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AGENCY CUSTOMER ID: LOC #: ACCORD® liki ADDITIONAL REMARKS SCHEDULE Page 2 of AGENCY NAMED INSURED REPUBLIC SERVICES, INC. 18500 N. ALLIED WAY POLICY NUMBER See First Page PHOENIX, AZ 85054 CARRIER NAIC CODE See First Page EFFECTIVE DATE: ADDITIONAL REMARKS CERTIFICATE NUMBER: 2023644 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 including on -going and completed operations 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. 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. 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. Stop gap coverage for NO, WA and WY is covered under policy no. WLR C67824064 and stop gap coverage for OH is covered under policy no. WCU C67824143, as noted on page 1 of this certificate. TEXAS EXCESS INDEMNITY AND EMPLOYERS LIABILITY: Insured is a registered non -subscriber to the Texas Workers Compensation Act. Insured 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 (#TNS C68990592) shown on this certificate provides excess Indemnity and Employers Liability coverage for the approved Indemnity Plan. Contractual Liability is included in the General Liability and Automobile Liability coverage forms. The General Liability and Automobile Liability policies do not contain endorsements excluding Contractual Liability. Separation of Insured (Cross Liability) coverage is provided to the Additional Insured, when required by written contract, per the Conditions of the Commercial General Liability Coverage form and the Automobile Liability Coverage form. The Umbrella/Excess Liability policy is follow form over the General Liability, Automobile Liability and Employer's Liability policies shown on this certificate. Insurer Affording Pollution Coverage - Tokio Marine Specialty Insurance Co. (NAIC # 23850) Policy No. PPK2290912 Contracting Operations Environmental Liability - $10,000,000 Per Contamination Incident/$10,000,000 General Aggregate Professional Liability- $10,000,000 Per Incident/$10,000,000 General Aggregate ACORD 101 (2008101) ©1988-2010 A The ACORD name and logo are registered marks of ACORD WdrMnur�INdalmr % REwEwEo 6.Mp PR/Iov®ppliv.�;, SA+1vNMh/. IR�1We'N ®'. ® Risk Managemen[Superv6ar