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AC•OR[f CERTIFICATE OF LIABILITY INSURANCE <br />5/1/2016 <br />DATE(MMIDOIYYYYI <br />1 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($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(los) 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 I.,OCktOn Companies <br />Three City Place Drive, Suite 900 <br />St. Louis MO 63141.7081 <br />CONTACT <br />NAME: <br />PHONE FA <br />tEe1M&AI"�°'-E'al:-----.--- INC. Her! <br />B <br />(314) 432.0500 <br />B.B: <br />_..._..__....n.____.... <br />INSURERS AFFORDING COVERAGE NAICU <br />RGD5000259.04 <br />INSURER A: XL rance America.Inc.24554 <br />5/1/2016 <br />INSURED T•Mobile US, Inc. <br />1358772 Its Subsidiaries and Affiliates <br />INSURERS: <br />INSURER e: National Union Fire Ins Co Pittsbu ] h PA 19445 <br />12920 SE 38th Street <br />Bellevue WA98006 <br />INSURER 0: <br />INSURER E; <br />INSURER F: <br />COVERAGES TMOBI CERTIFICATE NUMBER: 12900887 REVISION NUMRFR- YYYYYYY <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, PERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 1'0 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 />)LTH <br />TYPE OF INSURANCE <br />ADPL <br />6U D <br />POLICY NUMBER <br />POLICY EFF <br />MWODYr YYY <br />LIMITS <br />B <br />X COMMERCIAL GENERAL LIABILITY <br />Y <br />Y <br />RGD5000259.04 <br />5/1/2015 <br />5/1/2016 <br />EACH OQCURRENQE 1,000,000 <br />DAMAGE TO RENTED <br />PREMISES E.ccuRencla $ 1000 �O00 <br />--- -- <br />_ CLAIMS -MADE X OCCUR <br />. / <br />e�4yJ <br />\•� <br />PERSONAL&ADV INJURY $ 11000,000 <br />n•I�V" <br />('L <br />„OEN'LAGGREGATE LIMIT APPLIES PER: <br />GENERAL AOOREOATE S 2,000.0 9 <br />POLICYPRO- <br />-.-� _...... JECT X Lou <br />va, <br />p ODUCTS-COMPIOPAGG $ <br />5 <br />OTHER: <br />lie <br />B <br />AUTOMOBILE <br />LIABILITY <br />Y <br />Y <br />RADS `�((� t1 <br />�t'� <br />5/1/201$ <br />5{1/2016MUINEU <br />' -' § <br />(Etl..,mro) <br />X <br />ANY AUTO <br />(°�� <br />BODILY INJURY (Per person) <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY per er.Gtlenl 8 xx <br />.,a.]dh <br />PROPERTYDAMAGE5 XXXXXXX <br />_ <br />HIREOAUTOS AON_SWNED <br />$XXXXXXX <br />(] <br />X UMBRELLA UAB <br />}( <br />OCCUR <br />Y <br />N <br />19961923 <br />5/1/2015 <br />5/1/2016 <br />EACH OCCURRENCE $ 5000000 <br />C <br />C <br />EXCESS LIAB <br />CLAIMS -MADE <br />SIR ap lies per pulley <br />terms T conditions <br />AGGREGATE S 0 <br />OED 1. X I RETENTIONS 25,000 <br />§ xxxxxxx <br />A <br />'A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY /N <br />ANY PROPRIErORIPARTNERIEXeCUTIVE YIN <br />OFFICERIMEMBER EXCLUDED? N <br />NIA <br />N <br />RWD5000301-O:f AOS <br />RWR5000302.03 WI <br />5A/2Q$ <br />5/1/2015 <br />7/I/2QL6 <br />5/1/2016 <br />X STATUTE ER <br />E.L. EACH ACCIDENT $ 000 000 <br />E.L. DISEASE -EA EMPLOYEE $ 1,000,000 000 <br />000 <br />(Mandatary In NIB <br />Geecn6a antler <br />II Nis <br />OESCRIPFION PERATIONS be. <br />E.L. DISEASE, POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS ILOCATIONSI VEHICLES (ACORD 101, A40100nal Remarks Estimate, maybe mewhed if mare apace is required) <br />THIS CSR'UPIC'AT•E SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIq HOLDER APPLICABLE TO TriE CARRIERS LISTED AND THE POLICY Te or[an REFERENCED <br />The Certificate Holder and Other entities de011ed are additional insureds 011 a 11ri1Bary and non -Contributory basis Slider general liability and are additional <br />insured under automobile liability as required by written BDntract. Waiver of Subrogation applies under general liabillly and automobile liability as regired by <br />written contract. **See Attaullod Endorsements** Ri,,; SPECIAL EVEN'', CINCO DI: MAYO FESTIVAL IN SAN'CA ANA 5/3/2015. SEPARATION OF <br />INSUREDS AVINCLUDED UNDER GENERAL LIABILITY. <br />12900887 <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92701 <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 />er <br />ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD <br />&II rinhm rnnnwntl <br />