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Insurance Certificates 2016/17 Burrtec Waste & RecyclingClient#: 25638 BURRWAST ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1 5/12/2016 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 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 Marsh & McLennan Agency LLC Marsh &McLennan Ins Agncy LLC PO Box 85638; CA Lic #OH18131 San Diego, CA 92186 CONTACT Brenda Kennerly PHONE g58-875-3085 FAX 858-210-3916 A/C, No, Ext : A/C, No ADDRESS, brenda.kennerly@barneyandbarney.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Evanston Insurance Company 35378 INSURED INSURER B : Lexington Insurance. Company 19437 Burrtec Waste Group, Inc. INSURER c :Travelers Property Casualty Corn 25674 9890 Cherry Avenue INSURER D : Navigators Navi atSpecialty Insurance 36056 Fontana, CA 92335 INSURER E : ' `7 Liberty Insurance Underwriters 19917 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 CONTRACTOR 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 POLICY EXP MM/DD LIMITS A GENERAL LIABILITY X 3C31478 3/01/2016 03/01/2017 EACH OCCURRENCE $11000000 X COMMERCIAL GENERAL LIABILITY PREMISES ERENTED ccr nce $100,000 CLAIMS -MADE 4 OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $1,0009000 X BI/PD Ded:25000 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PRO LOC JECT $ C AUTOMOBILE LIABILITY X TC2JCAP4255B980TIL 3/01/2016 03/01/201 aocid.n SINGLE LIMIT Ea MINED 2,0009000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS B UMBRELLA LIAB X OCCUR 021391622 03/01/2016 03/01/2017 EACH OCCURRENCE s5,000,000 X AGGREGATE s5,000,000 EXCESS LIAB CLAIMS -MADE DIED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBERY / N EXCLUDED? N / A X TC2JUB4256BO24TIL1 03/01/2016 03/01/201 X TVCYTLMIT ERH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 D Excess Liability SF16EXC86805711C 3/01/2016 03/01/2017 $3,000,000 over $5M E Excess Liability 100014503902 03/01/2016 03/01/2017 $1,000,000 over $3M Each Occ/Agg Limit DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Job: Operations pertaining to named insured for certholder. City of La Quinta, its elective and appointive boards, commissions, officials, employees, agents and volunteers are additional insureds, primary and non-contributory per endorsements attached. Umbrella/Excess liability follows form of Primary policies. WN]a G's I I a LAd\ Ia1 F. Lai Rolla WRIF1\0 Uf aA AG\IL Lei City of La Quinta SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 78495 Calle Tampico ACCORDANCE WITH THE POLICY PROVISIONS. La Quinta, CA 92253-2839 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S773054/M768689 VANJ A4Ca ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Barney & Barney, a Marsh & McLennan Insurance Agency LLC company Burrtec Waste Group, Inc. CARRIER 7-CODEi EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Named Insured schedule Burrtec Waste Group, Inc. Agua Mansa MRF, LLC AVCO Disposal, Inc. Burr Group LP Burr Group, Inc. Burr Properties, LLC Burrline LLC Burrtec Environmental, LLC Burrtec Recovery & Transfer, LLC Burrtec Retirement savings Plan Burrtec Waste & Recycling services, LLC Burrtec Waste Industries, Inc. Burrtec Waste Industries, Inc. (formerly P5P Waste services, Inc.) Burrtec Waste Industries, Inc. DBA: Burbank Recycling Burrtec Waste Industries, Inc. DBA: Agua Mansa Recycling & Transfer Co. Burrtec Waste Industries, Inc. DBA: Burrtec Recycling & Transfer Co. Burrtec Waste Industries, Inc. DBA: Burrtec Recycling Center Burrtec Waste Industries, Inc. DBA: Coachella valley Compost Burrtec waste Industries, Inc. DBA: Coachella valley Transfer station Burrtec Waste Industries, Inc. DBA: Desert Disposal Burrtec Waste Industries, Inc. DBA: East valley Recycling & Transfer Burrtec Waste Industries, Inc. DBA: Inland Empire Recycling Burrtec waste Industries, Inc. DBA: Marks Disposal Burrtec Waste Industries, Inc. DBA: Tri-Co Burrtec Waste Industries, Inc. DBA: Tri-County Disposal Burrtec Waste Industries, Inc. DBA: Trico Disposal Burrtec Waste services, LLC Crestline Disposal Currans Rubbish Disposal, Inc. E. Cole Burr, individually and as Trustee of the Burr Family Trust EDCO Disposal Corp (but only as respects to vehicles registered in their name) ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACC ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Barney & Barney, a Marsh & McLennan Insurance