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Francine R. Digitally signed by Francine
<br />a. Villareal
<br />\/illarc�l Dare: 2021.07.01 16.4711
<br />ACC �® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE oslzuu
<br />s12021 """
<br />zozl
<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 />Marsh USA Inc.
<br />701 Market Street, Suite 1100
<br />St. Louis, MO 63101
<br />CONTACT
<br />Marsh U.S. Operations
<br />PHONE Pen, 866-966-4664 A� Ne .
<br />A MESS. AtLCenRequest@marsh.com
<br />INSURERS AFFORDING COVERAGE
<br />NAICR
<br />INSURER A: Old Republic Insurance Company
<br />24147
<br />CN103150778-GAW-CRT-21-22 N 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 0:
<br />INSURER E:
<br />Dallas, TX 75202
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: CHI-009523130-119 RFVIIQIr1N NIIMRFR.
<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 />INSD
<br />Me
<br />POLICYNUMBER
<br />POLICYEFF
<br />MMIDDNYYY)
<br />POLICYEXP
<br />(MMIDDrYYYy
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL ABILITY
<br />CLAIMS -MADE F OCCUR
<br />MWZY 31363621
<br />0610112021
<br />06/0112022
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />DAMAGETOREN ED
<br />PREMISES Ea occurrence
<br />$ 1.000,000
<br />MED EXP (Any one person)
<br />$ NA
<br />PERSONAL &ADV INJURY
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />X POLICY ❑ PRO-
<br />JECT LOC
<br />GENERALAGGREGATE
<br />$ 10,000,000
<br />PRODUCTS - COMPIOP AGG
<br />$ 2,000.000
<br />S
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />MWTB31363521
<br />06/0112021
<br />0610112022
<br />COMBINED SINGLE LIMIT
<br />Ea accitlent
<br />$
<br />1.000,000
<br />X
<br />BODILY INJURY (Per person)
<br />S
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident)
<br />( I
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident)
<br />$
<br />UMBRELLAUAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I I RETENTION$
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETOWPARTNEWEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />MWC 313638 21 (AOS)
<br />0610/
<br />06/01/2022
<br />X 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 />(Mandatory in Ni
<br />Dyes, IPTIONescribe under
<br />DESCRIPTION rude,
<br />OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Excess Workers'Compensadon/
<br />MWXS 313639 21 (OH,WA)
<br />06101/2021
<br />06/0112022
<br />EL Each Accident I 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 1D1, Additional Remarks Schedule, may be aneched 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 islare 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 Subrogaben is provided for General Liability, as required by written contract and allowable by law. This insurance is primary with respect to the interest of the
<br />Additional Insured and any other insurance maintained by Additional insured is excess and non-contributory 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
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Risk Management Division
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL
<br />BE DELIVERED IN
<br />20 Civic Center Plaza
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
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<br />fRvIEwED is APPRW®BY:
<br />@ 1988-2016 ACORD C
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<br />ACORD 25 (2016103)
<br />The ACORD name and logo are registered marks of ACORD
<br />Risk Management Analyst
<br />
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