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Cgnalryr9nNE,irvmne 9. <br />Francine R. Villareal wuaai <br />mre. mm.wnr nwmmw <br />CERTIFICATE OF LIABILITY INSURANCE I DATE 09101112020Drcrnl <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. 1 <br />If SUBROGATION 15 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 riahts to the certificate holder in lieu of such endorsemeri <br />PRODUCER <br />Marsh USA Inc. <br />701 Markel Street, Suite 1100 <br />St. Louis, MO 63101 <br />Alin: ATT.CedRequest@marsh.mm <br />INSURED <br />New Cingular Wireless PCS, LLC <br />One AT&T Plaza <br />208 South Akard <br />Room 1820 <br />Dallas, TX 75202 <br />US Centralized Services <br />866-966-0664 <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 />ADDL <br />INSD <br />SUER <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MNIDD <br />POLICY EXP <br />MMIDDIYYYY <br />LIMITS <br />A <br />X <br />COMMERCUILGENERALLMBIL <br />CLAIMS -MADE Fx_1 OCCUR <br />MWZY 31363620 <br />0610112020 <br />0610112021 <br />EACH OCCURRENCE <br />$ 2,000000 <br />PREMISES Ea emavenrs <br />$ 1,000,000 <br />MED EXP (Any one Person) <br />S NIA <br />PERSONAL &ADV INJURY <br />$ 2.000000 <br />GEN'L AGGREGATE LIMITAPPLIES PER: <br />X POLICY ❑ PE,CO7 LOC <br />GENERAL AGGREGATE <br />S 10,000,000 <br />PRODUCTS-COMPIOPAGG <br />IS 2,000,000 <br />$ <br />OTHER: <br />A <br />A <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />MWrTB 31363520 <br />MWZX 31363720 Mill <br />06101/2020 <br />06101/2020 <br />06101/2021 <br />06/0112021 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ 1,000A00 <br />BODILY INJURY (Per Person) <br />$ <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident], <br />P( <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />S <br />EXCESS LIM <br />CLAIMS -MADE <br />DED RETENTION $ <br />A <br />WORKERS COMPENSATION <br />ANO EMPLOYERS' LIABILITY YIN <br />ANYPROPRIETORIPARTNEWEXECUTIVE <br />QFFICEWMEMBEREXCLUDED? ❑N <br />(Mandatory In NH) <br />NIA <br />MWC 31363820 (ADS) <br />I <br />06/01/2021 <br />X PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />S 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE <br />5 1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />S 1,000,000 <br />A <br />Excess Workers' Compensation 1 <br />MWXS 31363920 (OH,WA) <br />06101020 <br />06/01/2021 <br />EL Each Accident I EL Disease <br />1,0DOGDO <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 Irmo,. apace 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 Lability and Automobile Liability policies but only with respect to ale requirements of the <br />contract between the Cedificate 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 nonconnibutory, with this insurance. <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 />rMi RLk MingeeodtXWaim <br />I�vrt-s i Mrrto�®8r- <br />01988.2016 ACORD C <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD tut Marragerrny Aruyer <br />