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HomeMy WebLinkAboutNEW CINGULAR WIRELESS PCS, LLC (4)„6URANCEONFILE Oq, WORK MAY PROCEED UNTIL INSURANCE EXPIRES �b f-t.?VLI Q DATEKOFCOUNCIL 0,.Pwk (11(sy��;p P-66ka) Ls SUPPLEMENT AGREEMENT A-2020-117B This Supplement ("Supplement'), is approved by Licensor this 2'9Fh day of M M 1,cVJ 2021 (the date executed by all parties, referred herein as "Supplement Effective Date"). 1. Supplement. Licensee has submitted an application for approval to use a Municipal Facility pursuant to that certain Municipal Facility License Agreement between Licensor and Licensee dated February 17, 2021 ("Agreement'). Licensor has reviewed the application and grants approval subject to the terms of this Supplement. All of the terms and conditions of the Agreement are incorporated hereby by reference and made a part hereof without the necessity of repeating or attaching the Agreement. In the event of a contradiction, modification or inconsistency between the terms of the Agreement and this Supplement, the terms of this Supplement shall govern. Capitalized terms used in this Supplement shall have the same meaning described for them in the Agreement unless otherwise indicated herein. IF THE SUPPLEMENT IS NOT COUNTER -SIGNED BY LICENSEE AND RETURNED TO LICENSOR WITHIN 30 DAYS AFTER LICENSOR HAS GRANTED APPROVAL, THE SUPPLEMENT SHALL BE VOID AND OF NO LEGAL EFFECT. IF LICENSEE STILL WANTS TO USE THE MUNICIPAL FACILITY, LICENSEE WILL BE REQUIRED TO SUBMIT A NEW APPLICATION AND ASSOCIATED FEES. 2. Licensed Area Description and Location. Licensee shall have the right to use the space on the specific Municipal Facility (the "Licensed Area”) depicted in Attachment 1 attached hereto to install Equipment as further listed in Attachment 2 attached hereto. 3. Equipment. The Equipment to be installed at the Licensed Area is described and depicted in Attachment 1. 4. Term. The term of this Supplement shall commence on the Supplement Effective Date and continue for the life of the Agreement, as described in Paragraph 2 of the Agreement. 5. License Fee/Alternate License Fee. The initial fee for this Supplement shall be as follows per year: $270.00. This fee is subject to annual increase as provided in the Agreement, and is payable in accordance with the Agreement. 6. Performance Bond. The Performance Bond [circle on is / snot covered by existing performance bond. If not covered by existing performance bond, a bond is required pursuant to Section 8 of the Agreement. Miscellaneous. [Signature page follows] A-1 A-2020-117B IN WITNESS THEREOF, the parties hereto have caused this Supplement to be legally executed in duplicate, effective upon execution by both parties. Licensor: CITY OF SANTA ANA, CA yr- Name: Nabil Saba Title: Executive Director Public Works Agency Date: 03/04/2021 Licensee: Accepted: N2W C.1r+J�UI6u' WIrp,ICSS 17 C-5 I LLCM R I Qlagw�re_ Attachments: Attachment 1 — Licensed Area (TUSTN 42) Attachment 2 — Equipment List and Description Rw Attachment 1 Licensed Area [Map showing licensed area of applicable Municipal Facility and showing proposed Equipment installation A-3 Q o Q w O 'O v N t v v 2 • per, m 6 N CO p NI IIVHS8%% V'i i VS3'I vlsOJ -._.._.._.._-._.--•-- N N DEODAR 5T -• - �— 1 f �• I I,.. �,' � III •I d x o --777 0 M ytj 13 ni 1 i � rCnva.9NM N J .. I I m Tr Antenna' Galtronics — GQ2410-06661 Mechanical Specifications Operating Temperature 40- to 158'F (4V to+TpQ Antenna Weight 163lbs PA kg) Antenna Diameter 10.0'(255mm) Antenna Height 24.9'1634 mm) Radome Material ASA RRUs: RRU-2203 — Total-3 RRU-2205 — Total-1 SHROUD W/ANTENNA: SPD: RSCAC-6533-P-120-D Strikesorb' ri p u' nscac..,, v.