COI - Waste Connections US, Inc. - Expires 2022-08-012021
® DATE (MM/ODlYYYY)
A�RLI CERTIFICATE OF LIABILITY INSURANCE 720//DDN
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 endorsements .
PRODUCER CONTACT
NAME: Certificate Unit _
Edgewood Partners Insurance Center PHONE 404-439-8000 ac No
200 Glenridge Point Parkway E-MAIL
Suite 400 ADDRESS: certificate@epicbrokers.com
Atlanta GA 30342
INSURERS AFFORDING COVERAGE NAIC 0
INSURER A: ACE American Insurance Company 22667
INSURED INSURER B : Indemnity Insurance Company of N A I 43575
Waste Connections US, Inc.
3 Waterway Square Place, Suite 110 INSURER c: ACE Property 8 Casualty Insurance Company 20699
The Woodlands, TX 77380 INSURER D :
INSURER E :
INSURER F :
COVERAGER rFRTIFIC_ATF NI IIURFR- oz01 a7a9;S I29:V1c1na1 n111RAMM10-
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.
POLICY EFF
LTR ; TYPE OF INSURANCE f WVD I POLICY NUMBER MMMDIYYYY i t WDDNYY LIMITS
A
X COMMERCIAL GENERAL LIABILITY
i HOO G72492547 8/1/2021 811/2022
� EACH OCCURRENCE
j $ 2.000.000
- CLAIMS -MADE 1 X OCCUR
DAMAGE TO RENTED
PREMISES (Ea occurrence) _-_i
MED EXP (Any one person)
$100_000
I Is
I $ 2,000.000
PERSONAL 8 ADV INJURY
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY ;� PRO
JECT LOC
GENERAL AGGREGATE
PRODUCTS COMPIOPAGG
I $ 5,000,000
$2,000,000
��--
$
OTHER:
I
A
AUTOMOBILE UABIUTY
ISA H25544717 8/1/2021 8/1/2022 COMBINED SINGLE LIMIT
$ 5,000.000
X ANY AUTO
BODILY INJURY (Per person)
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per accident _ _
_
I $
C
X 'UMBRELLA LIAR OCCUR
1 XEUG27614620 007
1 8112021 1 8/112022 EACH OCCURRENCE
j $1,000.000
EXCESS LIAR CLAIMS -MADE
ni
I DED ! X RETENTION $ _ --
j
i ! AGGREGATE -�
j
$1.000,000- -
$
H
B WORKERS COMPENSATION I WLR C67816389 (AOS) 8/12021 8/1/2022 ;X STATUTE OH
A AND EMPLOYERS' LIABILITY Y / N f WLR C67816420 (CA. MA) 8/12021 8/1/2022 i
ANYPROPRIETOR/PARTNERIEXECUTIVE IN ! N / A E.L. EACH ACCIDENT
OFFICERIMEMBEREXCLUDED? -- -- --
$ 1,500,000
--- ---
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE
U as. describe under —
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT
$1.500,000
--
{ $ 1,500,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
Named Insured Includes: Waste Connections, Inc. and all wholly owned subsidiaries. City of Gilroy is included as Additional Insured in accordance with the
policy provisions of the General Liability and Automobile Liability policies. A Waiver of Subrogation is granted in favor of City of Gilroy in accordance with the
policy provisions of the General Liability, Automobile Liability and Workers Compensation policies. Umbrella Liability follows form.
kor-M I IrikoA 1 t r1ULUtt1 IUANGtLLA f10N
City of Gilroy
7351 Rosanna Street
Gilroy CA 95029
USA
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
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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POLICY NUMBER: HDO G72492547
11
Endorsement Number: 108
COMMERCIAL GENERAL LIABILITY
CG20261219
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 Gilroy
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II — Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property
damage" 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:
1. In the performance of your ongoing operations;
or
2. In connection with your premises owned by or
rented to you.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III — Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable limits of
insurance;
whichever is less.
This endorsement shall not increase the
applicable limits of insurance.
CG 20 26 12 19 O Insurance Services Office, Inc., 2018 Page 1 of 1
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