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PROOF OF INSURANCE (2012) CLOSED �► -CM0 CERTIFICATE OF LIABILITY INSURANCE N °ATE(MM/2012 „) 02124/2012 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 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 llleu of such endorsement(s). PRODUCER I CONTACT NAME: CANNON COCHRAN MANAGEMENT SERVICES,INC. PHONE(A/C No.Ext): 800-853-6155 A FAX IA/C No.Ext): 17015 N.SCOTTSDALE RD. E-MAIL ADDRESS: SCOTTSDALE,AZ 85255 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: OLD REPUBLIC INSURANCE COMPANY 24147 INSURED INSURER B: LEXINGTON INSURANCE COMPANY 19437 REPUBLIC SERVICES,INC. (INSURER c: INDIAN HARBOR INSURANCE COMPANY 36940 18500 N.ALLIED WAY INSURER D: PHOENIX,AZ 85054 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 18303 REVISION NUMBER:4 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 TYPE OF INSURANCE ADDL SUBR� POLICY NUMBER POLICY EFF POLICY EXP LIMITS WVD (MM/DD/YYYY) (MMIDD/YYYY) A GENERAL LIABILITY MWZY 59257 06/30/2011 06/30/2012 EACH OCCURRENCE $5,000,000 X COMERCIAL GENERAL LIABILITY DAMGED TO RENTED CLAIMS-MADE F—X]OCCUR PREMISES(Ea occurence) $5,000,000 MED EXP(Any one person) �C (PERSONAL&INJURY I$5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: (GENERAL AGGREGATE $5,000,000 POLICY E�PROJECT E-1 LOC i PRODUCTS-COMP/OP AGG $5,000,000 AUTOMOBILE LIABILITY MWTB 21343 06/30/2011 06/30/2012 COMBINED SINGLE LIMIT A $5,000,000 X ANY AUTO (Ea Accident) X I ALL OWNED SCHEDULED BODILY INJURY(Per person) AUTOS AUTOS BODILY INJURY(Per accident) X HIRED AUTOS NON-OWNED PROPERTY DAMAGE (Per Accident) B X UMBRELLA LIAB XI OCCUR 2214223/2214224 06/30/2011 06/30/2012 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE I AGGREGATE $000.000 ,I DED D RETENTION$ A I'IPrd''ORKERS COMPENSATION Y/N N/A MWC 117108 00 AOS 06/30/2011 06/30/2012 XI WC Y LIMIT I I OTHER AND EMPLOYERS'LIABILITY MWXS 945 Excess WC OH 06/3012011 06/30/2012 TORY LIMITS u • ANY PROPRIETOWPARTNER/EXECUTIVE MWXS 946 Excess NSWC TX 06/30/2011 06/30/2012 E.L.EACH ACCIDENT $3,000,000 • 1OFFICEWMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $3,000.01 0 (MaMndolaary in NH) E.L.DISEASE-POLICY LIMIT $3,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below C POLLUTION LEGAL LIABILITY PECO02351504 06/30/2011 06/30/2012 $50,000,000 Each Occurrence DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Division Number:3893-Named Insured Includes:Consolidated Disposal Service,L.L.C.-Dba:Republic Services of Southern California-Allied Waste Services- American Waste See attached for additional remarks CERTIFICATE HOLDER - ... q.N U ANY OF THE ABOVE City of EI Segundo ACCORDANCE XPIRATIOE POT CY P ED POLICIES TICE BE CANCELLED 8 BEFORE THEREOF,NOTICE WILL BE DELIVERED IN VISIONS, 350 Main Street AUTHORIZED REPRESENTATIVE El Sed States A 90245-3813 Y "" 0 1988-2010 ACORD CORPORATION"All rights reserved. 4CORD 25(2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: ACORO O ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED REPUBLIC SERVICES, INC. POLICY NUMBER 18500 N.ALLIED WAY See First Page PHOENIX,AZ 85054 CARRIER NAIC CODE See First Page u EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE The following provisions apply when required by written contract.As used below,the term certificate holder also includes any person or organization that the insured has become obligated to include as a result of an executed contract or agreement. GENERAL LIABILITY: Certificate holder is Additional Insured when required by written contract. Coverage is primary and non-contributory when required by written contract. Waiver of Subrogation in favor of the certificate holder is included when required by written contract. AUTO LIABILITY: Certificate holder is Additional Insured when required by written contract. Waiver of Subrogation in favor of the certificate holder is included when required by written contract. WORKERS COMPENSATION AND EMPLOYERS LIABILITY: Waiver of Subrogation in favor of the certificate holder is included when required by written contract where allowed by state law. TEXAS EXCESS INDEMNITY AND EMPLOYERS LIABILITY: Republic Services,Inc.and its subsidiaries are registered non-subscribers to the Texas Workers Compensation Act.Republic Services, Inc.has filed an approved Indemnity Plan with the Texas Department of Insurance which offers an alternative in benefits to employees rather than the traditional Workers Compensation Insurance in Texas.The excess policy(#MWXS 946)shown on this certificate provides excess Indemnity and Employers Liability coverage for the approved Indemnity Plan. Contractual Liability is included in the General Liability coverage form.The General Liability policy does not contain an endorsement excluding Contractual Liability. The Excess Liability policy is follow form over the General Liability,Automobile Liability and Employer's Liability policies shown on this certificate. Additional Insured includes:City of El Segundo,when required by written contract. ACORD 101(2008/01) ©1988.2010 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE _Name Of Additional Insured Person(s) Or Organization(s) City of El Segundo 350 Main Street El Segundo, CA 90245-34,13 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or or- ganizations) shown in the Schedule, but only with respect to liability for "bodily injury", "property dam- age" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 U ISO Properties, Inc., 2004 Page 1 of 1 Endorsement#9 Republic Services, Inc. MWZY 59257 Effective: 6-30-11