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OMNIPOINT (T-MOBILE) (2)
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OMNIPOINT (T-MOBILE) (2)
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Last modified
8/12/2019 11:29:24 AM
Creation date
3/13/2019 11:26:37 AM
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Template:
Contracts
Company Name
OMNIPOINT (T-MOBILE)
Contract #
A-2008-290-01
Agency
PARKS, RECREATION, & COMMUNITY SERVICES
Council Approval Date
11/17/2008
Expiration Date
9/20/2024
Insurance Exp Date
4/1/2020
Destruction Year
2029
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A� �® CERTIFICATE OF LIABILITY INSURANCE <br />03/29/2 8 <br />page 1 of 2 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement <br />on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER CONAMETACT <br />'N <br />Willis of Pennsylvania, Inc. PHONE <br />877-945-7378FAX <br />_ND>: 888-467-2378 <br />c/o 26 Century Blvd. _ke[C_MO.EXT)' .. — <br />P. O. Box 305191 E-MAIL <br />Certificatee@$vi1liE. oom <br />Nashville, IN 37230-5191 iAn <br />I NSURER(S)AFFORDING COVERAGE NAIC# <br />I, IN$URERA: Federal Insurance Company 20281-005 <br />INSURED _ A� n <br />A—NSURER B: Travelers Property Casualty Co of Amer 25674-001 <br />W ,3�J'-(J <br />Crown Castle International � Lq <br />See Attached Named Insured List INSURER C: Berkshire Hathaway Specialty Insurance Cc 22276-001 <br />1220 Augusta Dr. Suite 600 <br />Houston, TX 77057 INSURER D: <br />INSURER E. <br />INSURERF: <br />COVERAGES CERTIFICATE NUMBER: 26194691 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES <br />DESCRIBED HEREIN IS SUBJECT TO ALL <br />THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICYEFF <br />ie.LIMITS <br />POLICY UP <br />A X COMMERCIAL GENERAL LIABILITY y Y '7021-02-28 4/1/2018 <br />4/1/2019 EACH OCCURRENCE I$ <br />1,000,000 <br />CLAIMS -MADE X OCCUR <br />PREMIScS (t.1NTEence) $ <br />1,000,000 <br />M ED EXP(Any one person) $ <br />5 000 <br />PERSONAL&ADV INJURY $ <br />11000,000 <br />GENT AGGREGATE U MIT APPLI ES PER. <br />GENERAL AGGREGATE $ <br />2,000,000 <br />X POLICY PRO- <br />JECT LOD <br />PRODUCTS -COMPIOPAGG '$ <br />2,000,000 <br />OTHER. <br />',$ <br />B AUTOMOBILE LIABILITY Y Y TC2JCAP-474M9749TIL18 4/1/2018 <br />4/1/2019 COMBINED SINGLE LIMIT(Ea acciden!) $ <br />1,000,000 <br />X ANYAUTO <br />i BODILY INJURV(Per person) I$ <br />OWNED - --SCHEDULED <br />AUTOSONLY <br />INJURY(Per <br />BODI LV INJURVPer accident '',$ <br />__AUTOS <br />HIRED NON OWNED <br />PROPERTYID 'I$ <br />_ <br />AUTOSONLY AUTOSONLY <br />(Peracciden0 <br />S <br />C X UMBRELLALIAB X OCCUR y y 47-UMO-303445-02 4/l/2018 <br />4/1/2019 EACH OCCURRENCE '$ <br />5,000,000 <br />EXCESS LIAB CLAIMS -MADE <br />AGGREGATE $ <br />51000,000 <br />DED X RETENTION$ 25,000 <br />$ <br />B WORKERS COMPENSATION TRKUB-474M970-1-18 4/1/2018 <br />4/1/2019 X OIH- <br />__FR <br />AND EMPLOYERS' UABILIT/ YIN <br />_STATURE <br />B ANY PROPRIETOR/PARTNER/EXECUTIVE Y TC2J0B-474M969-4-18 4/1/2018 <br />4/1/2019 E.L. EACHACCIDENT $ <br />1,000,000 <br />OFFICER/MEMBER EXCLUDED? <br />andatory <br />[M[Mandatory In NH) <br />EL DISEASE - EA EMPLOYEES <br />1,000,000 <br />desedbe under <br />DESCRIPTION OF OPERATIONS below <br />E. L. DISEASE -POLICY LIMIT $ <br />1,000,000 <br />DESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES(ACORO ID1, AddMonal Romance Schedule, maybe adached if more space is mquimd)I\n�n <br />BU #828440 - TM3009 El Salvador Park V <br />. V <br />\\� <br />See attached: <br />v" <br />GueJas�. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />City of Santa Ana <br />Attn: Insurance Compliance <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Coll:5195366 Tp1:2208919 Cert:26194691 ©1988-2015ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />
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