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.aco CERTIFICATE OF LIABILITY INSURANCE F DATE(MM/DD/YYYY) <br />L? 06/24/2010 <br />PRODUCER <br />Aon Risk insurance Services west, Inc. <br />Seattle WA office <br />1420 Fifth Avenue <br />suite 1200 <br />Seattle WA 98101-4030 USA <br />PHONE-(206) 749-4800 FAX-(206, <br />INSURED <br />T-Mobile USA, Inc. <br />its subsidiaries and Affiliates <br />12920 SE 38th street <br />Bellevue WA 98006 USA <br />,.?- ;Zoo?- <br />COVERAGES <br />CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY <br />CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br />ERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURERA: Fidelity & Guaranty ins Co 35386 •• <br /> <br />INSURERB: <br />National union Fire <br />ins Co of Pittsburgh <br />19445 ti <br />w <br />INSURER C: Discover Property & Casualty ins co 36463 d <br />INSURERD: Fidelity & Guaranty Ins U/w 25879 <br />INSURERE: United states Fidelity & Guaranty Co. 25887 6 <br /> SIR aoolies Der terms and conditions of the nolirv = <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY <br />PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. <br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED <br />INSR D' <br />LTR INS TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br /> ATE MM/DD/YYYY DATE MM/DD <br />B ERAL LIABILITY GL2264628 05/01/2010 05/01/2011 EACH OCCURRENCE $1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1,000,000 <br /> <br />CLAIMS MADE <br />OCCUR PREMISES (Ea occurrence) <br /> ® one person <br /> X Contractual Liability Incl. <br />PERSONAL & ADV INJURY <br />$1 <br />000 <br />000 <br /> ? , <br />, <br /> GENERAL AGGREGATE $2,000,000 <br /> AGGREGATE LIMIT APPLIES PER <br />GENT <br /> , PRODUCTS -COMP/OP AGG $2,000,000 <br /> POLICY PRO- <br />? LOC <br /> JECT <br />B AUTOMOBILE LIABILITY CA9835798 05/01/2010 05/01/2011 <br /> x ANY AUTO AOS COMBINED SINGLE LIMIT <br />(Ea accident) <br />$2,000,000 <br />B CA 9835799 05/01/2010 05/01/2011 <br /> ALL OWNED AUTOS MA <br /> BODILY INJURY <br /> SCHEDULED AUTOS ( Per person) <br /> HIRED AUTOS FO RM <br /> <br />OV <br />A BODILY INJURY <br /> NON OWNED AUTOS APPR (Per accident) <br /> PROPERTY DAMAGE <br /> -rC <br />I' C <br />G (Per accident) <br /> n <br /> GARAGE LIABILITY TTOR l V AUTO ONLY - EA ACCIDENT <br /> <br />H ANY AUTO <br />OTHER THAN EA ACC <br /> AUTO ONLY <br /> AGG <br />8 EXCESS/UMBRELLA LIABILITY 15972273 05/01/2010 05/01/2011 EACH OCCURRENCE $5,000,000 <br /> <br /> OCCUR ? CLAIMS MADE AGGREGATE $5,000,000 <br /> <br /> DEDUCTIBLE <br /> ® <br /> RETENTION <br />A D W 4 5 x C STATU• OTH- <br /> WORKERS COMPENSATION AND <br />N <br />y <br />' A05 To LIMITS I I ER <br />E EMPLOYERS <br />LIABILITY , <br />._L <br />IN I <br />ANY PROPRIETOR/PARTNER/EXE <br />VE D003w00409 05/01/2010 05/01/2011 E.L. EACH ACCIDENT $1,000,000 <br /> CUTI <br />LJ AZORWI <br /> REXCLUDED? <br />nN E.L. DISEASE-EA EMPLOYEE $11000,000 <br />D H <br />Mandarory D003W00410 05/01/2010 05/01/2011 <br /> Ifyes, describe under SPECIAL PROVISIONS below HI E.L. DISEASE-POLICY LIMIT $1, OOO , 000 <br /> OTHER <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />site No.: LA33321B Site Name: Rosita Park Site Address: 4600 w. Hazard Ave Santa Ana CA 92703. City of Santa <br />Ana is an Additional insured for General Liability solely as respect to operations of the Named insured at the <br />above location if required by contract. The insurance coverage provided shall be primary and any other insurance <br />ULKTINlCAI'E HOLDER CANCELLATION <br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />Attn: Laura Sheedy DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />20 Civic Center Plaza 8th floor 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />Santa And CA 92 707 USA BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY <br />OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE &e. _4z.41uiuevetsaaes Y. ??-fir. <br />ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserve <br />The ACORD Dame and logo are registered marks of ACORD ` <br />W <br />no <br />N <br />Ch <br />M <br />O <br />O <br />O <br />z <br />w <br />t <br />U <br />f?