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HomeMy WebLinkAboutInsurance Certificate: T-Mobile US, Inc ACoRD CERTIFICATE OF LIABILITY INSURANCE 5/1/2023 DATTE(MMIDD022) 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 Lockton Companies CONTACT Three City Place Drive,Suite 900 PHONE FAX IANC.No.Extl: (A/C.NW: St.Louis MO 63141-7081 EMAIL (314)432-0500 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC N INSURER A: Continental Casualty Company 20443 INSURED T-Mobile US,Inc. INSURER B:The Continental Insurance Company 35289 1358772 Its Subsidiaries and Affiliates, INSURER c:Transportation Insurance Company 20494 including Sprint Corporation 12920 SE 38th Street INSURER D Bellevue WA 98006 INSURER E: INSURER F: COVERAGES TMOBI CERTIFICATE NUMBER: 16975097 REVISION NUMBER: XXX)00(X 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A )( COMMERCIAL GENERAL LIABILITY 7012343900 05/01/2022 05/01/2023 EACH OCCURRENCE $ 10,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED $ 10 000.000 PREMISES(Ea occurrence) Y Y MED EXP(Any one person) $ 25,000 PERSONAL&ADV INJURY $ 10,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 20.000,000 1 POLICYn PES X LOC PRODUCTS-COMP/OP AGG I$ 20,000,000 OTHER: $ A AUTOMOBILE LIABILITY 7012343878 05/01/2022 05/01/2023(Ea acl J SINGLE LIMIT $ 5,000,000 X ANY AUTO BODILY INJURY(Per person) $)()000(XX OWNED SCHEDULED Y y BODILY INJURY(Per accident) $ AUTOS ONLY —AUTOS )000000( HIRED NON-OWNED PROPERTY DAMAGE $XXX)00CX AUTOS ONLY —AUTOS ONLY (Per accident $XXX)00(X B X UMBRELLA LIAB X OCCUR CUE 7014886953 05/01/2022 05/01/2023 EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB CLAIMS-MADE N N SIR applies per policy AGGREGATE $ 5,000,000 B DED X RETENTION$10,000 terms&conditions WORKERS COMPENSATION X STATUTE OTR_ B AND EMPLOYERS'LIABILITY Y/N 7012343895(AOS) 05/01/2022 05/01/2023 B ANY PROPRIETOR/PARTNER/EXECUTIVE 7012343881 05/01/2022 05/01/2023EL.EACH ACCIDENT $ 2,000,000 G, OFFICER/MEMBER EXCLUDED? N N/A N CA) (Mandatory in NH) 7012447142 AZ,MA,OR,WI) 05/01/2022 05/01/2023E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,0.00__ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) The Certificate Holder and other entities defined by written contract,statute,permit application or written agreement are additional insureds on a primary and non-contributory basis under general liability and are additional insured under automobile liability as required by written contract.Waiver of Subrogation applies under general liability and automobile liability as required by written contract.**See Attached Endorsements** / CERTIFICATE HOLDER CANCELLATION See Attachments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 16975097 AUTHORIZED REPRESENTATIVE CITY OF ASHLAND CITY HALL 20 E.MAIN STREET ASHLAND,OR 97520 ACORD 25(2016/03) ©1988-2015 ACO ORPORATION.All rights reserved The ACORD name and logo are registered marks of ACORD Attachment Code : D590641 Master ID: 1358772, Certificate ID: 16975097 ilA LOCXTCIN CITY OF ASHLAND CITY HALL 20 E. MAIN STREET ASHLAND, OR 97520 IMPORTANT NOTICE Dear Certificate Holder for T-Mobile and its subsidiaries (including Sprint): In our continued effort to provide timely certificate delivery, Lockton Companies is transitioning to paperless delivery of Certificates of Insurance going forward. To ensure future renewals of this certificate,we need your email address. Please contact us via one of the methods below, referencing Certificate ID 16975097 • Email:stl-edelivery@lockton.com • Phone:314-812-3888 If we do not receive your email address via one of the above methods prior to the client's next renewal, we will assume you no longer need the certificate. If you received this certificate through an internet link where the current certificate is viewable, we have your email and no further action is needed. The above inbox is for collecting email addresses for renewal electronic certificate delivery ONLY. You will not receive a response from this inbox. Thank you for your cooperation. Lockton Companies Lockton Companies Three CityPlace Dr, Suite 900/St. Louis,MO 63141-7088 314-432-0500/lockton.com AttachmeMi278 Master ID: 1358772, Certificate ID: 16975097 i • POLICY HOLDER NOTICE COUNTRYWIDE It is understood and agreed that: If the Named Insured has agreed under written contract to provide notice of cancellation to a party to whom the Agent of Record has issued a Certificate of Insurance,and if the Insurer cancels a policy term described on that Certificate of Insurance for any reason other than nonpayment of premium,then notice of cancellation wi l l be provided to such Certificate holders at least 30 days in advance of the date cancellation is effective. If notice is mailed,then proof of mailing to the last known mailing address of the Certificate holder on file with the Agent of Record will be sufficient to prove notice. Any failure by the Insurer to notify such persons or organizations wi l l not extend or invalidate such cancellation,or impose any liability or obligation upon the Insurer or the Agent of Record. This endorsement,which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy,unless another Form No: CNA75014XX(01-2015) Policy No: 7012343900 Endorsement Effective Date: 05/01/2022 Policy Effective Date: 05/01/2022 Underwriting Company: Continental Ca s ua lty Compa ny ©Copyright CNAAII Rights Attachment Code : D559289 Master ID: 1358772, Certificate ID: 16975097 CNA ,___ ,, , NOTICE OF CANCELLATION TO CERI1FICATEHOLDERS It is understood and agreed that: If you have agreed under written contract to provide notice of cancellation to a party to whom the Agent of Record has issued a Certificate of Insurance,and if we cancel a policy term described on that Certificate of Insurance for any reason other than nonpayment of premium,then notice of cancellation will be provided to such Certificateholders at least 30 days in advance of the date cancellation is effective. If notice is mailed,then proof of mailing to the last known mailing address of the Certificateholder on file with the Agent of Record wi l l be sufficient to prove notice. Any failure by us to notify such persons or organizations will not extend or invalidate such cancellation,or impose any liability or obligation upon us or the Agent of Record. This endorsement,which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy,unless another Form No: CNA68021XX(02-2013) Policy No:7012343878 Endorsement Effective Date: 05/01/2022 Policy Effective Date:05/01/2022 Endorsement No: Policy Page: Underwriting Company:Continental Casualty Company