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HomeMy WebLinkAboutInsurance Certificate: AT&T Corp A ~ ® DATE tMMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE o5l09l2017 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 NAME: _ _ - Marsh USA Inc. PHONE J~FAX 701 Market Street, Suite 1100 (AIC. No, Ext~ 1A1C No~_ St. Louis, MO 63101 E-MAIL Attn: ATT.CertRequest@marsh.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 018566-GAW-CRT-17-18 X X MJimen INSURER A : Oltl Republic Insurance Company 241-47-- INSURED INSURER B AT&T Corp. _ One AT&T Plaza INSURER C 208 South Akard Street INSURER D Room 1830.06 _ - _ Dallas, TX 75202 _INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: CHI-005613913-13 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. ADDL SUBR POLICY EFF ~ POLICY EXP INSR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS LTR A X COMMERCIAL GENERAL LIABILITY MWZY 310368 ~06101I2017 0610112018 EACH OCCURRENCE _ _ $ 1,000,000 - ~ DAMAGE TO RENTED CLAIMS-MADE ~X~ OCCUR PREMISES (Ea occurrence~__ $ 1,000,000 _ - MED EXP (Any one person) $ NIA - - _ _ - - - PERSONAL & ADV INJURY $ 1.000,000 - - - - GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10.000,000 X POLICY ll JE ~ II LOC PRODUCTS COMP/OP AGG $ 1000,000 J __J - - - - - OTHER: $ A AUTOMOBILE LIAE►IL;TY ! MWTB 310367 0610112017 0610112018 COM3INED SINGLE LIMIT $ 1,000,000 Ea accident A X ANY AUTO MWZX 310369 (M!) (See Attached) 0610112017 0610112018 BODILY INJURY (Per person) $ _ _ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTO - _ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS _tP?r accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION MWC 310370 00 0610112017 0610112018 X I PER OTH- AND EMPLOYERS' LIABILITY STATUTE _ ER Y ! N 1000,000 ANY PROPRIETORIPARTN[RIEXECUTIVE(`, j N 1 A E.L. EACH ACCIDENT _ _ $ _ _ OFFICER/MEMBER EXCLUDED? ~ J (Mandatory in NH) E _L DISEASE - EA EMPLO_Y_EE $ 1,000,000 If yes, describe under 1.000,000 DESCRIPTION OF (}PERATIONS below E.L. DISEASE -POLICY LIMIT $ A Excess Workers' Compensation 1 M4NXS 310371 (OH-WA) 06!0112017 0610112018 EL Each Accident l EL Disease 1,000,000 Employers' Liability See Second Page ELDisease-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 OISDl10014382, 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 •..~c...~:..~ ©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 RD® of A~~ ADDITIONAL REMARKS SCHEDULE Page 2 2 AGENCY NAMED INSURED Marsh USA Inc. AT&T Corp. One AT&T Plaza POLICY NUMBER ~ 208 SOUfh Akard Street Room 1830.06 Dallas, i X 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 310371 (OH-WA) Self-Insured Retentions OH & WA - $500,000,000 (except Terrorism) OH & WA - $600,000,000 Terrorism ****t****RRtk***#***RR**#*#**# Excess Automobile Liability - MWZX 310369 (MI) Combined Single Limit - $1,000,000 Self-Insured Retention - $1,000,000 ACORD 101(2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Rislf Management AT&T Services, Inc. aye AT&T Plaza 208 South Akartf, Suite 2131 Dallas, TX 1202 May 3, 2911 To 1Nh~m It May Concern: Subject: Subsidiaries ofAT&T Inc. certificates of Insurance ~C~I} Memorandum of Insurance ~MC~I} 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 Coverages} for the fi11117 - fi11118 policy period. Kindly note, AT&T also provides a Memorandum of Insurance tMQly for Third Parties. Please take a moment to access the website below and review the information. If the MQ~I satisfies your organization's requirements and the CSI is no longer required, please indicate on the front of the Certificate and fax to. ~1 ~-948-4341. v~ ~ ~`t,`,C~~~ i_~f~~~~~~.;.~f~,°~~~;~iE'~~~`i;;?