|
Francine R. Olenally signed by Franrin.
<br />P.Wlarsal
<br />ViIIarPal Dale. 2021.ozoll6:am1
<br />ACORDV CERTIFICATE OF LIABILITY INSURANCE
<br />DATE MloOrcvyv)
<br />Qslzslzazl
<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 pollcy(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 StrInceet,
<br />701 Markel Street, Suite 1100
<br />St. Louts, MO 63101
<br />COSNAMEACT Marsh IN. $. Operations
<br />PHONE 66&966 466Q FAX
<br />c o AIC No
<br />EMAIL
<br />D RESS: Att.CerlRequest@marsh.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC9
<br />CN103150778-GAW-CRT-21-22 N Y kvl66g Y
<br />INSURERA: Old Republic Insurance Company
<br />24147
<br />INSURED
<br />New Cng War WIreIS55 PO$, 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-0090.1130.09 Rpvisin; Mnnnaco.
<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 OFINSURANCE
<br />ADDLSUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYVY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIALGENERAL LIABILITY
<br />MWZY 31363621
<br />0610112021
<br />0610112022
<br />EACHOCCURRENCE
<br />$ 2,000,000
<br />CLAIMS -MADE El OCCUR
<br />A A ES( ED
<br />PREMISES Eaaoocccurrence
<br />$ 1,000,000
<br />MED EXP(Any one arson)
<br />$ NIA
<br />PERSONAL a ADV INJURY
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERALAGGREGATE
<br />$ 10,000,000
<br />X POLICY EJECT RC- LOG
<br />PRODUCTS - COMP/OP ADD
<br />$ 2,000,000
<br />$
<br />OTHER
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />MWTB 31363521
<br />NV0112021
<br />0810112022
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accldom)
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />AMAGE
<br />$
<br />UMBRELLA LIAB
<br />OCCUR
<br />RRENCE
<br />$
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />:::W
<br />DIED RETENTION$
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />MWC 313638 21 (ADS)
<br />06101/01
<br />0610112022
<br />OTH-
<br />ANDEMPLOYERS'LIABILITV YIN
<br />E ERANYPROPRIETORIPARTNEWEXECUTIVE
<br />CIDENT
<br />$ 1,000,000
<br />NIA
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />Excess Workers' Compensation l
<br />MWXS 31363921(OH,WA)
<br />06101l2021
<br />0610112022
<br />EL Each Accident l EL Disease
<br />1,000,000
<br />Employers' Llabllily
<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: City of Santa Ana Municipal Facilities License Agreement.
<br />The City of Santa Ana, its officers, officials, employees and volunteers is/are included as Additional Insured under the General Liability policy but only with respect to the requirements of the contractbetween the
<br />Certificate Holder and the Insured. Waiver of Subrogation is provided for General Liability, as required by written contract and allowable bylaw. This insurance is primary with respect b the Interest of the
<br />Additional Insured and any other insurance maintained by Additional Insured is excess and noncontributory 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 />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />9)1988-2016 ACORD C ,1tJ1MJ�„,,,,
<br />ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD 11IMMEEMRisk Management AnaHst
<br />
|