Loading...
HomeMy WebLinkAboutInsurance Certificate: AT&T Corp GATE YYYY ,aco CERTIFICATE OF LIABILITY INSURANCE 05/27 /2014 /20,4 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 Market Street, $Ulle 1100 PHONE FAX o NC No : SL Louis, MO 63101 E-MAIL AW: ATT.CertRequest@marsh.com ADDRESS: INSURERS AFFORDING COVERAGE NAICd 018566-GAW-CRT-14-15 X X MAIM INSURER A: Old Republic Insurance Company 24147 INSURED AT&T Corp. INSURER B One AT&T Plan INSURER C 208 South Akard Street Roan 2731 INSURER D Dallas, TX 75202 INSURER E NSURER F COVERAGES CERTIFICATE NUMBER: CHI-004548956-06 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 UBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS A GENERAL LIABILITY MWZY 302356 06101/2014 06/01/2015 EACH OCCURRENCE $ 1,000'000 X COMMERCIAL GENERAL LIABILITY DAMA TO RENTED 1,000,000 PREMISES Ea occunence $ CLAIMS-MADE M OCCUR MED EXP (Any one person) $ N/A PERSONALS ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMPIOP AGO $ 1,000,000 X POLICY PRO- LOC $ .IFCT A AUTOMOBILE LIABILITY MWTB 302129 001/2014 06/0112015 COMBINED SINGLE LIMIT 1,000,000 Ea accident) 1 A X ANY AUTO MWZX 302130 (MI) See Second Page 06/01/2014 0610112015 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per acciaem) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ $ HIRED AUTOS AUTOS 4EACH nt UMBRELLA LIAR OCCUR URRENCE $ EXCESS LIAR CLAIMS1 DE TE $ DELI RETENTION$ $ A WORKERS COMPENSATION MWC30234000 0610112014 06101/2015 TATU- o7H- AND EMPLOYERS' LIABILIT Y ANY PROPRIETOR/PARTNER/EXECUTIVE YIN ACCIDENT $ 1,000,000 OFFICEWMEMBER EXCLUDED? NIA (Mandatory in NH) E L. DISEASE - EA EMPLOYE $ 1.000'000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E1 . DISEASE - POLICY LIMIT $ A Excess Workers'Compensation/ MNXS 302341 (OH-WA) 06/01/2014 06/0112015 EL Each Accident I EL Disease 1,000,000 Employers' Liability See Second Page EL DiseasePolicy Limit 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONSI VEHICLES fAeach ACORD 101, Additional Remarks Schedule, If more space Is required) Re: Contract QISD/10014362, Address. Medford, Medford, OR 97503-0000 The City 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 the contract betseen the Certificate Holler and the insured. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Administrative Services, Ref: Cust#000027 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E. Main St. ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee JAwuons.: ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD I i AGENCY CUSTOMER ID: 018566 LOC St. Louis ,ac " ADDITIONAL REMARKS SCHEDULE Page 2 of 2 11i AGENCY NAMED INSURED Marsh USA Inc. AT&T Corp. One AT&T Plaza POLICY NUMBER 208 South Akard Street Room 2731 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' Compensalum - MWXS 302341 (OH-WA) Self-Insured Retentions OH - $500,000,000 WA - $500,000,000 Excess Automobile Liability - MWZX 302130 (MI) Combined Single Limit - $9,000,000 Self-Insured Retention-$1,000,000 7 I I ACORD 101 (2008101) D 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Frisk Management AT&T Services, Ina One AT&T Plaza 208 South Akard, Suite 2731 Dallas, TX 75202 April 15, 2014 To Whom It May Concern: Subject: Subsidiaries of AT&T Inc. Certificates of Insurance (COI) Memorandum of Insurance (MOI) You are receiving this because you have been identified as a Third Party who has requested a Certificate of Insurance from an AT&T Entity. AT&T has currently renewed its' Casualty Coverage(s) for the 6/1/14 -6/1/15 policy period. Kindly note, AT&T also provides a Memorandum of Insurance (MOI) for Third Parties. Please take a moment to access the website below and review the information. If the MOI satisfies your organization's requirements and the COI is no longer required, please indicate on the front of the Certificate and fax to: 212-948-4341. hitps:!(www. marsh.c;om,'mci?client-D526 If the COI is still necessary and requires modifications, please contact the AT&T employee responsible for your business relationship and ask that employee to authorize the necessary updates by following their standard request protocol. COI's will only be sent or modified when requested by the AT&T employee responsible for the business relationship. This would also include COI renewals. Thank you for assisting Subsidiaries of AT&T Inc. Sincerely, AT&T Services, Inc. Risk Management 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. PIL 029 10 10 MWZX 302130 SpeciFed Subsidiaries of AT&T Inc. 0610112014 - 0610112013 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 MWIB 302129 AT&T Inc. 0610112014 - 0610 111 0 1 5 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 mall, 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. PIL 029 10 10 WaY302356 AT&T1nc. 0"112014-06/01/2015 ~ i IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY NOTICE OF CANCEIATION 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 cancetation. 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 0101010 MSUim COPY