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HomeMy WebLinkAboutNEW CINGULAR WIRELESS PCS, LLC (9)INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES 2 0- O1 �A1 CLERK OF COUNCIL DATE: SUPPLEMENT AGREEMENT A-2020-117G o . awA(�o,, U6) C3.�)-O-- This Supplement ("Supplement'), is approved by Licensor this Ah day of FC bYUGty , 20 2-2 (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 January 27, 2022 ("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. 7. Miscellaneous. [Signature page follows] A-1 A-2020-117G IN WITNESS THEREOF, the parties hereto have caused this Supplement to be legally executed in duplicate, effective upon execution by both parties. Accepted: Licensor: CITY OF SANTA ANA, CA By: 1. 6a`" s Q h�- Name: Nabil Saba, P.E. Title: Executive Director Public Works Agency Date: 01/31/2022 Licensee: By: (^A-C- Name: Title: Afe i AKZA MANaArq£C Date: 02 - 0SM2 Attachments: Attachment 1 —Licensed Area (Tustn Node 055) 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 U � n • • 0 • M n r N Antenna: Galtronics — GQ2410-06661 Mechanical Specifications Operating Temperature 40'to 158-F (-& to+10°q Antenna Weight 163lbs (1.4 kg) Antenna Diameter 10.0" (255 mm) Antenna Height 24.9" (634 mm) Radome Material ASA RRUs: RRU-2203 — Total-3 RRU-2205 — Total-1 SHROUD W/ANTENNA: SPD: RSCAC-6533-P-120-D wq Strikesor6' a u' L nsc+cscv.v-imn ON Francine R. Digitally signed by Francine R. Villareal \/illn Taal Date: 2021.07.01 16:47:11 A�RO� CERTIFICATE OF LIABILITY INSURANCE DATE 12021 AYYY 062612021 THIS CERTIFICATE 15 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 Marsh USA Inc. 701 Market Street, Suite 1100 St. Louis, MO 63101 NpNE, Marsh I U.S. Operations PWC,HONNo Exh. E 866-966-4664 aL Ne , Eo A LESS: ALCertRequest@mamh.can INSURERS AFFORDING COVERAGE NAICIf INSURER A: Old Republic Insurance Company 24147 CN1031W778-GAW-CRT-21-22 N Y kvl66g Y INSURED New Cingular Wireless PCS, LLC INSURER B INSURER C One AT&T Plaza 208 South Akard Room 1820 INSURER D INSURER E: Dallas, TX 75202 INSURER F COVERAGES CERTIFICATE NUMBER: CHI-009523130-09 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 INM MIMP POLICYNUMBER POLICY EFF IMMIDDIYYYN'l POLICY EXP fMMIDDfYYYYJLIMITS A X COMMERCIALGENERAL LIABILITY CLAIMS -MADE El OCCUR MWZY 31363621 06101/2021 06101/2022 EACH OCCURRENCE $ 2,000,000 DAMAGE TO REN PREMISES Ea occurrence $ 1,000,000 MED EXP (Any oneperson) $ N/A PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: % POLICY JECT LOC GENERA -AGGREGATE $ 10,000,000 PRODUCTS - COMPIOPAGG $ 2,000,000 $ OTHER A AUTOMOBILE LIABILITY MWTB 31363521 0610112021 06101/2022 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 % BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS P BODILY INJURY (Per accident ( ) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE er accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DIED RETENTION$ $ A WORKERS COMPENSATION ANDEMPLDYERS-LIABILITY ANYPROPRIETORIPARTNER/EXECUTIVE YIN OFFICERIMEMBEREXCLUDEDT � (Mandatory in NH1 NIA MWC 313638 21 (ADS) 06101/2021 0610112022 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 IF yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Excess Workers' Compensation MWXS 313639 21 (OH,WA) 06101/2021 0610112022 EL Each Accident l EL Disease 1,000,000 Employers' Liability See Second Page EL Disease -Policy Limit 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: City of Santa Ana Municipal Facilities License Agreement. The City of Santa Ana, its officers, officials, employees and volunteers istare included as Additional Insured under the General Liability policy 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, as required by written contract and allowable by law. This insurance is primarywith respect to the interest of the Additional Insured and any other insurance maintained by Additional Insured is excess and non-conldbutory with this insurance. Contractual Liability under the General Liability but only to the extent dictated by policy terms, exclusions, and conditions. 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 ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92702 of Marsh USA Inc. w=_... Welt MalmganodDh9slan REMEIRED 6MPROV®8Y: @ 1988-2016 ACORD C ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD =�'' Risk Managemenn Analyst ACORO® `� AGENCY CUSTOMER ID: CN103150778 LOC #: St. Louis ADDITIONAL REMARKS SCHEDULE Page 2 of AGENCY NAMED INSURED 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 DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: L5 FORM TITLE: Excess Workers' Compensation -MWXS 313639 21 (OH -WA) Sell Insured Retentions OH & WA-$500,000,000 (except Terrorism) OH & WA-$600000,000 Tercrism REmEwED & APPROVED 8Y: ACORD 101 (2008/01) © 2008 ACORD Ci I sl a7 (-`� ,� PZ. vs-" wj The ACORD name and logo are registered marks of ACORD '=�—MJFM Risk Management Analyst POLICY NUMBER:MWZY 313636 21 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations All Persons or Organizations as Required by Written The Locations as specified in the written contracts or Contract or Agreement. agreements. In no event shall the insurance provided exceed the scope of coverage or limits required by said contract or a reement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contractor agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to Us intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project livk Mnmgrniod Dlvlcian a`9 t REMekM&tAPtP,Ra4m EIr q r nkmG.mt ram. Y..fvw CG 2010 1219 © Insurance Services Office, Inc., 2018 � - Risk Managen ntAnaot MWZY 313636 21 AT&T Inc. 06101/2021-0610112022 C. With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following is added to insurance; Section III — Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the applicable required by a contract or agreement, the most we limits of insurance. will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or RMeM ilM Im RE"Eweo &rrM�tPte1 /w���®�Bv: OI l.Y13LiJ5 Y.