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State of California California Integrated Waste Management Board <br /> CERTIFICATE OF LIABILITY INSURANCE <br /> (If additional space needed,add attachment.) <br /> Name of Insurer: Address:Powers Leavitt CA Insurer License Number: <br /> Crum&Forster Specialty PO Box 125 Or OW83446 <br /> NAIC Number:24856 <br /> Buckeye,AZ 85326 <br /> Phone Number:480 948 7913 <br /> Name of Insured:CRM Co LLC Address:1301 Dove Ste 4940 <br /> Newport Beach,CA 92660 <br /> Phone Number: 949-263-9100 <br /> Major Waste Tire Facilities Covered:(Enter Information for Each Facility) LIMITS OF LIABILITY <br /> Name: Address: Major Waste Tire Per Occurrence:* Annual Aggregate:* <br /> Facility Information <br /> Number <br /> CRM Co LLC 1404 S Fresno $1,000, 000 $2,000, 000 <br /> Ave I$ -7 <br /> Stockton, CA <br /> 95206 <br /> Total: <br /> Policy Number: Effective Date: 05/26/2015 <br /> EPK-108702 <br /> *Excluding legal defense costs and deductibles <br /> INSURER CERTIFICATION: <br /> 1. The insurer hereby certifies that it has issued liability insurance covering personal injury and/or property <br /> damage to the insured listed above in connection with the insured's obligation to demonstrate financial responsibility <br /> under Title 14,California Code of Regulations,Division 7,Chapter 6,Article 10. The coverage applies to the <br /> above-listed facility(ies)for accidental occurrences arising from the operation of the facility(ies). <br /> 2. Indicate whether this coverage is❑primary or❑excess coverage. <br /> 3. The limits of liability are the amounts stated above for"per occurrence"and"annual aggregate", <br /> exclusive of legal defense costs. If an excess coverage insurance policy is being provided,complete the following <br /> sentence: <br /> $4,000,000 per occurrence and$2,000,000 annual aggregate in excess of the underlying limits of <br /> $1,000.000 per occurrence and$ 2,000,000 annual aggregate.] <br /> CIWMB 146(12/01) E 01'2 0V <br /> SEP 3 0 2015 <br /> BYE ft'k J0 fdW1fA <br />