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TRUCKED NON-HAZARDOUS WASTE DISPOSAL PERMIT <br /> Terms and Conditions <br /> Addendum C <br /> EBJWUD CERTIFICATE OF COMMERCIAL <br /> AUTO/TRUCKING LIABILITY INSURANCE <br /> r <br /> q , N <br /> IA- <br /> V- <br /> Ds A <br /> ,��:n aN <br /> t <br /> gi[ <br /> .. .....!, <br /> THE FOLLOWING DESCRIBED POLICY HAS BEEN ISSUED TO: <br /> District Permit Number: <br /> Insured: <br /> Address: <br /> LOCATION AND DESCRIPTION OF PROJECT/AGREEMENT: <br /> Trucked non-hazardous waste permitted for disposal at designated EBMUD Wastewater Treatment facilities <br /> TYPE OF INSURANCE:AutomobilofTrucking Liability: CoveragelEndorserrients as required by agreement. <br /> LIMITS OF LIABILITY: (MINIMUM) $1,000,00010ccurrence,Bodily Injury,Properly Damage-Auto Liability <br /> SELF INSURED RETENTION($)-, (AutorTrucking) A- t1000 IK?D-�SIISOC> <br /> Aggreg ate Llmits (Autw7rucking) t110061V00 <br /> INSURANCE COMPANY(IES): (Autorrrucking) T,�C)tl <br /> POLICY NUMBER(S): (6utorrru king) S'�TO[6�-��1,�00 <br /> POLICY TERM: From: (Autoaruck rim A 1%1.U471 To: (Au /Trucking) A I I I t (9 <br /> THE FOLLOWING COVERAGES OR ENDORSEMENTS ARE INCLUDED IN THE POLICY(IES): <br /> 1. 0 The coverage is Primary to any other applicable insurance carded by the District, <br /> 2, N The policy(les)covers contractual liability, <br /> 3. M The policy(les)covers the use of owned,non-owned,and hired automobiles and trucks. <br /> 4. Z The policy(ies)will not be canceled nor the above coverageslendorsements reduced without 30 days written notice to <br /> East Bay Municipal Utility District at the address above. <br /> IT IS HEREBY CERTIFIED that the above policies provide liability Insurance as required by the agreement between the <br /> East Bay Municil al Utility District and the insured. <br /> Signed Finn Wwi,26 T. R <br /> -a <br /> Address qW 1� S Date Phone <br /> er <br /> n .GMS UFO20-30.doc <br /> If submittina transporters Insurance and transporter Is not the Permit Holder <br /> JPrfnt Name of Person Authorized to Sign on Behalf orthe Third-Patty],on behalf <br /> of ws-.- ter company name of Insurecill agree to defend, indemnify,and hold <br /> harmless istrict and its Dfrectors,officers, agents, and employees from and against any and all loss, <br /> liability, expense, claims,suits, and damages, including attorneys'fees, arising out of or resulting from <br /> [enter name of Third-Party Company], its generators, its haulers,brokers,associates', employees', sub- <br /> cM or Mor agents' operation or perfo nce under this Agreement. <br /> Transportation Company Representative Signature Date <br />