�.o1M: per, Ka„t�t��:.%-'. Page 2 of 2 © Insurance Services Office, Inc., 2018 � Risk Management Analyst MWZY 31363621 AT&T Inc 06101/2021-06/01/2022 11 POLICY NUMBER:MWZY 313636 21 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations All Persons or Organizations as Required by Written The Locations as specified in the written contracts or Contract or Agreement. agreements. In no event shall the insurance provided exceed the scope of coverage or limits required by said contract or a reement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contractor agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. "REmEwm&APPRavED&r .CG 20 37 1219 © Insurance Services Office, Inc., 2018I MWZY 313636 21 AT&T Inc. 061012021 •06/0112022 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED AMENDMENT - PRIMARY AND NON-CONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM As respects any person(s) or organization(s) included as an additional insured and with whom you have agreed in a written contract, agreement or permit to provide primary insurance on a non-contributory basis, this insurance will be primary to and non-contributing with any other insurance available to such person(s) or organ ization(s). In no event shall the insurance provided exceed the scope of coverage or limits required by said contract or agreement. wekMmcganadDW1on ReAEWED&APPa Sr -.. GL 739 042 0612 1 AIRWI Ruk Management Analyst MWZY 31363621 AT&T Inc. 0610112021 - 06/0112022 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS This endorsement modifies the notice of cancellation of insurance provided hereunder by adding the following: A. In the event this policy is cancelled for any permissible reason, other than for nonpayment of premium, we shall endeavor to provide advance written notice of cancellation to certificate holders set out in the schedule on file with the Company, after notifying the first Named Insured of such cancellation. Notice of cancellation to certificate holders may be made by any commercially reasonable means, including mail, electronic mail, facsimile transmission or courier service. B. This advance written notification of a cancellation of coverage is intended as a courtesy only. Our failure to provide such advance written notification will not extend the policy cancellation date, nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. RoleMowgone tDisistan ,=i k RI:vIEWPD& APPkovED Br . PIL 029 10 10 �� Risk Management Analyst W MTB 31363521 AT&T Inc. 0610112021 - 06101/2022 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS This endorsement modifies the notice of cancellation of insurance provided hereunder by adding the following: A. In the event this policy is cancelled for any permissible reason, other than for nonpayment of premium, we shall endeavor to provide advance written notice of cancellation to certificate holders set out in the schedule on file with the Company, after notifying the first Named Insured of such cancellation. Notice of cancellation to certificate holders may be made by any commercially reasonable means, including mail, electronic mail, facsimile transmission or courier service. B. This advance written notification of a cancellation of coverage is intended as a courtesy only. Our failure to provide such advance written notification will not extend the policy cancellation date, nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. IUdtMw>agmadDMalnn RWEw2D&APm Elr. PIL 029 10 10 MWZY 313636 21 AT&T Inc. 06/01/2021 - 06/012022 Risk Management Analyst OLD REPUBLIC INSURANCE COMPANY WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY POLICY NOTICE OF CANCELATION TO CERTIFICATE HOLDERS ENDORSEMENT This endorsement modifies the notice of cancelation of insurance provided hereunder by adding the following: A. In the event this policy is canceled for any permissible reason, other than for nonpayment of premium, we shall endeavor to provide advance written notice of cancelation to certificate holders set out in the schedule on file with the Company, after notifying the Insured first named in item 1 of the Information Page of such cancelation. Notice of cancelation to certificate holders may be made by any commercially reasonable means, including mail, electronic mail, facsimile transmission or courier service. B. This advance written notification of a cancelation of coverage is intended as a courtesy only. Our failure to provide such advance written notification will not extend the policy cancelation date, nor negate cancelation of the policy. All other terms and conditions of this policy remain unchanged. WC 99 03 64 (03/11) e R1skM0sagmamtDMsta i A REAEwm&APPRIN®BN - Page 1 of 1 ll Risk Management Analyst