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(a)Bankruptcy or insolvency of the insured shall not relieve the insurer of its obligations under the policy to which this certification applies. (b) The insurer is liable for the payment of amounts within any deductible applicable to the policy.Nvith a right of reimbursement from the insured for any such payment made by the insurer. (c) Upon request by the Board or its designee,the insurer agrees to furnish to the Board or its designee the original policy and all endorsements. (d) Cancellation or any other termination of this certificate,whether by the insurer or the insured,will be effective only upon written notice and only after the expiration of 60 days after a copy of such written notice is sent by certified mail,and received by the Board or its designee,as evidenced by the return receipts. (See exception, section(e)) (e) Cancellation due to non-payment of premiums is effective only upon written notice and only after the expiration of 10 days after the date on which the operator and the Board or its designee have received the notice of termination,as evidenced by return receipts. The party below certifies and signs under penalty of perjury under the laws of the State of California that the information in this document is true and convect to the best of his or her knowledge,that this document is being executed in accordance with the requirements of Title 14,California Code of Regulations,Division 7,Chapter 6, Article 10,Section 18491,and that the insurer is licensed by the California Department of Insurance to transact the business of insurance in the State of California as an❑admitted carrier or❑eligible excess or surplus lines insurer. Signature of Individual Authorized to Sign on Behalf Title of Authorized Person: of Insurer: Producer 99* ype 'nted a of Person Signing: Date:09/25/2015 Stephen Reece Address of Person Signing:I l l E Monroe Ave Ste 200 Buckeye,AZ 85326 Phone Number of Person Signing:480-348-5956 PRIVACY STATEMENT This information is requested by the California Integrated Waste Management Board under Title 14,California Code of Regulations,Division 7,Chapter 6,Article 10,Section 18491,in order to verify adequate financial assurance of major waste tire facilities. Completion of this form is mandatory. The consequence of not completing the form is denial or revocation of a permit to operate a major waste tire facility. Information may be provided to the U.S. Environmental Protection Agency,State Attorney General,Air Resources Board,California Department of Toxic Substances Control,Energy Resources Conservation and Development Commission, Water Resources Control Board,and California Regional Water Quality Control Boards. For more information or access to your records, contact the California Integrated Waste Management Board, 1001 1 Street,P.O. Box 4025,Sacramento,California 95812-4025,(916)341-6000. CIWMB 146(12/01) Page 2 of 2