Agency LLC company Burrtec Waste Group, Inc. CARRIER 7-CODEi EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Edward G. Burr, Sandra L. Burr, Cole Burr and Tracy A. Burr, Individually and Burr Properties: 9910, 9934, 9930, 9964, 9820, 9890, 9982 Cherry Ave, Fontana, CA and 17000 Abbey Lane, corner of Abbey Lane and Bimini (5 acres), and 18997 Abbey Lane, Victorville California Empire Disposal, LLC Fontana Rubbish Collectors, Inc. Inland BioEnergy, LLC Jack's Disposal, Incorporated DBA: Yukon Disposal .jack's Disposal, Incorporated Kaiser Recycling Corporation KGB Properties, LLC (formerly Burr Girls, LLC) Lake Arrowhead Disposal Lucerne Valley Disposal, Inc. Monte Vista Disposal, Inc. Mountain Disposal Services, Inc. Rancho Disposal service, Inc. Rialto Services, Inc. Running springs Disposal TECMEC Maintenance Enterprise, Inc. Tracy A. Burr, individually and as Trustee of the Burr Family Trust Tri-County Disposal, Inc. Tri-County Disposal, Inc. DBA: Gary's Disposal (but only as respects to vehicles registered in this name) Victorville Disposal, Inc. West Valley MRF, LLC West Valley Recycling and Transfer, Inc. Yucaipa Disposal, Inc. ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD III ESSEX INSURANCE. CONEVANY mmm CONSTRUCTION PROJECTS PER PROJECT GENERAL AGGREGATE LIMIT Entry optional if shown in the Common Policy Declarations. if no entry is shown, the effective date of the endorsement is the same as the effective date of the policy. *ATTACHED TO AND FORMING *EFFECTIVE DATE OF *ISSUED TO PART OF POLICY NO. ENDORSEMENT 3C31478 03/01/2016 City of La Quinta THIS ENDORSEMENT AMENDS THE LIABILITY COVERAGE FORM OR COVERAGE PART (hereinafter referred to as Coverage Form), AND APPLIES TO THE ENTIRE POLICY. A. For all sums covered under this policy, exclusive of SUPPLEMENTARY PAYMENTS which shall continue to apply as stipulated, the maximum amount payable under this policy is $5,000,000. Subject to the foregoing: B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which can be attributed only to ongoing operations at a single designated construction project: 1. A separate Construction Project General Aggregate Limit applies to each construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard", and for medical expenses under Coverage C regardless of the number of: a. Insureds, b. Claims made or "suits" brought, or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Construction Project General Aggregate Limit for that construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Construction Project General Aggregate Limit for any other construction project. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Construction Project General Aggregate Limit. C. Forall sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which cannot be attributed only to ongoing operations at a single construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable, and 2. Such payments shall not reduce any Construction Project General Aggregate Limit. D. When coverage for liability arising out of the "products -completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Construction Project General Aggregate Limit. ME-313 (08/09) Page 1 of 2 E. If the applicable construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. F. The provisions of Section III — Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. ME-313 (08/09) Page 2 of 2 INSURED: Burrtec Waste Group, Inc. POLICY #: 3C31478 POLICY PERIOD: 03/01/2016 TO 03/01/2017 COMMERCIAL GENERAL LIABILITY ESSEX INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED LOCATION(S) GENERAL AGGREGATE LIMIT A. For all sums covered under this policy, exclusive of SUPPLEMENTARY PAYMENTS which shall continue to apply as stipulated, the maximum amount payable under this policy is $5,000,000. Subject to the foregoing: B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which can be at- tributed only to operations at a single designated ''location" shown in the LOCATION OF PREMISES COVERED BY THIS POLICY section of Commercial General Liability Coverage Part — Supplemental Declarations: 1. A separate Designated Location General Aggregate Limit applies to each designated "location", and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Location General Aggregate Limit is the most we will pay for the sum of all damages under Cov- erage A, except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard", and for medical expenses under Coverage C regardless of the number of: a. Insureds, b. Claims made or "suits" brought, or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Location General Aggregate Limit for that designated "location". Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Location General Aggregate Limit for any other designated "location" shown in the LOCATION OF PREMISES COVERED BY THIS POLICY section of Commercial General Liability Coverage Part — Supplemental Declarations. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Ex- pense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declara- tions, such limits will be subject to the applicable Designated Location General Aggregate Limit. C. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which cannot be at- tributed only to operations at a single designated "location" shown in the LOCATION OF PREMISES COVERED BY THIS POLICY section of Commercial General Liability Coverage Part — Supplemental Declarations: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable, and 2. Such payments shall not reduce any Designated Location General Aggregate Limit. D. When coverage for liability arising out of the "products -completed operations hazard" is provided, any payments for damages because of "bodily injury'' or "property damage" included in the "products -completed operations hazard" will ME 316 08 09 Page 1 of 2 reduce the Products -completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Des- ignated Location General Aggregate Limit. E. For the purposes of this endorsement, the Definitions Section is amended by the addition of the following definition: "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted on- ly by a street, roadway, waterway or right-of-way of a railroad. F. The provisions of Section III — Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. All other terms and conditions remain unchanged. ME3150809 Page 2of2 INSURED: Burriec Waste Group, Inc. POLICY #: 3C31478 MARKEL` POLICY PERIOD: 03/01/2016 TO 03/01/2017 COMMERCIAL GENERAL LIABILITY Essex Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM PRODUCTSICOMPLETED OPERATIONS COVERAGE FORM LIQUOR LIABILITY COVERAGE FORM PROFESSIONAL LIABILITY COVERAGE FORM Please refer to each coverage form to determine which terms are defined. Words shown in quotations on this endorsement may or may not be defined in all coverage forms. SCHEDULE Person or Entity'. Any person or organization to whom you are obligated by valid written contract to provide such coverage. Additional Premium: (Check box if fully earned.❑) WHO IS AN INSURED is amended to include the person or entity shown in the Schedule above as an Additional Insured under this insurance, but only as respects negligent acts or omissions of the Named Insured and only as respects any coverage not otherwise excluded in the policy. Our agreement to accept an Additional Insured provision in a contract is not an acceptance of any other provisions of the contract or the contract in total. When coverage does not apply forthe Named Insured, no coverage or defense shall be afforded to the Additional Insured. No coverage shall be afforded to the Additional Insured for injury or damage of any type to any "employee" of the Named Insured or to any obligation of the Additional Insured to indemnify another because of damages arising out of such injury or damage. All other terms and conditions remain unchanged. MEGL 0009-01 0411 Includes copyrighted material of Insurance Services Office, Inc. with its Page 1 of 1 permission. INSURED: Burrtec Waste Group, Inc. POLICY #: 3C31478 POLICY PERIOD: 03/01/2016 TO 03/01/2017 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART PROMUCTSYCOMP ill CPERATIONS LIABILITY COVERAGE PART The fallowing is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that. (1) The additional insured is a Named Insured under such other insurance, and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured CG 20 01 04 13 C) Insurance Services Office, Inc., 2012 Page 1 of 1 INSURED: Burrtec Waste Group, Inc. POLICY #: TC2JCAP4255B980TIL POLICY PERIOD: 03/01/2016 TO: 03/01/2017 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 1. The following is added to Paragraph A.1.c., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in SECTION II. 2. The following is added to Paragraph B.5., Other Insurance of SECTION IV — BUSINESS