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Home My WebLink AboutPW17-276 - Insurance Certificate - T-Mobile US, Inc. - Liability Coverage - 05/01/2021-^ A,CORD-l-"CERTIFICATE OF LIABILITY INSURANCE @ I 988.201 5 511t2022 DATE (MM/DD/YYYY} 04t28t2021 ONLY TIVELY CERTIFICATETHIS ISSUEDts AAS OFMATTER TIONINFORMA AND CONFERS RIGHTSNO THEUPON HOLDER.CERTIFIGATE THISCERTIFICATENOTDOESAFFIRMAORNEGATIVELYOREXTENDTERALTHEAMEND,COVERAG AFFORDEDE THEBY BELOW.POLtCtES CERTIFICATHIS TE OF DOESINSURANCE CONSTITUTENOT A CONTRACT THEBETWEEN ISSUING AUTHORIZEDrNsuRER(S),REPRESENTATIVE OR THEANDPRODUCER,TECERTIFICA HOLDER. PRODUCER Lockton companies Three City Place Drive, Suite 900 St. Louis MO 63141-7081 (314) 432-0500 rNsuRER A , Continental tfIMPORTANT:certiflcatethe isholder an ADDITIONAL the mustINSURED,ADDITIONALhave orpolicy(ies)be endorsed,provisions SUBROGATION ts su to termsthe andWAIVED,bject conditions theof certainpolicy endorsement.an Apoliciesrequiremay statement thisondoescertificateconfernottohtscertificatethetnholderoflieusuchendorsement(s). rNsuRER B : The Continental lnsurance Comoanv 35289 INSURER c: TransDortation lnsurance Comnanv 20494 INSURER D: INSURER E : lNsuRED T-Mobile us, lnc. 1 3587 7 2 lts Subsidiaries and Affitiates, including Sprint Corporation 12920 SE 38th Street Bellevue WA 98006 INSURER F: MAY THEPERIODNDITED.THSTANDINGNOTW REQUIRE TERMMENT Ro tTtCOND OFON CONTRACTANY OR OTHER ENTDOCUM RESWTH TOPECTtcWHTHHcISCATEERTIFIEDrssuMAYORPINSUTHEERANCBYAFFORDEDERTAIN,ETH POLIC DES DESCRIBE HEREIN IS Ua ECTBJ TO ryPE OF INSURANCE POLICY NUMBER LIMITS EACH OCCURRENCE s 10 000.000 UAMAST IURENIEL) PRFMISFS rFa ^.r,,rran.a\$ 10 000 000 [rED EXP lAnv on6 oerson]$ 25 000 PERSONAI &ADVIN.IIIRY $ 10.000.000 .]FNFRAI AGGRFGATF $ 20 000 000 PRODUCTS . COMP/OP AGG $ 20 000 000 A COMMERCIAL GENERAL LIABILITY LIIVIT APPLIES PER: X X CLAIMS-MADE OCCUR POLICY OTHER: lfg lX ioc Y Y to1z34390rJ u5tu1l2u2 uStt)1t2022 $ $ 5,000,000 3ODILY INJURY (Per person)S XXXXXXX BODILY INJURY (Per accidenl $ XXXXXXX $ XXXXXXX A AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON.OWNED AUTOS ONLY X Y Y 7012343878 05t01t2021 05101t2022 $ XXXXXXX X EACH OCCURRENCE $ 5,000,000UMBRELLA LIAB EXCESS LIAB X AGGREGATE $ 5,000.000 B B B DED X RETENTION $ 1 O,OOO N N cuE 7014886953 SIR aDDlies Der oolicv terms'& conditiohs ' 0510112021 0510112022 $ X lEF.[r' 'rr IUIH.IED E L EACH ACCIDFNT $ 2,000,000 E.L, DISEASE - EA EMPLOYEE $ 2,000.000 B Bc WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORYPARTNER/EXECUTIVE OFFICER/It4EIt4BER EXCLUDED? (Mandatory ln NH) lf y6, dscribe under DESCRIPTION OF OPERATIONS below N N/A N (AOS) (cA) (AZ;MA,OR,w) 7012343895 70't2343881 7012447142 I I 1051o1t202 05to1t202 05t01t202 05t01t2022 05t01t2022 05t01t2022 E.L- DISEASE. POI ICY I IMIT $ 2 000 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addltional Romarks Schedule, may be attached tf mors space ts required) The Certificate Holder and other entities defined by written contract, statute, permit application or written agreement are additional insureds or subrogation applies'under generaT liability and dutomobiie tHbiirty;s reqJiied o"v wTifrEn'c-Jritiill].6etAidihEi H"odH'ffi;d#"'i " ""''"' ' TE a- AUTHORIZED REPRESENTAl'IVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVEREO IN ACCORDANCE WITH THE POLICY PROVISIONS. 16975805 CITY OF KENT, WASHINGTON ATTN: TOM BRUBAKER- ASST.CIry ATTY 220 4TH AVENUE SOUTH KENT, WA 98032-5895 ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD RA N. AII reserved Attachment Code : D590641 Master tD:1358772, Certificate ID: .16975g05 CITY OF KENT, WASHINGTON ATTN: TOM BRUBAKER- ASST.cITY ATTY. 220 ATH AVENUE SOUTH KENT, WA 98032-5895 IMPORTANT hIOTICE Dear Certificate Holder for T-Mobile and its subsidiaries (including Sprint): In our continued effort to provide timely certif icate delivery, LocktonCompanies is trans'itioning to paperless delivery of Certificaies of Insurancegoi ng forward. To ensure future renewals o Please contact us via one o 15975805 hi s certi f i cate, we need your emai t address. he methods below, referencing Certif.icate ID ftft . Email : stl -edel ivery@lockton. con. Phone: 314-81.2-3888 If we do not receive your email address v'ia one of the above methods prior tothe client's next renewal, we will assume you no longer need the certificate. if you received this certificate through an internet link where the currentcertificate'is viewable, we have your email and no further action is needed. The above inbox is for collecting enail addresses for renewal electroniccertfficate delivery 1lVLY. You wiII not recefve a response fron this fnbox. Thank you for your cooperation. Lockton Companies Lockton Companies I'iilr:,: {,'i* lrl:rr'r,: i ii' i:iL:itr: t,:ili} r' 1':it. l.r;rri:.. h'ii.; {i.l i:i j "'l{liiii I l.J-43-l*050{J / locklon.corn Att""h.CliffFf27 8 Maste r tD : 1 3587 7 2, certif icate I D : 1 6e7 5805 It is understood and agreed that: lf the Named lnsured has agreed under written contract to provide notice of cancellation to a pafi to whom the Agent of Record has issued a Certificate of lnsurance, and if the lnsurer cancels a policy term described on that Certificate of lnsurance for any reason other than nonpayment of premium, then notice of cancellation will be provided to such Certificate holders at least 30 days in advance of the date cancellation is effective. lf notice is mailed, then proof of mailing to the last known mailing address of the Certificate holder on file with the Agent of Record will be sufficient to prove notice, Any failure by the lnsurer to notify such persons or organizations will not extend or invalidate such cancellation, or impose any liability or obligation upon the lnsurer or the Agent of Record. All other terms and conditions of the policy remain unchanged This endorsement, which forms a part of and is for attachment to the policy issued by the designated lnsurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another :effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy. Form No: CNA75014XX(01-2015) Endorsement Effective Date: 0510112021 Endorsement No: Page: 1 of 1 Underwriting Company: Continental Casualty Company Policy No: 7012343900 Policy Effective Date: 0510112021 @ Copyright CNA All Rights Reservod.