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Attachment to ACORD Certificate for T- Mobile USA, Inc. <br />The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage <br />afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policv. <br />INSURED <br />T- Mobile USA, Inc. <br />its subsidiaries and Affiliates <br />12920 SE 38th Street <br />Bellevue wA 98006 USA <br />A — k C, 4 Z�S^-2' <br />ADDITIONAL POLICIES <br />INSURER <br />INSURER <br />INSURER <br />INSURER <br />INSURER <br />If a policy below does not incluc' <br />certificate form for policy limits. <br />,.., ...v.u.a..un, I VIUr ID Ine corresponamg poi icy on the ACORD <br />Certificate No : 570040831758 <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSR <br />SUBR <br />wvD <br />POLICY NUMBER/ <br />POLICY DESCRIPTION <br />POLICY EFF <br />(MM/DD/YYYY) <br />POLICY EXP <br />(MM/DD/YYY1) <br />LIMITS <br />WORKERS COMPENSATION <br />1 <br />� <br />N/A <br />D003wo0410 <br />HI <br />05/01/2010 <br />05701/2011 <br />C <br />N/A <br />D003WO0411 <br />NVNJ <br />5/01/201 <br />05/01/2011 <br />Certificate No : 570040831758 <br />