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A� H CERTIFICATE OF LIABILITY INSURANCE
<br />o0910112020DYYYY)
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT US Centralized Services
<br />NAME:
<br />Marsh USA Inc.
<br />PWC.HONNo.E 866-966-4664 uc
<br />701 Market Street, Suite 1100
<br />E No
<br />E-MAIL Att.CertRequestl�marsh.com
<br />ADDRESS:
<br />St. Louis, MO 63101
<br />Attn: ATT.CertRequest@marsh.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: Old Republic Insurance Company
<br />24147
<br />CN103150778-GAW-CRT-20-21 Y Y kvt66g Y
<br />INSURED
<br />New Cingular Wireless PCS, LLC
<br />INSURER B :
<br />One AT&T Plaza
<br />INSURER C :
<br />208 South Akard
<br />INSURER D
<br />Room 1820
<br />Dallas TX 75202
<br />INSURER E:
<br />INSURERF:
<br />COVERAGES CERTIFICATE NUMBER: CHI-009523130-05 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADOL
<br />SUER
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DDIYYYY
<br />POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERALLIABILITY
<br />MWZY 31363620
<br />06/01/2020
<br />0610112021
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />CLAIMS -MADE -XI OCCUR
<br />DAPRMAGE TO RENTED
<br />EMISES Ea occurrence
<br />$ 1,000,000
<br />MED EXP (Any one person)
<br />$ NIA
<br />PERSONAL& ADV INJURY
<br />$ 2,000,000
<br />GENT
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERALAGGREGATE
<br />$ 10,000,000
<br />POLICY JET LOC
<br />X
<br />PRODUCTS -COMPIOP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />MWT831363520
<br />06101/2020
<br />0610112021
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />A
<br />X ANY AUTO
<br />Mi 31363720(MI)
<br />06/01/2020
<br />06/0112021
<br />BODILY INJURY (Per person)
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DIED I I RETENTION
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY Y / N
<br />OFFCEWMEMBEREXCLU ED ECUTIVE
<br />(Mandatory in NH)
<br />NIA
<br />131363820(ADS)
<br />0610112020
<br />0610112021
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />8 yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE- POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Excess Workers' Compensation I
<br />MWXS 31363920 (OH,WA)
<br />06101/2020
<br />06101/2021
<br />EL Each Accident / EL Disease
<br />1,000,000
<br />Employers' Liability
<br />See Second Page
<br />EL Disease -Policy Limit
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re I City of Santa Ana Municipal Facilities License Agreement
<br />City of Santa Ana, its council members, officers, and employees islare included as Additional Insured under the General Liability and Automobile Liability policies but only with respect to the requirements of the
<br />contract between the Certificate Holder and the Insured. Waiver of Subrogation is provided for General Liability, Automobile Liability and Workers' Compensation as required by wdtlen contract and allowable by
<br />law. This insurance is primary with respect to the interest of the Additional Insured and any other insurance maintained by Additional Insured is excess and noncontdbutory with this insurance,
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Risk Management Division THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza, 4th floor ACCORDANCE WITH THE POLICY PROVISIONS,
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />a RisltTlanagenlmt DivisionREVIEWED & APPROV®BY:
<br />rJ 19118-2016 ACORD C %�± c`-awr.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD' Rnk Management analyst
<br />
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