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11'.11 CERTIFICATE OF LIABILITY INSURANCEI /l/201;
DATE (MMIDD/YYYY)
F 12/11/201;
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 COIJSTITUTE 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 lieu of such endorsement(s).
PRODUCER LOCKTON COMPANIES, LLC
5847 SAN FELIPE, SUITE 320
HOUSTON TX 77057
866 - 260 -3538
CORTAUr
NAME:
A/C, No, Ext : AIC, No):
E -MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: ACE American Insurance Compariv
22667
INSURED WASTE MANAGEMENT HOLDINGS, INC. & ALL AFFILIATED,
1300299 RELATED & SUBSIDIARY COMPANIES INCLUDING:
WASTE MANAGEMENT, INC. - HARRIS SANITATION
7382 TALONA DRIVE
WEST MELBOURNE FL 32904
INSURER B: Indemnity Insurance Co of North America
43575
INSURER C: ACE Property & Casualty Insurance Co
20699
INSURER D:
1/1/2015
INSURER E:
$000000
INSURER F:
$ 5,000,000
COVERAGES WASMA51 CERTIFICATE NUMBER: 3420932 REVISION NUMBER: XXXXXXX
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
INSR
SUBR
WVD
POLICY NUMBER
POLICY EFF
MM /DD/YYYY
POLICY EXP
MM /DD/YYYY
LIMITS
A
GENERAL LIABILITY
Y
Y
HDOG2732924A
1/1/2014
1/1/2015
EACH OCCURRENCE
$000000
PREMISES (Ea RENTED
$ 5,000,000
X COMMERCIAL GENERAL LIABILITY
MED EXP (Any one person)
XXXXXXX
CLAIMS -MADE FTI OCCUR
PERSONAL & ADV INJURY
$ 5.000 000
X XCU INCLUDED
X
ISO FORM CG 00011207
GENERAL AGGREGATE
$ 6,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$ 6,000,000
PRO -
POLICY X JECT X LOC
$
A
AUTOMOBILE
LIABILITY
Y
Y
MMT 1- I08816025
1/1/2014
1/1 /2015
EaeoclEDISINGLELIMIT
$ 1,000000
BODILY INJURY (Per person)
$ XXXXXXX
O
AUTOS NED AUTODULED
1xxANYAUT
BODILY INJURY (Per accident
$ XXXXXXX
PROPERTY DAMAGE
Per accident
$XXXXXXX
NON -OWNED
HIRED AUTOS X AUTOS
$ XXXXXXX
MCS -90 1 1
C
X
UMBRELLA LIAB
X
OCCUR
Y
Y
XOOG27054961
1/1/2014
1/1/2015
EACH OCCURRENCE
$ 15,000,000
AGGREGATE
$ 15,000 000
EXCESS LIAB
CLAIMS -MADE
DIED RETENTION
$ XXXXXXX
B
�'
•
.$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR /PARTNER /EXECUTIVE YIN
OFFICER /MEMBER EXCLUDED?
(Mandatory in NH)
NIA
Y
WLR 047876345 (AOS)
WLR C47S76307 (AZ, CA &
SCF C47876369(WI)
1/1/2014
�I /I /2014
1/1/2014
1/1/2015
1 /1/201
1/1/2015
TWO STATU- OTH-
X TORY LIMITS
E.L. EACH ACCIDENT
$ 3,000,000
E.L. DISEASE - EA EMPLOYEE
3,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
s 3,000,000
•
EXCESS AUTO
LIABILITY
Y
Y
XSA H08816013
1/1/2014
1/1/2015
COMBINED SINGLE LIMIT
$9,000.000
(EACH ACCIDENT)
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES /(Attach ACORD 101, Additional Remarks Schedule, 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. ADDITIONAL INSURED IN FAVOR
OF THE CITY OF SEBASTIAN (ON ALL POLICIES EXCEPT WORKERS' COMPENSATION /EL) WHERE AND TO THE EXTENT REQUIRED BY
WRITTEN CONTRACT.
CERTIFICATE HOLDER CANCELLATION
3420932
CITY OF SEBASTIAN
1225 MAIN STREET
SEBASTIAN FL 32958
ACORD 25 (2010/051
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
IN
NORM
C
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