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ACo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br /> ko....----- 5/1/2015 4/30/2014
<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 be endorsed, If SUBROGATION IS WAIVED, subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER Lockton Companies CONTACT
<br /> p` NAME:
<br /> Three City Place Drive,Suite 900 PHONE FAX
<br /> St. Louis MO 63141-7081 _IE-MAILo,Exth (AIC,No):
<br /> (314)432-0500 ADDRESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA:XL Insurance America, Inc. 24554
<br /> INSURED T-Mobile US,Inc. INSURER B:Greenwich Insurance Company 22322
<br /> 1366122 flea Metro PCS Communications,Inc. INSURER C:National Union Fire Ins Co Pittsburgh PA 19445
<br /> Its Subsidiaries and Affiliates INSURERD:
<br /> 12920 SE 38th Street
<br /> Bellevue WA 98006 INSURER E:
<br /> INSURER F:
<br /> COVERAGES TMOBI CERTIFICATE NUMBER: 12900887 REVISION NUMBER: XXXXXXX
<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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
<br /> B x COMMERCIAL GENERAL LIABILITY Y Y RGD500025903 5/1/2014 5/1/2015 EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 1,000,000
<br /> MED EXP(Any one person) $ 5,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY JECT X LOC
<br /> PRODUCTS-COMP/OP AGG S 2.000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY Y y RAD500025703 AOS 5/1/2014 5/1/2015 (Es accident)
<br /> ddenot)IN'IL LIMI I $ 2,000,000
<br /> B RAD500025803MA 5/1/2014 5/1/2015 (Ea
<br /> X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX
<br /> ALL OWNED ^SCHEDULED BODILY INJURY(Per accident) $ XXXXXXX
<br /> AUTOS AUTOS._
<br /> - A OWNED (PerPROPERTY accident)
<br /> DAMAGE $ XXXXXXX
<br /> HIRED AUTOS AUTOS
<br /> 5 XXXXXXX
<br /> C x UMBRELLA LIAB X OCCUR Y N 49131346 5/1/2014 5/1/2015 EACH OCCURRENCE $ 5,000,000
<br /> C EXCESS LIAB CLAIMS-MADE SIR applies per policy
<br /> C terms&conditions AGGREGATE $ 5,000,000
<br /> DED X RETENTION5 25,000 $ XXXXXXX
<br /> A N WORKERS COMPENSATION I'EN 0I H-
<br /> ANDEMPLOYERS'LIABILITY RWD500030102 AOS 5/1/20I4 5/1/2015 X ISTATUTEI IER
<br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N RWR500030202 WI 5/1/2014 5/1/2015 E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? N N/A I,000,000
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER,APPLICABLE TO THE CARRIERS LISTED AND THE POLICY'FERMIS)REFERENCED.
<br /> The Certificate 1-folder and other entities defined are additional insureds on a primary and non-contributory basis under general liability and are additional
<br /> insured under automobile liability as required by written contract.Waiver of Subrogation applies under general liability and automobile liability as required by
<br /> written contract.**See Attached Endorsements** RE:SPECIAL EVENT,CINCO DE MAYO FESTIVAL IN SANTA ANA 5/3-5/4/2014.SEPARATION OF
<br /> INSUREDS ARE INCLUDED UNDER GENERAL LIABILITY.
<br /> CERTIFICATE HOLDER 1'CANCELLATION See Attachments
<br /> 12900887 pr-LA, .
<br /> CITY OF SANTA ANA ;�1,'- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> i` 5� THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 20 CIVICTACENTER PLAZA ~�,• .- ,_,,F 1V PV` ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> SANTA ANA CA 92701 , � L`<� ,; C\ -
<br /> • r
<br /> P5 / AUTHORIZED REPRESENTATI
<br /> 2
<br /> k.
<br /> ©1988-2 ACORD CORPORATI N. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
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