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HomeMy WebLinkAboutNEW CINGULAR WIRELESS PCS, LLC (6)INSURANCE ON FILE Off' WORK MAY PROCEED UNTIL INSURANCE EXPIRES A-2020-117D Cb `V to , l • loll CLERK OF COUNCIL Q DATE: SUPPLEMENT AGREEMENT VWN (11(Silvio, ?,Oh12S) La This Supplement ("Supplement"), is approved by Licensor this 24IIh day of MA12LIj 2021 (the date executed by all parties, referred herein as "Supplement Effective Date"). 1. Sup In einent. 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 / s not 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] ICI A-2020-117D 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 By: �A L \3(Z 4 � Name: Nabil Saba Title: Executive Director Public Works Agency Date: 03/04/2021 Licensee: Accepted: t-Vw C+Nular W,r21t6S -PC S, lCc, *i-L%*Uare It. ,*crA \�cb.IT��,t:yytd'I Mcb,1�1, Cuvpwal�M 1 1 � I+s•. wlavlotsft.� Title: Date: Attachments: Attachment 1 — Licensed Area (TUSTN 66) Attachment 2 — Equipment List and Description A-2 Attachment 1 Licensed Area [Map showing licensed area of applicable Municipal Facility and showing proposed Equipment installation A-3 d vLo F s m O 0Lr s l C C 0 Z uj W ll •P � o N g � v e Ayr:^, avv-nlA s d w x R 0 M r r W C"J O �J r . m L i Ld O � • MLif j ' 1 us;m • a • i s C W O z C C_9 Al Z JU N J V II H w 20LLI K Q Uu U.` Q L4 J iL I Antenna' Galtronics — GQ2410-06661 Mechanical Specifications Operating Temperature -40'to 158°F(AT to+70.0 Antenna Weight 163 Its (7A kg) Antenna Diameter 10A' (255 mm) Antenna Height 24Y (634 mm) Radome Material ASA RRUs: RRU-2203 — Total-3 RRU-2205 — Total-1 SHROUD W/ANTENNA: SPD: RSCAC-6533-P-120-D �aF Strtkeso►tr u u u' fl5GIG614R1p0-0 A-7 Francine R. Villareal �k tlww�wn.,�Ke_ ACOR& CERTIFICATE OF LIABILITY INSURANCE D09101020OrcYYY) 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 poiicy(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. PHONE 8669fi6-0664 ue Na 701 Markel Sueet, Suite 1100 SL Louis, MO 63101 nooaess: AIt.CenRequest(ajmarsh.com Alin: ATT.Cer1Request@marshcom INSURERS AFFORDING COVERAGE NAICk INSURER A: Old Republic Insurance Company 24147 CNiD3150778-GAW-CRT-20-21 Y Y kvi66g Y INSURED New Cingulaz Wireless PCs, LLC INSURER B : INSURER C : One AT&T Plaza 208 South Aland Room 1820 INSURER 0: INSU0.ER E: Dallas, TX 75202 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 rypE OF INSURANCE ADDLSUBR POUCYNUMBER POLICY EFF (IMMIDDANYIn POLICY EXP fMIWDOfTYYYILIMITS A X COMMERCIAL GENERAL LABILITY CLAIMS -MADE M OCCUR MWZY 31363620 0610112020 0610112021 EACH OCCURRENCE $ 2,000,000, DAMA TETORENTED PREMISES Ea adcurrancel $ 1,000,000 MED EXP (Any one person) S NIA PERSONAL &ADV INJURY $ 2.000,000 GENIE AGGREGATE LIMIT APPLIES PER: X POLICY PRO- JECT LOC ❑ GENERAL AGGREGATE $ 10,000,000 PRODUCTS -COMPIOP AGG 3 2,000,000, S OTHER: A AUTOMOBILE LIABILITY MWTB 31363520 06/01/2020 06/0112021 COMBINED SINGLE LIMIT E...Wenl $ 1,000,000, A X ANY AUTO MWZX 31363720 (MI} 06/01/2020 06/01/2021 BODILY INJURY (Pa Pen.) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident ( ) S HIRED NOWO MED AUTOS ONLY AUTOS ONLY AMAGE $ 11 UMBRELLA LIAS OCCUR RENCE $ VAGGRE�� $ EXCEBS LIAR CLAIMS -MADE DED RETENTIONS S _ A WORKERS COMPENSATION AND EMPLOYERV LIABILITY YIN OFFICERIMEMBER EXCLUDED? ❑N (Mandatory In NH) NIA MWC 31363820(ADS) 06/01/2021 OTH- E ERAN�YPROPRIETORIPARTNEWUECUTIVE CIDENT . S 1,000,000 E.L. DISEASE -EA EMPLOYEE S 1,000,000` If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 A Excess Workers' Compensation I MWXS 31363920 (ORWA) ON112020 061012021 EL Each Acpdent l EL Disease 11000.000 Employers' Liability See Second Page EL DiseasaPollcy Limit 1000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Ramarke Schedule, may be a0ached If more apace is mgulred) Re City of Santa Ana Municipal Facilities License Agreement City of Santa An, 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 noo- onlydutery with this insurance. City of 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, 4th floor ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92701 of Marsh USA Mc. ra..� .MY VAlorrWVEDO r BEytvim iAPMne,FwH»� 8r,. ©1988.2016 ACORD C NoIi it esAww+Mlec ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORDry111O,,,�„r JM.air.r AGENCY Marsh USA Inc. POLICY NUMBER CARRIER AGENCY CUSTOMER ID: CN103150778 LOC #: St. Louis ADDITIONAL REMARKS SCHEDULE NAIC CODE THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insul Excess Workers' Compensation 4WXS 31363920 (OH -WA) Sell Insured Retentions OH & WA - $500,000,000 (except Termnsm) 011 & WA-$600,000.000 Termrom Excess Automobile Liability - MWZX 31363720 (MI) Combined Single Limit -$1,00D,000 Self Insured Retention -$1,000,000 NAMED INSURED New Cingular W reless PCS, LLC One AT&T Plaza 208 South Akard Room 1820 Dallas, TX 75202 EFFECTIVE DATE: Page 2 of 2 I�NE�[4D 4 APrRaAD BY: 101 (2008I01) 92008 ACORD Ci 1 fK� v:Uit4a� The ACORD name and logo are registered marks of ACORD +W aasageMexr N+Mpl 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 sham in the schedule above. We wig mail such notice to the address shown in the schedule above at least the number of days sham for cancellation in the schedule above before the effective date of cancellation. PI L 028 05 10 REVIEWED s i rm im FU#4 4 R PIM-4- 1- MW2Y 312636 20 AT&T Inc. 06/01=0 - 06101=21