HomeMy WebLinkAboutL008-09 - 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.