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<br />A� Oe CERTIFICATE OF LIABILITY INSURANCE
<br />D09luino20D )
<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 />PHO866-966-4664
<br />701 Market Street, Suite 1100
<br />WC,FAX
<br />N ue No
<br />VDRess: AILCertRequest@marsh.com
<br />SL Louis, MO 63101
<br />Attn: ATT.CertRequest@marsh.mm
<br />INSURERS AFFORDING COVERAGE
<br />NAIL#
<br />INSURER A: Old Republic Insurance Company
<br />24147
<br />CN103150778-GAW-CRT-20-21 Y Y kv166g Y
<br />INSURED
<br />New Cingular Wireless PCS, LLC
<br />INSURER B:
<br />INSURER C :
<br />One AT&T Plaza
<br />208 South Akard
<br />Room 1820
<br />INSURER D :
<br />Dallas, TX 75202
<br />INSURER E
<br />INSURER F :
<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 />ADDLSUBR
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDO
<br />POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LABILITY
<br />MWZY 31363620
<br />06/01/2020
<br />0610V2021
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />CLAIMS-MADE1fl OCCUR
<br />AMA ETOftENTED
<br />PREMISES Ea occurrence
<br />$ 1,W0,000
<br />MED EXP(Anyone parson)
<br />$ NIA
<br />PERSONAL &ADV INJURY
<br />$ 2,000,000
<br />Gli AGGREGATE LIMITAPPLIES PER
<br />GENERAL AGGREGATE
<br />It 10,000,000
<br />X POLICY ❑PEO LOG
<br />PRODUCTS - COMPIOP AGG
<br />It 2,000,000
<br />It
<br />OTHER:
<br />A
<br />ALEGMOBILELIABILITY
<br />MWTB 31363520
<br />OSI0112020
<br />06ifiv 21
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />It 1,000,000
<br />A
<br />X
<br />ANY AUTO
<br />MWZX 31363720 (MI)
<br />06/0112020
<br />061012021
<br />BODILY INJURY (Per parson)
<br />S
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LAYIN BILEN
<br />OFFCEOR/MEMB REXCLU ED?ECUTIVE FNI
<br />(Mandatory in NH)
<br />MIA
<br />MWC 31363820 (AOS)
<br />11
<br />06101021
<br />X I PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />S 1,000,000
<br />Ryes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,W0,000
<br />A
<br />Excess Workers' Compensation I
<br />MV✓XS 31363920 (OH,WA)
<br />0610112020
<br />06/01/2021
<br />EL Each Accident 1 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 LOCATIONS I VEHICLES (ACORD 101, AddKlonal Remarks Schedule, may be attached ifmore space Is required)
<br />Re : 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 written 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 noncontributory with this insurance.
<br />Cityof 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, 4lh floor ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701
<br />AUTHORNED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />Mi k
<br />REVIfYPED 6 APPROVED BY:
<br />©1988.2016 ACORD C
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD wtMarraganent Anayst
<br />
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