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ALCM ° CERTIFICATE OF LIABILITY INSURANCE 5/1/2017 DATE(MMIDDIVYYY) 4/14/2016 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 Ileu of such endorsonumhs). PRODUCER LOCI(ton Companies Three City Place Drive, Suite 900 SL Louis MO 63141-7081 (314)432-0500 CONTACT NAME: FAX A Ent : AIC No): L E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC INSURER A: XL Insurance America Inc. 24554 INSURED T -Mobile US, Inc. 1358772 Its Subsidiaries and Affiliates 12920 SE 38th Street Bellevue WA 98006 INSURER B: Greenwich Insurance Company 22322 INSURER C: National Union Fire Ins Cc Pitts. PA 19445 INSURER 0 : IN INSURER F: COVERAGES TN40131 CERTIFICATE NUMBER' 14001710 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 TYPE OF INSURANCE ADDL INSD SUER ME POLICY NUMBER POLICVEFF (MMIDDIYYYYl POLICYEXP IMMIDDMWILIMITS B X COMMERCIAL GENERAL LIABILITY Y Y RGD5000259-05 5/1/2016 5/1/2017 EACH OCCURRENCE S 1,000,000 CLAIMS -MADE FT OCCUR PREMG ES Ea Eccur ante 5 1,000,000 MED EXP (Any one person 5 OOO PERSONAL &ADV INJURY 5 1,000,000 GENL AGGREGATE LIMIT APPLIES PER POLICVF—] JECT LOC GENERAL AGGREGATE 52000000 PRODUCTS-COMP/OPAGG 5 2,000,000 OTHER 5 B AUTOMOBILE LIABILITY Y Y RAD5000257-05 5/1/2016 5/1/2017 COMBINED SINGLE LIMIT $2000000 BODILY INJURY (Per person) $ XXXXXXX X ANY AUTO AUTOS NED gUTOSULED BODILY INJURY (Per accident $ XXXXXXX HIREDAUTOSNON-OSWNED Pa0accPdTYDAMAGE $ XXXXXXX $XXXXXXX G X UMBRELLA LIAB AT OCCUR Y IAT 19086894 5/1/2016 5/1/2017 EACH OCCURRENCE $ 5,000,000 G C EXCESS LIAB CLAIM -MADE SIR apphes per Policy terms K conditions AGGREGATE $ 5,000,000 DED I X I RETENTION$ 25,000 $ XXXXXXX 1 1 A A WORKERS CORS'LIAILIT ANDEMPLOORIPARIABILIXE VIN ANY PROPRIETORIPARTNEWEXECDTIVE ❑ ONEXCLUDED? N (Mandatory in NHl If yes, describe under DESCRIPTION OF OPERATIONS below NIA I N RWD5000301-04 AOS RWR5000302-04 WI 5/1/2016 5/1/2016 5/1/2017 5/1/2017 X PER- 9TH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE IOQQQOQ E.L. DISEASE -POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached If more space is requirtsd ,.1 by The Certifioate Holder and other entities defined by written contract, staNte, ppermit application or written agreement are additional vraweds,o¢ g�yry{iaR\Nj,�i�A-o8i>ffibutory basis under general liability and are additional ineared under automobile habillly as reclined by written covtracC Weivar of Subrogation app nernl liability and automobile liability as reclined by written contract -cSea Attached Endorsements - RE: SPECIAL EVENT - CITY OF SANTA ANA CIFICO DE MAYO EVJNT APRIL 30, 2016'rFROUGH MAY 1, 2016. '� r_ I Guavas SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 14001710 CITY OF SANTA ANA PARKS & RECREATION COMMUNITY SERVICES AGENCY ATTN: CLERK OF THE CITY COUNCIL PO BOX 1988 SANTA ANA CA 92702-1988 The ACORD name and logo are registered marks of ACORD r