AUTO CONDITIONS: Regardless of the provisions of paragraph a. and paragraph d. of this part 5. Other Insurance, this insurance is primary to and non-contributory with applicable other insurance under which an addi- tional insured person or organization is the first named insured when the written contract or agreement between you and that person or or- ganization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy pe- riod, requires this insurance to be primary and non-contributory. CA T4 74 02 15 © 2015 The Travelers Indemnity company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. POLICY NUMBER: TC2JCAP4255B980TIL COMMERCIAL AUTO CA2001 1013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LESSOR - ADDITIONAL INSURED AND LOSS PAYEE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Burrtec Waste Group, Inc. Endorsement Effective Date: SCHEDULE Insurance Company: Policy Number: TC2JCAP4255B980TIL Effective Date: 03/01/2016 Expiration Date: 03/01/2017 Named Insured: Burrtec waste Group, Inc. Address: Additional Insured (Lessor): All Lessors; Designation or Description of "Leased Autos": All leased autos of the Insured Address: Designation Or Description Of "Leased Autos": CA 20 01 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 2 Coverages Limit Of Insurance Covered Autos Liability $ 2,000,000 Each "Accident" Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Comprehensive $ 10,000 Deductible For Each Covered "Leased Auto" Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Collision $ 10,000 Deductible For Each Covered "Leased Auto" Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Specified Causes Of Loss $ Deductible For Each Covered "Leased Auto" Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Coverage 1. Any 'leased auto" designated or described in the Schedule will be considered a covered "auto" you own and not a covered "auto" you hire or borrow. 2. For a "leased auto" designated or described in the Schedule, the Who Is An Insured provision under Covered Autos Liability Coverage is changed to include as an "insured" the lessor named in the Schedule. However, the lessor is an "insured" only for "bodily injury" or "property damage" resulting from the acts or omissions by: a. You; b. Any of your "employees" or agents; or c. Any person, except the lessor or any "employee" or agent of the lessor, operating a "leased auto" with the permission of any of the above. 3. The coverages provided under this endorsement apply to any 'leased auto" described in the Schedule until the expiration date shown in the Schedule, or when the lessor or his or her agent takes possession of the "leased auto", whichever occurs first. B. Loss Payable Clause 1. We will pay, as interest may appear, you and the lessor named in this endorsement for "loss" to a "leased auto". 2. The insurance covers the interest of the lessor unless the "loss" results from fraudulent acts or omissions on your part. 3. If we make any payment to the lessor, we will obtain his or her rights against any other party. C. Cancellation 1. If we cancel the policy, we will mail notice to the lessor in accordance with the Cancellation Common Policy Condition. 2. If you cancel the policy, we will mail notice to the lessor. 3. Cancellation ends this agreement. D. The lessor is not liable for payment of your premiums. E. Additional Definition As used in this endorsement: "Leased auto" means an "auto" leased or rented to you, including any substitute, replacement or extra "auto" needed to meet seasonal or other needs, under a leasing or rental agreement that requires you to provide direct primary insurance for the lessor. Page 2 of 2 © Insurance Services Office, Inc., 2011 CA 20 01 10 13 INSURED: Burrtec Waste Group, Inc. POLICY #: TC2JU13425613024TIL1 AW TRAVELERSJ POLICY PERIOD: 03/01/2016 TO: 03/01/2017 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 ( A) — POLICY NUMBER - WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. The additional premium for this endorsement shall be °10 of the California workers' compensation pre- mium. Schedule Person or Organization Job Description BLANKET WHERE REQUIRED BY WRITTEN CONTRACT This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 03/01/2016 Policy No. TC2JU642566024TIL1 Endorsement No. Insured Premium Insurance Company: Travelers Property Casualty Co. Countersigned by DATE OF ISSUE: ST ASSIGN: Page 1 of 1