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ACORH CERTIFICATE OF LIABILITY INSURANCE ll 5/1/2016 GATE (MMIGDNWY) 1 4/30/2015 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms 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 LOCtoon Companies Three City Place Drive, Suite 900 St. Louis MO 63141-7081 (314) 432-0500 CONTACT PHONE FAX C, No Ext : AIC No): a ADDRESS: X COMMERCIALGENERAL LI ABILITY INSUREI AFFORDING COVERAGE NAIC k INSURER A: XL Insurance America Inc. 24554 RGD5000259-04 INSURED T -Mobile US, Inc. INSURER a: Greenavich Insurance Company 22322 INSURER C: National Union Fire Ins Co Pittsburgh PA 19445 1358772 Its Subsidiaries and Affiliates 12920 SE 38th Street Bellevue WA 98006 INSURER 0: INSURER E t INSURER F � COVERAGES TMOBI CERTIFICATE NUMBER: 12900887 REVISION NUMBER: XXXXXXX 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. INSR LTR rypE OF ADDL INSD SUER WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIODM/YY LIMITS B X COMMERCIALGENERAL LI ABILITY Y Y RGD5000259-04 5/1/2015 5/1/2016 EACH OCCURRENCE OAMAGE TO RENTED PREMISES (E.occurcence) $ 1 000 000 CLAIMS -MADE OCCUR t�x / /' MED EXP (Anyoneperson) $ 5,000 ed Y�•a VPERSONAL SADV INJURY $ 1,000,000 GEN'L �. AGGREGATE LI MIT APPLIES PER GENERAL AGGREGATE $ 2000000 _ POLICY- ''PRO - ECT ,,XLOG Ja.� PRODUCTS - COMPIOP AGG $2000000 $ I OTHER'. VTe B AUTOMOBILE LIABILITY Y Y RAD50Oe It\ Q� Ir�Yt i-� 5/1/2015 5/1/2016 MBI ED SINGLE MIT $ (Ea ancidenq 2,000,000 BODILY INJURY (Per person) $ XXXXXXX X ANY AUTO AOSCHEDULED AUTO' AUTOS �/�� V BODILY INJURY Per accident $ XXXXXXX PROPERTY DAMAGE $XXXXXXX NON -OWNED HIRED AUTOS AUTOS $XXXXXXX C X I UMBRELLA LIABX OCCUR Y N 19961923 5/1/2015 5/1/2016 EACH OCCURRENCE $ 5,000,000 C11 EXCESS LIAB CLAIMS -MADE SIR applies per policy AGGREGATE $5000Q00 DED I X I RETENTION 25,000 5 X'xX'X'xxx 1 1 A `A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIM REXCLUDED? NIA N RWD5000301-03 AOS RWR5000302-03 WI 5/1/201$ 5/1/2015 $/1/201( 5/1/2016 X STATUTE ER E.L. EACH ACCIDENT $ 1000000 E. L. DISEASE- EA EMPLOYEE$1OQQOQO (Mandatory InNH) In NH) If yes descree under DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101, Additional Remarks Schedule, may be attached If more space is requlrem THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY Ti REFERENCED. The Certificate Holder and other entities defined are additional insureds on a primary and non-contributory basis under general liability and are additional insured under automobile liability as required by written contract. Waiver of Subrogation applies under general liability and automobile liability as required by written contract. **See Attached Endorsements** RE: SPECIAL EVENT, CINCO DE MAYO FESTIVAL IN SANTA ANA 5/3/2015. SEPARATION OF INSUREDS ARE INCLUDED UNDER GENERAL LIABILITY, CERTIFICATE HOLDER CANCELLATION See Attachments 12900887 CITY OF SANTA ARIA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 CIVIC CENTER PLAZA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA CA 92701 AUTHORIZED REPRESENTAT ACORD 25 (2014/01) © 1988-3T MCORD CORPORAT-UN. All rights reserved. The ACORD name and logo are registered marks of ACORD