Loading...
HomeMy WebLinkAboutCAG2020-129 - Insurance Certificate - New Cingular Wireless PCS, LLC - Certificate of Liability Insurance - 06/01/2023 ,aCCOR o�® CERTIFICATE OF LIABILITY INSURANCE D05/06/2023D/YvyY) 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 Marsh U.S.Operations MARSH USA,LLC. NAME: 800 Market Street,Suite 1800 AIC NNo Ext: 866-966-4664 A/C No), St.Louis,MO 63101 E-MAIL ADDRESS: Att.CertRequest@marsh.com INSURER(S)AFFORDING COVERAGE NAIC# CN103150778-GAW-CRT-23-24 N Y Y INSURER A:Old Republic Insurance Company 24147 INSURED INSURER B: New Cingular Wireless PCS,LLC One AT&T Plaza INSURER C: 208 South Akard INSURER D: Room 1820 Dallas,TX 75202 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: CHI-009390211-06 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DDIYYYY MM/DDIYYYY A X COMMERCIAL GENERAL LIABILITY MWZY 313636 23 06/01/2023 06/01/2024 EACH OCCURRENCE $ 5,000,000 CLAIMS-MADE 1XI OCCUR PREM SES(Ea occur ante) $ 1,000,000 MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 X POLICY❑ PRO- POLICY ❑ LOC PRODUCTS-COMP/OP AGG $ 5,000,000 OTHER: $ A AUTOMOBILE LIABILITY MWTB 313635 23 06/01/2023 06/01/2024 COMBINED SINGLE LIMIT $ 5,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident L $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION MWC 313638 23(AOS) 06/01/2023 06/01/2024 X PER OTH- AND EMPLOYERS'LIABILITY YIN N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 5,000,000 OFFICER/MEMBER EXCLUDED? ❑N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 5,000,000 If yes,describe under 5,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Excess Workers'Compensation/ MWXS 313639 23(OH,WA) 06/01/2023 06/01/2024 EL Each Accident/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,Additional Remarks Schedule,may be attached if more space is required) The City,its officials,employees&volunteers is/are 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 and Automobile Liability,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 non-contributory with this insurance. CERTIFICATE HOLDER CANCELLATION City of Kent WA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 220 Fourth Avenue South THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Kent,WA 98032 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN103150778 LOC#: St. Louis ,a`oRo ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED MARSH USA,LLC. New Cingular Wireless PCS,LLC One AT&T Plaza POLICY NUMBER 208 South Akard Room 1820 Dallas,TX 75202 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Excess Workers'Compensation-MWXS 313639 23(OH-WA) Self Insured Retentions OH&WA-$500,000,000(except Terrorism) OH&WA-$600,000,000 Terrorism ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD