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HomeMy WebLinkAboutInsurance Certificate: T-Mobile US, Inc. _ 1 • • ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `,.� 5/1/2022 04/28/2021 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 St.Louis MO 63141-7081Xt)' (AIC.No): E-MAILE MAI� (314)432-0500 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC#_ 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: 16984381 REVISION NUMBER: XXXXXXX 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. INSRI ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY 7012343900 05/01/2021 05/01/2022 EACH OCCURRENCE $ 10,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED $ PREMISES(Ea occurrence) 10,000,000 _ MED EXP(Any one person) $ 25,000 Y Y PERSONAL&ADV INJURY $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 20,000,000 71 POLICY JE X LOC PRODUCTS-COMP/OP AGG $ 20,000,000__ OTHER: I $ A AUTOMOBILE LIABILITY 7012343878 05/01/2021 05/01/2022 Ee aBG eDn SINGLE LIMIT $ 5,000,000 X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX OWNED r—SCHEDULED Y Y BODILY INJURY(Per accident) $ )00000 X AUTOS ONLY —AUTOS $ XXXXXXX HIRED. NON-OWNED PROPERTY DAMAGE AUTOS ONLY —AUTOS ONLY {Per accident) $ XXXXXXX B X .UMBRELLA LIABX OCCUR CUE 7014886953 05/01/2021 05/01/2029�CH 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 I STATUTEI IOER B AND EMPLOYERS'LIABILITY Y-/N • 7012343895 AOS) 05/01/2021 05/01/2022 B ANY PROPRIETOR/PARTNER/EXECUTIVE 7012343881 05/01/2021 05/01/2022 E.L EACH ACCIDENT $ 2,000,000 C OFFICER/MEMBER EXCLUDED? N N/A N CA) (Mandatory In NH) 7012447142 AZ,MA,OR,WI) 05/01/2021 05/01/2022 E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under ' DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I 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 r THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 16984381 • AUTHORIZED REPRESENTATIVE CITY OF ASHLAND,OREGON • ATTN:CITY ADMINISTRATOR • CITY HALL,20 EAST 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