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HomeMy WebLinkAboutInsurance Certificate: AT&T Corp (2) ® DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/2112018 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 have ADDITIONAL INSURED provisions or 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 -IA/C, No. A/c No : St. Louis, MO 63101 E-MAIL Attn: ATT.CertRequest@marsh.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC # 018566-GAW-CRT-18-19 X X _ MJimen INSURER A : Old Republic Insurance Company 24147 INSURED AT&T Corp INSURER B : . 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-007321957-21 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 LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DDIYYYV A X COMMERCIAL GENERAL LIABILITY MWZY313636 06/01/2018 06/01/2019 EACH OCCURRENCE $ 1,000,000 1A AGE CLAIMS-MADE 111 OCCUR PRME SESOEa oocur 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 X POLICY ❑ PROECT ❑ LOC PRODUCTS - COMP/OP AGG $ 1,000,000 J OTHER. $ MWTB 313635 06/01/2018 06/01/2019 COMBINED SINGLE LIMIT A AUTOMOBILE LIABILITY Ea accident $ 1,000,000 A X ANY AUTO MWZX 313637 (MI) 06/01/2018 06/01/2019 BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR _ CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION MWC 313638 00 06/01/2018 06/01/2019 X PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICE RIM EMBER EXCLUDE D? ❑N NIP` (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Excess Workers' Compensation / MWXS 313639 (OH, WA) 06/01/2018 06/0112019 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 107, 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 _3~t nnns+o► ~~4 . c tom„ u ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 018566 LOC St. Louis AC "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 1830.06 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 II Excess Workers' Compensation - MWXS 313639 (OH-WA) Self-Insured Retentions OH & WA - $500,000,000 (except Terrorism) OH & WA - $600,000,000 Terrorism Excess Automobile Liability - MWZX 313637 (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 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. 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. III P 1 L 029 iu 10 MW7B 313635 Ar&r lnc. 06(01/1018 - 0610112019 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY NOTICE OF CANCELLATION TO ClERTIFICATE 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 MYYIX 313637 AT&T Inc. 06AD112018 - 0610112019 i 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. 8. 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. II ~I PIL 029 10 10 MWZY 313636 AT&T Inc. 08AD112018 - 0"113019 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 caneelation 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 certifi cate 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 caneelation of coverage is intended as a courtesy only. Our failure to provide such advance written notification will not extend the policy canceiation date, nor negate cancelation of the policy. All other terms and conditions of this policy remain unchanged. PC 010 10 10