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HomeMy WebLinkAboutInsurance Certificate: AT&T Corp `2015 YYY' CERTIFICATE OF LIABILITY INSURANCE 0511°ATE9/12 0 1 5 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: PHONE---- ..FAX 701 Market Street, Suite 1100 St. Louis, MO 63101 E-MAIL - - Attn: ATT CertRequest@marsh.com _AoDRESS; INSURER(S) AFFORDING COVERAGE NAIC # 018566-GAW-CRT-15-16 X X MJIM INSURER A : Old Republic Insurance Company 24147 INSURED AT&T Corp. INSURER B : One AT&T Plaza INSURER C : 208 South Akard Street Room 2731 INSURER D Dallas, TX 75202 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: CHI-005613913-08 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 - ADDL SUBR LTR TYPE OF INSURANCE POLICY NUMBER MM/DDYYYY MM DD YYYY `LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY 304717 06/01/2015 06101/2016 EACH OCCURRENCE $ 1,000,000 _DA ffP CLAIMS-MADE X-1 l OCCUR PREIM SESOEa ooTE ante/ $ 1,000,000 MED EXP (Any one person) $ N/A PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 10,000,000 POLICY PRO- L 1 - - - JECT LOC PRODUCTS - COMP/OP AGG $ _ 1,000,000 N 0 OTHER. A AUTOMOBILE LIABILITY MWTB 304716 06/01/2015 06/01/2016 COMBINED SINGLE LIMIT idence $ 1,000,000 - - - A ANY AUTO MWZX 304718 (MI) See Attached 06i0112015 O6iU i/2016 BODILY INJURY (Per person) $ ALL OWNED- SCHEDULED AUTOS _ AUTOS BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE - - HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE _ $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION MWC 30471900 06/01/2015 06/01/2016 X PER OTH- AND EMPLOYERS' LIABILITY Y / N _ STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? a N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under - _ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Excess Workers' Compensation / MWXS 304720 (OH-WA) 06/01/2015 06/01/2016 EL Each Accident / EL Disease 1,000,000 Employers' Liability See Second Page EL Disease-Policy Limit 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re Contract OiSD/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 between the Certificate Holder 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 Mukheriee _Yxt c~e.+aaa .,,NA-1AC *'AP, @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 018566 LOC St. Louis ADDITIONAL REMARKS SCHEDULE Page 2 of 2 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 TAIC 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 304720 (OH-WA) Self Insured Retentions OH & WA - $500,000,000 (except Terrorism) OH & WA - $600,000,000 Terrorism Excess Automobile Liability - MWZX 304718 (MI) Combined Single Limit - $1,000,000 Self Insured Retention - $1,000,000 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Risk Management AT&T Services, Inc. One AT&T Plaza 208 South Akard, Suite 2731 Dallas, TX 75202 April 21, 2015 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 6/1/15 - 6/1/16 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. 1i tos//online marsh.cormmarsliconnectpublic/marsh2/publicrmoi?client=120539681 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 (12106) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMLNT CHANGES THE POLICY, PLEASE READ I-1 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 ;his policy remain unchanged. PII. 029 19 10 M W78 304716 A T& T h c, 0610112015 - 0610112016 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASL RFAD 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 Nan,ed 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 data, nor negate cancellation of the policy All other terms and conditions of this policy remain unchanged. PIL 020 10 10 MWZY 304717 AT&T Inc. 0610112095 - 0610112016 IL 10 (12/06) 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 tU WC304719 00 AT&T Services, Inc. 06101/2015 - 0610112016 IL 10 (92106) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGLS THE POLICY. PLEASE READ IT CARLFULLY. 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. can 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 snail, 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 We policy. All ether terms and conditions of this policy remain unchanged. PIL 429 10 10 MWZX 304716 AT&T tnc_ 0610112415 - 0610112016