|
Francine R. Digitally signed by Francine
<br />R. Villareal
<br />\/illn Taal Date: 2021.07.01 16:47:11
<br />A�RO� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 12021 AYYY
<br />062612021
<br />THIS CERTIFICATE 15 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 />Marsh USA Inc.
<br />701 Market Street, Suite 1100
<br />St. Louis, MO 63101
<br />NpNE, Marsh I U.S. Operations
<br />PWC,HONNo Exh. E 866-966-4664 aL Ne ,
<br />Eo A LESS: ALCertRequest@mamh.can
<br />INSURERS AFFORDING COVERAGE
<br />NAICIf
<br />INSURER A: Old Republic Insurance Company
<br />24147
<br />CN1031W778-GAW-CRT-21-22 N Y kvl66g 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 />INSURER E:
<br />Dallas, TX 75202
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: CHI-009523130-09 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 />INM
<br />MIMP
<br />POLICYNUMBER
<br />POLICY EFF
<br />IMMIDDIYYYN'l
<br />POLICY EXP
<br />fMMIDDfYYYYJLIMITS
<br />A
<br />X
<br />COMMERCIALGENERAL LIABILITY
<br />CLAIMS -MADE El OCCUR
<br />MWZY 31363621
<br />06101/2021
<br />06101/2022
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />DAMAGE TO REN
<br />PREMISES Ea occurrence
<br />$ 1,000,000
<br />MED EXP (Any oneperson)
<br />$ N/A
<br />PERSONAL&ADV INJURY
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />% POLICY JECT LOC
<br />GENERA -AGGREGATE
<br />$ 10,000,000
<br />PRODUCTS - COMPIOPAGG
<br />$ 2,000,000
<br />$
<br />OTHER
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />MWTB 31363521
<br />0610112021
<br />06101/2022
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />%
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />P BODILY INJURY (Per accident
<br />( )
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />er accident
<br />$
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DIED RETENTION$
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />ANDEMPLDYERS-LIABILITY
<br />ANYPROPRIETORIPARTNER/EXECUTIVE YIN
<br />OFFICERIMEMBEREXCLUDEDT �
<br />(Mandatory in NH1
<br />NIA
<br />MWC 313638 21 (ADS)
<br />06101/2021
<br />0610112022
<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 />IF yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Excess Workers' Compensation
<br />MWXS 313639 21 (OH,WA)
<br />06101/2021
<br />0610112022
<br />EL Each Accident l 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 / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: City of Santa Ana Municipal Facilities License Agreement.
<br />The City of Santa Ana, its officers, officials, employees and volunteers istare included as Additional Insured under the General Liability policy but only with respect to the requirements of the contract between the
<br />Certificate Holder and the Insured. Waiver of Subrogation is provided for General Liability, as required by written contract and allowable by law. This insurance is primarywith respect to the interest of the
<br />Additional Insured and any other insurance maintained by Additional Insured is excess and non-conldbutory with this insurance. Contractual Liability under the General Liability but only to the extent dictated by
<br />policy terms, exclusions, and conditions.
<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 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92702
<br />of Marsh USA Inc.
<br />w=_... Welt MalmganodDh9slan
<br />REMEIRED 6MPROV®8Y:
<br />@ 1988-2016 ACORD C
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD =�'' Risk Managemenn Analyst
<br />
|