~;~Frf~#°F::~~1~~_:`'*~~:~~~~~~I~;'i°~~-~~"~,E~~`~~~E~~~~1„`~r~€~1:;;~~~,€~;mm~~`~,'..;,^~~~~~~~~ If the CSI 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. CQI's will ol~~!y be sent or modified when requested by the AT&T employee responsible far the business relationship. This would also include CSI renewals. Thank you for assisting Subsidiaries of AT&T Inc. Sincerely, AT&T Services, Inc. Risk Managemel~t IL ~ ~1fQ~ t~L EPUL~ IU C~~N TI~ll~S Ef~DC~RSEf~ENT ~He~~GES THE PO~IGY, P~.EA~E READ IT CARE~U~.LY~. ~I~TIE ~~41~CELLATIN T ET~F~T~ ~t~LD~ This endarsernent rnadifias the native of cancellatian of insurance ~ravided hereunder key adding the fallav~~inc~; fie, In the event this ~alic~ is cancelled far any ~erraissihle reason, ether than far nanpa~ment of premiurn, eve shall er~deavar to pravide advance ~rritten native of canc~:llatian to certificate halders set a«t in the schedule an file pith the Carnpany, after r~atif~ir~~ tl~e first Flamed Insured of such cancellatian. ~latice of cancellatian to certificate hc~ldec~s may he made by ar~y camr~~ercially reasanable means, including mail, electranic ~r~ai+, facsir~ile tra€~sinissiar~ a~~ caurier service. This advance ~~ritten natificatian of a ci~ncellatian of average is i~~tended as a caurtes~ aniyR, fur failure to pravide such advance v~rritten natificatian ~vill net extend the f~alicy can€~eliatian date, nar negate cancellatian of the palic~. All ether terms and canditians of this ~alic~ rernair~ unchanged. Ply, X29 ~'VItT~3310367 A7~,Tlt~~. 06,'01I201~'-D6fUli~tllE IL 1 ~ ELI N N~ + PAY THIS END~~EIENT HAKES THE P~LI~Y. ~LEA~E REAa IT AREFLlLL`~'. N~JTIE ELLTI+~N T+~ ETIF1~►TE HLDER~ This endorsement modifies the notice of cancellation of insurance provided hereunder by adding th+e following: In ~e event this policy is cancelled for any perrnissihle reason, other than for nonpayment of premium, a shall endeavor to provide advance ~rit#en notice of cancellati®n to certificate holders set out in the schedule on ale Frith fibs ~or~pany, affier notifying the first Named Insured of such ncellation. Notice of cancellation to certificate holders may fee made ray any commercially reasor~ahle means, including rr~ail, electronic mail, facsimile transmission or courier service. This advance ~rrritten notification of a cancellation of coverage is intended as a courtesy only. Cur failure to provide such advance ~rritten notification mill not ex#end the policy cancellation date, nor negafie ~ncellation of the policy. All osier terms and editions ort this policy remain unchanged. PILOT 1~ 1Q ~`~~f~~' GGIlP~~S,Ti~~1 Abp I~PI~C~Y~R~ tal~~~L~ INI~ ~E P~L~~~ T t.°~1 TEA T~~,T' This ~ndt~r~~rrr~:nt rnadi~~~ tl~~ g~atic;~ at can~alatic~r c:~~ in~ura~tca pravidad ~c~rauni~~r ~~di~~ tha faiia~i~~; A. Iri the ~~~aE~t ii`~is ~aiia~ i~ c~ar~~lad far any rr,~~~:~i9t~ raa~c~r~, ~itt~~r tha~~ ~c~r n~,i~,3~rr~ant a~ ~r~n~i~m, s~~all ~r~d~a~vnr to ~jr~~~ida ad~an~~e ~rrittar~ natica rat c;ar~~,aiatia~ to ~a~rtifirsata ~~alder~ yet aut in tl~~ srh~dui€~ ~~r~ pith tha ~ampan~; attar nati~ir~~ Eha ~n~~~rad ~~r~t named ire it~:rT~ ~ a~ the ~n~armatiar~ ~a~a of s+~~:~M aanaaiati~r~a ~tatic;a ar ~anc:alatiar~ to %arti~~tc; ~~aid~r:~ rr~ade ar~y car~rc~raiaily raa~ana~►la r~:~ns, i~~audinc~ s~~°ai1, ~~I~caR~c~~~,i~ r~~~i~, tJ~a~~~in~ila trar~~mi~~iar~ ar ca~riar ~~rvird~, T~i~ advann.~ +~rittan t~ati~ir^~atiar~ of ~ r~ar~cc~~~tian ofi ~;a~~~ra~~ is ~ntr~rt~d ~s ca~~rt~~y an~~. far ~ail~r~ to ~r~vide ~csc~ ad~ann~; ~ritt~n r~ati#;catic~r~ cif! nat a4t~r~d the ~aliay ca~o~lati~n data, nar n~~at~ aaroc;~:iatian ~f tf~~ ~alic~. AI( ~th~r t~rrn~ and aanditian~ a~ tf~is a~iay rarr~in rann~a~~~c~d. iL 1 41~Dfi~ ~ E~Li ihiUAN~ i~l~Y THIS EN~C~RSEf~EI~IT ~HANt~ES THE POLICY. f~~EASE READ !T ~AREEUI~t~Y, NgTIC C3F C~LLATiN T~ CTIITE ~~LDER This endarsement n~adifies the notice of cancellation of insurance pravided hereunder fay adding the failawin~~ fn the event this palicy is cancelled fiat any permissible reason, ether than for nonpayment afi premium, we shall endeavor to provide advance written notice of cancellation to certificate holders set out in the schedule an file with the Gor~pany, after notifying the first Named Insured of such car~ceilatian. Notice of cancellation to certificate holders may k~e made by any commercially reasonable means, including mail, electronic mail, facsimile transmission ar €~aurier service, This advance written natificatian of a cancellation of coverage is intended as a caurfesy only. Cur fail«re to prc~virle such advance written nati~catian will net extend tl~e palicy cancellation date, nor negate cancellation of the palicy. Alf other terms a«d car~ditions of this palicy rerr~ain unchanged. Ply. f~~g 10 n~t~~~~~ss ar~rt~~. a~~alt~o~~mo~fo~~~sf~