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Such assignment may be conditional upon consent of the insurer, provided that such consent Is not unreasonably refused. The insurer further certifies that if will not cancel, terminate, or fail to renew this policy except for failure to pay the premium, and that the automatic renewal of the policy provides the Insured with the option of renewal at the face amount of the expiring policy. If there is a failure to pay the premium and the insurer elects to cancel,terminate or not renew the policy, the insurer will send notice by either registered or certified mail to the operator and the CIWMB. Cancellation, termination, or failure to renew may not occur, however, during the one hundred twenty(120)days beginning with the date of receipt of the notice by the operator and the CIWMB, as evidenced by the return receipts. Cancellation,termination, or failure to renew will not occur and the policy will remain In full force end effect In the event that on or before the date of expiration: (1) The CIWMB or local enforcement agency deems the facility abandoned; or (2) The permit is terminated or revoked or a new permit is denied by the CIWMB or local enforcement agency; or (3) - Closure is ordered by the CIWMB;or any other State or Federal agency, or a court of competent jurisdiction;or (4) The operator is named as a debtor in a voluntary or Involuntary proceeding under Title 11 (Bankruptcy) U.S.Code; or (5) All delinquent premium payments have been brought current. If this policy is used in combination with another mechanism,this policy shall be considered primary coverage. Whenever requested by the California integrated Waste Management Board of the State of California,the insurer agrees to furnish to the CIWMB a certified copy of the original policy listed above, including all endorsements thereon. The party below certifles and signs under penalty of perjury that the information In this document is true and correct to the best of his or her knowledge,and satisfies the requirements of Title 27,California Code of Regulatio inion 2, Subdivision 1, Chapter 6. Notarial Seal -Alda L EmdmrctaNotaryPublic oMtu (Auth zed Ignature of Insurer) (Title) My Cml*o 'x#res ,lune 21,2004 Scott Batt,ARM brietuber,PWrmy won olhlotedos (Ty yed or printed Name of PersSlgning) na re 11 � n®ss o Sigpaw I PRIVACY STATEMENT The Information Practices Act(California Civil Code Section 1798.17)and the Federal Privacy Act(5 U.S.C.552a(e)(3))require that this notice be provided when collecting personal Information from individuals. AGENCY REQUESTING INFORMATION: California Integrated Waste Management Board. -UNIT RESPONSIBLE FOR MAINTENANCE OF FORM: Financial Assurances Section, California integrated Waste Management Board,8800 Cal Canter Drive,'Sacramento,CA 95828. Contact the Manager. Financial Assurances Section,at(916)265-2200. CA-SOLID WASTE-CPC(1/00) Page 2 CiWM8 106(4/96)