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HomeMy WebLinkAboutInsurance Certificate: AT&T Corp A�® CERTIFICATE OF LIABILITY INSURANCE DATE12012 vvv) anrzou 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 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 USA Inc. NAME: 701 Markel Street.Suite 1100 PHONE A/C No SL Lois,MO 63101 E-MAIL Attn:ATT.CerlRequeri@ marsh com ADDRESS: INSURERS)AFFORDING COVERAGE NAIC a 018566-GAW-CRT-12-13 X X INSURER A:Old Republic Insurance Co 24147 INSURED INSURER B: AT&T Corp. One AT&T Plaza INSURER C: 208 South Akard Street INSURER D Rom 2731 Dallas,TX 75202 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: CHI 004548956.01 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 AD�Ll UBR POLICYEFF 'POLICY LTR POLICY NUMBER MM/DD/TTYT MWDD/YYYY LIMITS A GENERAL LIABILITY MWZY 59628 06/01 12012 06101/2013 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMMG�O a occ.d 1 lX)0OW PREMISES En occurrence $ CLAIMS-MADE M OCCUR MED EXP(Any one person) $ N/A PERSONAL B ADV INJURY $ 1,000.000 GENERAL AGGREGATE $ 10,000.000 GEN-L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGG $ 1,000,000 X POLICY PRO- LOC $ A AUTOMOBILE LIABILITY MWTB 21585 06101 12012 0610112013 COMBINED SINGLE LIMIT 1000000 IEa aLCi=anll $ X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per amWern $ NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Pera¢idanl UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ OED I I RETENTION Is A WORKERS COMPENSATION MWC 11746400 0610112012 0610112013 X WC STATU` OTH- AND EMPLOYERS'LIABILITY Y/N YJJMlIS ER ANY PROPRIETOR/PARTNER/EXECUTIVE 1,000,000 OFFICER/MEMBER EXCLUDED? � N/A EL EACH ACCIDENT $ _ (Mandatory in NH) I EL.DISEASE-EA EMPLOYEE $ 1,000,000 If yyes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATONS/LOCATONS/VEHICLES (Attach ACORD 101,Additional Remark,Schedule,if more space is required) Ro:Contract QISD/10014382,Address:Medford.Medford,OR 97503-0000 The Cry of Ashland,and its elected and appointed officers,officials,agents and employees are included as Additional Insured under the General Liability and Automobile Liability policies but Only with respect to the requirements of file contract between the Certificate Holder arid the Insured. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Alin:Adminsbative Services,Ref:Cush V D V THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E.Main SL D ACCORDANCE WITH THE POLICY PROVISIONS. Ashland,OR 97520 AUTHORIZED REPRESENTATIVE OCT J-4- 2012 of Marsh USA Inc. _ Manashi Mukherjee �LaxaoL� �T4..at�r.aiaea. U U1 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo re registered marks of ACORD AGENCY CUSTOMER ID: 018566 LOC p: St. Louis r� ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. AT&T Cap, One AT&T Plaza POLICY NUMBER 208 South Akard Street Room 2737 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 Coverage evidenced applies to Subsidiaries of AT&T Inc.,EXCLUDING Pacific Bell Telephone Company,Nevada Bell Telephone Company,Southwestern Bell Telephone Company,Illinois Bell Telephone Company, Indiana Bell Telephone Company,Michigan Bell Telephone Company,The Ohio Bell Telephone Company,Wisconsin BeII,Inc.,The Southern New England Telephone Company and BellSouth I01CCemmUNeatI0115, -LC,WITH THE EXCEPTION OF Workers Compensation ACORD 101 (2008101) 0 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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. S. 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. d!?iA7.Y�iY'..+ !!y";,._. iii+;s.'7l•tf-=G::''!.":.^.:' IL 10 (12106) 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. PIL 029 10 10 AT&T Inc. MWTB 21585 Policy Term: 6-1-12-6-1-13 I IL 10 (12106) OLD REPUBLIC INSURANCE COMPANY WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY NOTICE OF CANCELATION TO CERTIFICATE HOLDERS 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. PC 010 10 10 AT&T Services, Inc., and Affiliates MWC117464 00 Policy Term:6-1-12-6-1-13 0000786 SP 0356 -0Ot-P 7w-I City of Ashland Attn:Administrative Services, Ref: Cust#000027 20 E. Main St. Ashland, OR 97520