copyrighted material of ISO Properties, Inc„ used Velth its permission. Named Insured: Trilogy Medwaste, Inc. Policy Effective Date: 01/01/2021 Policy Expiration Date: 01/01/2022 This endorsement effective: 12:01 A.M. 01/01/2021 forms a part of Policy No:1000636688211 Starr Indemnity & Liability Company Amendatory Endorsement In consideration of the premium shown below, it is hereby understood and agreed this endorsement is attached to and forms part of the above policy and is effective as shown above. This endorsement amends only the changes which are indicated by check in the box immediately preceding such change: 1. ❑ Policy is 2. ❑✓ ltem(s) listed below are added to the policy schedule. 3. ❑Name of Insured is amended as shown below. 4. ❑Insured mailing address is amended as shown below 5. ❑ Policy term is amended to: The following is hereby amended to the policy schedule: 6. ❑Endorsement No is null and void 7. [] Description of items) is amended as shown below. 8. ❑ Limit of Liability is as shown below. 9. R Policy Reinstated 10. ❑Other, as shown below Form CA 20 01— lessor -Additional insured and loss Payee has been added to the policy. All other policy terms and conditions remain unchanged. Breakdown: $ 0.00 Premium $ 0.00 Terrorism Premium $ 0.00 Grand Total Issue Date: 01/01/2021 Authorized Representative POLICY NUMBER; 1000636688211 COMMERCIAL AUTO CA 20 01 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LESSOR - ADDITIONAL INSURED AND LOSS PAYEE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Trilogy Medwaste, Inc. Endorsement Effective Date: 01/01/2021 SCHEDULE Insurance Company: Starr Indemnity & Liability Company Policy Number: 1000636688211 Effective Date: 01101/2021 Expiration Date: 01/01/2022 Named Insured: Trilogy Medwaste, Inc. Address: 8664 Katy Fwy Ste 200 Houston, TX 77024 Additional Insured (Lessor): As required by contract/as their interest may appear Address: As required by contract/as their interest may appear Designation Or Description Of "Leased Autos": As required by contract/as their interest may appear CA 20 0110 13 © Insurance Services Office, Inc., 2011 Page 1 of 2 Coverages Limit Of Insurance Covered Autos Liability $ Each "Accident" Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Comprehensive $ Deductible For Each Covered "Leased Auto" Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Collision $ Deductible For Each Covered "Leased Auto" Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Specified Causes Of Loss $ Deductible For Each Covered "Leased Auto" Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Coverage 1. Any "leased auto" designated or described in the Schedule will be considered a covered "auto" you own and not a covered "auto" you hire or borrow. 2. For a "leased auto" designated or described in the Schedule, the Who Is An Insured provision under Covered Autos Liability Coverage is changed to include as an "insured" the lessor named in the Schedule. However, the lessor is an "insured" only for "bodily injury" or "property damage" resulting from the acts or omissions by: a. You; b. Any of your "employees" or agents; or c. Any person, except the lessor or any "employee" or agent of the lessor, operating a "leased auto" with the permission of any of the above. 3. The coverages provided under this endorsement apply to any "leased auto" described in the Schedule until the expiration date shown in the Schedule, or when the lessor or his or her agent takes possession of the "leased auto", whichever occurs first. B. Loss Payable Clause 1. We will pay, as interest may appear, you and the lessor named in this endorsement for "loss" to a "leased auto". 2. The insurance covers the interest of the lessor unless the "loss" results from fraudulent acts or omissions on your part. 3. If we make any payment to the lessor, we will obtain his or her rights against any other party. C. Cancellation 1. If we cancel the policy, we will mail notice to the lessor in accordance with the Cancellation Common Policy Condition. 2. If you cancel the policy, we will mail notice to the lessor. 3. Cancellation ends this agreement. D. The lessor is not liable for payment of your premiums. E. Additional Definition As used in this endorsement: "Leased auto" means an "auto" leased or rented to you, including any substitute, replacement or extra "auto" needed to meet seasonal or other needs, under a leasing or rental agreement that requires you to provide direct primary insurance for the lessor. Page 2 of 2 O Insurance Services Office, Inc., 2011 CA 20 01 1013