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ACC>RV CERTIFICATE OF LIABILITY INSURANCE <br />is . 5/11/2016 <br />DATE 0/20 MYY) <br />4/30/2015 <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(les) 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 <br />Three City Place Drive, Suite 900 <br />St. Louis MO 63141-7081 <br />(314) 432-0500 <br />CONTACT <br />PHONE FAX <br />A/C No: <br />E-MAIL <br />ADDRESS: <br />RGD5000259-04 <br />7•, <br />V�`I <br />7p <br />�.e1PVv `�� <br />V ` <br />,` �a.� <br />NIe <br />5/1/2015 <br />INSURERS AFFORDING COVERAGE NAIC k <br />INSURER A: XL Insurance ACneriea Inc. 24554 <br />DAMAGE TO RENTED <br />PREMISES (Ea occurrence) $ 1,000,000 <br />INSURED T -Mobile US, Inc. <br />INSURER B: 2 <br />INSURER C: National Union Fire Ins Co Pittsburgh PA 19445 <br />1358772 Its Subsidiaries and Affiliates <br />12920 SE 38th Street <br />Bellevue WA 98006 <br />INSURER 0: <br />INSURER E <br />INSURER F: <br />AUTOMOBILE <br />X <br />COVERAGES TMOBI CERTIFICATE NUMBER: 17900RR7 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 <br />LTR <br />TYPE OF INSURANCE _JNp <br />ADDL <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDIYYYY <br />POLICY EXP <br />MMIDD/Y1'YY <br />LIMITS <br />B <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MAGE X 'OCCUR <br />Y <br />Y <br />RGD5000259-04 <br />7•, <br />V�`I <br />7p <br />�.e1PVv `�� <br />V ` <br />,` �a.� <br />NIe <br />5/1/2015 <br />5/1/2016 <br />EACH ORC <br />DAMAGE TO RENTED <br />PREMISES (Ea occurrence) $ 1,000,000 <br />MED EXP An one erson $ ,000 <br />PERSONAL &ADV INJURY $ 1,060,000 <br />_GEN'L AGGREGATE LIMIT APPLIES PER', <br />POLICY PEC XLOC <br />OTHER', <br />GENERAL AGGREGATE $2. 00000 <br />PRODUCTS-COMPIOPAGG 2.000M0 <br />5 <br />B <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />ALL OS SCHEDULED <br />AUTOS AUTOS <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />AUTOS <br />Y <br />Y <br />RADS I� <br />��4 n I F` <br />�1 . <br />5/l/2O I5 <br />SII/2016COM <br />MII <br />N $ <br />(Ea accident) 2,000,000 <br />BODILY INJURY(Perperson) s XXXXXXX <br />BODILY INJURY Per accident $ XXXXXXX <br />PROPERTYDAMAGEAGE 5 XXXXXXX <br />$ XXXXXXX <br />G <br />G <br />C <br />X UMBRELLA LIAB <br />EXCESS UAB <br />__7DEr <br />}( <br />OCCUR <br />CLAIMS -MADE <br />Y <br />N <br />1 <br />t9961923 <br />SIR applies per Policy <br />terms & conditions <br />1 <br />5/1/2015 <br />5/1/2016 <br />EACH OCCURRENCE $ 5,000,000 <br />AGGREGATE $ 5,000,000 <br />X <br />I RETENTION 25,000 <br />1 5 xxxxxxx <br />A <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE YIN <br />OFFICERIMEMBER EXCLUDED? N <br />(Mandatory In NH) <br />DIf <br />ESCRIPTION OF OPERATIONS below describe under <br />N <br />RWD5000301-03 W1 <br />-03 <br />RWR5000302-03 W[ <br />5/1/2015 <br />5/1/201$ <br />5/1/2016 <br />5/1/2016 <br />- <br />X STATUTE ER <br />E.L.EACH ATDENT $ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE $ (000 000 <br />E. L. DISEASE -POLICY LIMIT 1 5 1000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I 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 10 THE CARRIERS LISTED AND THE POLICY TERM(5) REFERENCED. <br />The Certificate Holder 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 5/3/2015. SEPARATION OF <br />INSUREDS ARE INCLUDED UNDER GENERAL LIABILITY. <br />12900887 <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92701 <br />ACORD 25 (2014/01) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />CC) <br />The ACORD name and logo are registered marks of ACORD <br />riahtR r®eerved <br />