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AGENCY CUSTOMER ID: <br /> LOC 4: <br /> ACORD ADDITIONAL REMARKS SCHEDULE <br /> AGENCY NAMED INSURED <br /> REPUBLIC SERVICES,INC <br /> POLICY NUMEIER 18500 N.ALLIED WAY <br /> Sea FIrSt page PI EDENI�f,AZ B5R754 <br /> CARRIER NAIC CODE <br /> See First Pa E"ECTIVE DATE _ <br /> ADDITIONAL REMARKS <br /> THIS ADOmONAL RE VAR KS FORM 15 A 5CHIEDULE TO AC ORD FORM. <br /> FORM NumaER: 25 FORM TITLE: _f;ERTIFICATE OF LIABILI'T'Y INSURANCE <br /> The following provisions apply when required by written contract.As used below.the term carrifrrate holder also Includes any person or organ:z�'.tion that <br /> the insured has become obligated to include as a result of an executed contract or agreement <br /> GENERAL LIABIL1 Y <br /> Certificate holder is Additional Insured when required by written contract <br /> Coverage is primary and non-Coninbutory when required by untlen coninct <br /> Waiver of Subrogation in favor of the mridicate holder is inciuded when required by written contract. <br /> AUTO LIABILITY <br /> Canif'cale holder is Add rho naI Insured when required by written contract <br /> Waiver of SubrogatKm In favor of the cartrftcata holder is Included when raqurad by written contract. <br /> WORKERS COMPENSATION AND EMPLOYERS t_IA81LITY <br /> Waiver of Subrogation in favor of the certifiaite holder is included when required by written contract where allowed by state law <br /> Stopgap coverage for ND,WA and WY is covered under policy no.WLR C64412917 and stopgap coverage for OH is covered under policy no WCU <br /> C6441289rl.as noted on page 1 of this certificate. <br /> TEXAS EXCESS INDEMNITY AND EMPLOYERS LIABILITY <br /> Republic Sarvicas,Inc and As subsidiaries are registered non-subscribers to the Texas Workers Compensation Act republic Se-vlces.Inc.has filed an <br /> approved Indamnity Plan with the Texas Department of Insurance which offers an alternative in benefits to employees rather than the traditional Workers <br /> Compensation Insurance in Texas The excess policy(11TNS C4916Ia436)shown on this certificate provides excess Indemnity and Employers Liabilihf <br /> coverage for the approved Indemnity Plan <br /> Contractual LiaL4rty is indudad+n the General Ltabilrty and Automobile LLobIrty coverage forms The General LiabIity and Automobile Liability poll'cies do <br /> not contain endorsements excluding Contractual Liability_. <br /> Separation of Insured{Cross Ltabllry)coverage is provided to the Additional Insured,when requuad by written contract.per the Conditions of the <br /> Commarciat General Liabil ity Coverage form and the Automobile Liability Coverage form <br /> ACORD 101 t26e6r41] DIDBB-2010 ACORD CORPORATION.All rights rosarved, <br /> Tna AC OR nama arid logo ma rrgtsrane marks of ACORD <br /> Papa 21 of 33 <br /> Attachment number 2\n <br /> E-1 Page 137 <br />