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HomeMy WebLinkAboutInsurance Certificate: AT&T Corp DATE (MM/DDNYYY) ACJRU CERTIFICATE OF LIABILITY INSURANCE 05/18/2016 THIS RTIFICATE 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). CONTACT PRODUCER NAME: Marsh USA Inc. PHONE FAX 701 Market Street, Suite 1100 A/c No Ext : A/C No): St. Louis, MO 63101 E-MAIL ADDRESS: Attn: ATT.CertRequest@marsh.com INSURERS AFFORDING COVERAGE NAIC # 018566-GAW-CRT-16-17 X X MJimen INSURER A : Old Republic Insurance Company 24147 INSURED INSURER B : AT&T Corp. One AT&T Plaza INSURER C : 208 South Akard Street INSURER D : Room 2731 Dallas, TX 75202 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: CHI-005613913-11 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 POLICY EFF POLICY EXP TR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY 307524 06101/2016 06/01/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE a OCCUR PREMISES Ea occurrence $ 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 1,000,000 PRO- PRODUCTS - COMP/OP AGG $ X POLICY ~ JECT LOC OTHER: $ A AUTOMOBILE LIABILITY MWTB 307523 06/0112016 06/01/2017 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident', A X ANY AUTO MWZX 307525 (MI) See Attached 06/01/2016 0610112017 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS 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 307526 00 0610112016 06101/2017 X PER OTH- AND EMPLOYERS' LIABILITY v/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE I N/A E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Excess Workers' Compensation ! MWXS 307527 (OH-WA) 06/0112016 06/01/2017 EL Each Accident/ EL Disease 1,000,000 Employers' Liability See Second Page EL Disease-Policy Limit 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Contract QISD/10014382, 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 Mukherjee -.tea ©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 ACG R 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 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 307527 (OH-WA) Self-Insured Retentions OH & WA - $500,000,000 (except Terrorism) OH & WA - $600,000,000 Terrorism ,mot,'......,..,* Excess Automobile Liability - MWZX 307525 (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 IL 10 (12106) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANCES 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 folders 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 conditior:s of this policy remain unchanged. PIL 029 "0 10 MVrTB 307523 AT&T Inc. 0610112016 - 0610112017 IL 10 (1206) OLD REPUBLIC INSURANCE COMPANY THIS ENDOR5EMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS This endorsement modifies the notice of cancellation of insurance provided here.Under by adding the following: A. In the event this policy is cancelled for any permissible reason, other than for, nonpayrnent 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- . 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. P iL 029 10 10 MVYZY 307524 A T& 7' Inc. 06,0112016 - 06/01/20.17 IL 10 (12!06) OLD REPUBLIC INSURANCE COMPANY WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY NOTICE OF A CELA.TION 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 prernium, we shall endeavor to provide advance written notice of cancelation to certificate holders set out in the schedule on fiie 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 cancellation date, nor negate cancelation of the policy. All other terms and conditions of this policy r€ main unchanged. PC 010 10 10 MWC307526 00 AT&T Services, Inc, 061{)1!2016 - 06/0111/2017 IL 10 (12106) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE REAL? 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, vre shall endeavor to provide advance written notice of cancellation to certificate holders set out in the schedule on file with the Companyf, after notifying the first Named Insured of such cancellation. Notice of cancellation to cetlificate holders may be made by any commercially reasonable means, including mail, electronic mail, facsimile transn'llission or courier service_ R. This advance written notification of a cancellation of coverage is intended as a courtesy only. Our failure to provide such advance w itten 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 3137525 AT&T Inc. 06101!2016 - 06101/2017