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AGENCY CUSTOMER ID: <br />LOC #: <br />A� ® ADDITIONAL REMARKS SCHEDULE <br />Page 2 of 2 <br />AGENCY <br />NAMED INSURED _ <br />Willis Toxers Watson Insurance Services West, Inc. <br />Republic Services, Inc <br />18500 N Allied Way <br />Phoenix, M 85054 <br />POLICY NUMBER <br />See Page 1 <br />CARRIER <br />NAIC CODE <br />See Page 1 <br />Be' Page 1 <br />EFFECTIVE DATE: See Page 1 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance <br />INSURER AFFORDING COVERAGE: Everest National Insurance Company NAIC#: 10120 <br />POLICY NUMBER: XC5EX01356-211 EFF DATE: 06/30/2021 EXP DATE: 06/30/2022 <br />TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br />Excess Liability Per Occurrence $10,000,000 <br />Aggregate $10,000,000 <br />INSURER AFFORDING COVERAGE: National Union Fire Insurance Company of Pittsburgh NAIC#: 19445 <br />POLICY NUMBER: 21335714 EFF DATE: 06/30/2021 EXP DATE: 06/30/2022 <br />TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br />Excess Liability Par Occurrence $10,000,000 <br />Aggregate $10,000,000 <br />INSURER AFFORDING COVERAGE: Steadfast Insurance Company NAIC#: 26387 <br />POLICY NUMBER: AEC 3956336-01 EFF DATE: 06/30/2021 EXP DATE: 06/30/2022 <br />TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br />Excess Liability Per Occurrence $15M p/o $25M <br />Aggregate $15M p/o $25M <br />INSURER AFFORDING COVERAGE: Westchester Surplus Lines Insurance Company NAIC#: 10172 <br />POLICY NUMBER: G71813046 002 EFF DATE: 06/30/2021 EXP DATE: 06/30/2022 <br />TYPE OF INSURANCE: <br />Excess Liability <br />ACORD 101 (2008101) <br />LIMIT DESCRIPTION: LIMIT AMOUNT: <br />Per Occurrence $1OM p/o $25M <br />Aggregate $1OM p/o $25M <br />f•ALl:ifeTKa7 7rLTi7 <br />The ACORD name and logo are registered marks of ACORD <br />SR ID: 21613305 BATCH: 2245022 CERT: W22213408 <br />f,�en�nap ryq �la�Mrl�y,�n,yM1 <br />� REVIEWED&APPRovm Br. <br />®: RUk ManzgenSup <br />