�zo.o A-7 el9na%,pnMEy leonine P. Francine R. Villareal wun m,.. rozP.w.m noammoe A� Oe CERTIFICATE OF LIABILITY INSURANCE D09luino20D ) 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 have ADDITIONAL INSURED provisions or 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 CONTACT US Centralized Services NAME: Marsh USA Inc. PHO866-966-4664 701 Market Street, Suite 1100 WC,FAX N ue No VDRess: AILCertRequest@marsh.com SL Louis, MO 63101 Attn: ATT.CertRequest@marsh.mm INSURERS AFFORDING COVERAGE NAIL# INSURER A: Old Republic Insurance Company 24147 CN103150778-GAW-CRT-20-21 Y Y kv166g Y INSURED New Cingular Wireless PCS, LLC INSURER B: INSURER C : One AT&T Plaza 208 South Akard Room 1820 INSURER D : Dallas, TX 75202 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: CHI-009523130-05 REVISION NUMBER: 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 ADDLSUBR POLICYNUMBER POLICY EFF MMIDO POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LABILITY MWZY 31363620 06/01/2020 0610V2021 EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE1fl OCCUR AMA ETOftENTED PREMISES Ea occurrence $ 1,W0,000 MED EXP(Anyone parson) $ NIA PERSONAL &ADV INJURY $ 2,000,000 Gli AGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE It 10,000,000 X POLICY ❑PEO LOG PRODUCTS - COMPIOP AGG It 2,000,000 It OTHER: A ALEGMOBILELIABILITY MWTB 31363520 OSI0112020 06ifiv 21 COMBINED SINGLE LIMIT Ea accident It 1,000,000 A X ANY AUTO MWZX 31363720 (MI) 06/0112020 061012021 BODILY INJURY (Per parson) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ A WORKERS COMPENSATION ANDEMPLOYERS'LAYIN BILEN OFFCEOR/MEMB REXCLU ED?ECUTIVE FNI (Mandatory in NH) MIA MWC 31363820 (AOS) 11 06101021 X I PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE S 1,000,000 Ryes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,W0,000 A Excess Workers' Compensation I MV✓XS 31363920 (OH,WA) 0610112020 06/01/2021 EL Each Accident 1 EL Disease 1,000,000 Employers' Liability See Second Page EL Disease -Policy Limit 1,000,000 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, AddKlonal Remarks Schedule, may be attached ifmore space Is required) Re : City of Santa Ana Municipal Facilities License Agreement City of Santa Ana, its council members, officers, and employees islare included as Additional Insured under the General Liability and Automobile Liability policies but only with respect to the requirements of the contract between the Certificate 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 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 noncontributory with this insurance. Cityof Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Risk Management Division THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 CIVIC Center Plaza, 4lh floor ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92701 AUTHORNED REPRESENTATIVE of Marsh USA Inc. Mi k REVIfYPED 6 APPROVED BY: ©1988.2016 ACORD C ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD wtMarraganent Anayst AC RO O® iii AGENCY CUSTOMER ID: CN103150778 LOG #: St. Louis ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMEDINSURED Marsh USA Inc. New Cingular Wireless PCS, LLC One AT&T Plaza 208 South Akard POLICY NUMBER Room 1820 Dallas, TX 75202 CARRIER NAIC CODE EFFECTIVE GATE: ADDITIONAL THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance _ Excess Workers Compensation-MWXS 31363920(OHMA) Sell Insured Retentions OH & WA - $500.000,000 (except Tenonsm) OH & WA - $600,000,000 Terrorism Excess Automobile Liability- MWZX 31363720 (MI) Combined Single Limit -$1,000,000 Sett insured Retention - $1,00g000 RENEMMis MPROVe r. ACORD 101 (2008/01) © 2008 ACORD C The ACORD name and logo are registered marks of ACORD pw aA;rwrOemerR arwTlpt IL 10 (12106) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CANCELLATION PROVIDED BY US SCHEDULE Number of Days Notice of Cancellation: 30 Person or Organization: All persons or organizations as required by written contract or agreement. Address: The addresses as specified in the written contracts or agreements. Provisions If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, and a number of days is shown for cancellation in the schedule above, we will mail notice of cancellation to the person or organization shown in the schedule above. We will mail such notice to the address shown in the schedule above at least the number of days shown for cancellation in the schedule above before the effective date of Cancellation. PI L 028 05 10� �in�wrn csr MN2Y 313636 20 AT&T Inc. 06/012020.06I012021