OMNIPOINT COMMUNICATIONS INC. (T-MOBILE) -2008

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- DG? -? ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04i24,2011 F 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 NAME: AOn Risk insurance services West, Inc. N Seattle WA Office No.Ext): (866) 283-7122 (A/C.No.: (847) 953-5390 (A/C 1420 Fifth Avenue E-MAIL Suite 1200 ADDRESS: Seattle WA 98101-4030 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: National Union Fire Ins CO Of Pittsburgh 19445 T-Mobile USA, Inc. INSURER B: Greenwich Insurance Company 22322 its subsidiaries and Affiliates 12920 SE 38th street INSURER C: Travelers Property Cas Co of America 25674 Bellevue WA 98006 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570042271957 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE INADDL SR SUBR WVD POLICY NUMBER IMM/DDfYYYY) MMID LIMITS B GENERAL LIABILITY RGD EACH OCCURRENCE $1,000,006, X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $1,000,000 CLAIMS-MADE X? OCCUR MED EXP (Any one person) $5,000 X Contractual Liability Incl. PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 t` GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 v POLICY PRO X LOC O r - B AUTOMOBILE LIABILITY RAD 5000257 05/01/2011 05/01/2012 COMBINED SINGLE LIMIT $2 000 000 LO ADS Ea accident , , B X ANY AUTO RAD 5000258 05/01/2011 05/01/2012 BODILY INJURY( Per person) O Z ALL OWNED AUTOS SCHEDULED AUTOS MA BODILY INJURY (Per accident) y HIRED AUTOS NON-OWNED PROPERTY DAMAGE V AUTOS Per accident 1= 0 A X UMBRELLA LIAR X OCCUR 25030274 05/01/2011 05/01/2012 EACH OCCURRENCE $5,000,005 t„1 SIR applies per policy ter ns & condit ions EXCESS LUIS CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION C WORKERS COMPENSATION AND HC23UB474M4871 05/01/2011 05/01/2012 X WC STATU- OTH- EMPLOYERS' LIABILITY Y / N AOS TORY LIMITS ER C ANY PROPRIETOR / PARTNER! EXECUTIVE OFFICERlMEMBEREXCLUDED? NIA HR7UB474M4883 05/01/2011 05/01/2012 E.L. EACH ACCIDENT $1,000,000 (Mandatory in NH) if -es describe under wI E.L. DISEASE-EA EMPLOYEE $1,000,000 , DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $1, 000, 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Site Number: LA028990D, Site Name: Fire Station. City of Santa Ana is an Additional Insured for General Liability solely as respect to operations of the Named insured at the above location if required by contract. The policies certified hereon are Primary to other insurance available to the certificate Holder, but only to the extent required by written contract with the Insured, and always subject to the policy terms, conditions and exclusions. CERTIFICATE HOLDER ELLATION = SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE - 2 EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Cit f S t an a Ana y o Attn: Sandi Gottlietf CommuniT;?gv:,. AU. FOR ED REPRESENTATIVE , 20 Civic center Plaza M-25 Santa Ana CA 92701 USA ASST tmW 41 ?LM4XM14a1W Ya X JL ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD