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A� �® CERTIFICATE OF LIABILITY INSURANCE DATE /2012 VYYY) 0813112012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Marsh IDSA, Inc. 4400 Comedca Bank Tower 1717 Main Street Dallas, TX 75201-7357 CONTACT NAME: PHONNo Exit' E-MAIL ADDRESS: _ INSURERIS) AFFORDING COVERAGE NAIC N Atm: dallas.certs@marsh corn Fax: 212-9480519 INSURER A: Insurance Company Of The State Of PA 19429 1163165-CAS-GAWU-12-13 LA 0620A 5M Y No INSURED McIroPCS Communications, Inc. National Union Fire Insurance Co. of PA 19445 INSURER B i - INSURER C. New Hampshire Insurance Company 23841 2250 Lakeside Boulevard Richardson, TX 75082 INSURER D : Illinois National Insurance Company 23817 INSURER E : Commerce And Industry Ins Co 19410 INsuRER F : National Union Fire Insurance Co 19445 COVERAGES CERTIFICATE NUMBER: HOU-00206646945 REVISION NtIMRFR-5 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDONYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY GL7146386 09/01/2012 09101/2013 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LJIABILITY X�I nlI CLAIMS -MADE L OCCUR DAMAGE 1,006000 PREM SES (Ea ocur ante $ c MED EXP (Any one person) $ 10,000 X Limited Pollution Liab/General -Policy PERSONAL 8 ADV INJURY $ 1,000,000 x Agy. Limit Per $1BMM _ GENERAL AGGREGATE $ 2,006000 GE NT AGGREGATE LIM IT APPLIES PER: PRODUCTS - COMPIOP AGO $ 2,000,000 X POLICY r X PRO- X LOC IFCT $ A F AUTOMOBILE X LIABILITY ANY AUTO CA3447212 (AOS) CA3447213 (MA) 09/01/2012 09/01/2012 09/01/2013 09/01/2013 COMBINED SINGLE LIMIT 1,000,000 Ea accident $ BODILY INJURY (Pei person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Peramitlent $ ) X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident Comp/Coll Deductible $ 1,000 B X UMBRELLA UAB X OCCUR 13273331 09/01/2012 09/01/2013 EACH OCCURRENCE $ 5,000,000 _. AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ 1 D WORKERS COMPENSATION WC043464600(FL) 0910112012 09/01/2013 X WC STATu- OTH- F F G AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/E%ECUTIVE YIN OFFICER/MEMBEREXCLNERE (Mandatory in NH) If ye,i, desmie under DESCRIPTION OF OPERATIONS below NIA WC043464598(CA) WC043464599 (MA,ND,OH,WA,WY) WC043464601 (AOS) 09101/2012 0910112012 09/01/2012 09101/2013 09/0112013 09/01120131,006000 _ E.L EACH ACCIDENT $ 1,000,000 _ E. L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Romania Schedule, If more space is requlradl Re: Site IL LA0620A - 2115 W Mcfadden Ave., Santa Ana, CA 92704. Where required by written contract Certificate Holder is an Additional Insured (except on WorkersComp) as respects operations of the Named Insured. - City of Santa Ana -City Attorneys Office 20 Civic Center Plaza (kh23) PO Box 1988 Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. William Hines ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD