T-MOBILE U.S.A., INC. (3) - 2017

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CERTIFICATE OF LIABILITY INSURANCE snrzol6 DATE(MMIY, 5/4/201717 THIS CERTIFICATE IS ISSUED AS AMATTER 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 ACONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 Lockton Companies Three CIryty Place Drive, Suite 900 StLOuftO63141-7081 (314)432-0500 CONTACT HONE FAX a/C No Ezl: (A/C, No: E-MAIL INSURER A XL Insurance America, Inc. 24554 INSURED T-Mobile US, Inc. - 1359691 12920 SE 38th Sheelbsidiaries and �lia es Bellevue WA98006 INSURERS : GreennovichlitsuranceComparry 22322 INSURER C : National Union Fire Ins Co Pitts. PA 19445 L VVCEJI 11VIU151 UCRIINUAIE NUMBER' 1467" 2 REVISION NUMBER' 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE NAY 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. INSft TYPE OF INSURANCE AOBL SUBR POLICYNUMBER POLICY EPF 5/1/2017 POLICY EXP 5/1/2018 LIMITS B y I COMMERCIAL GENERAL LIABILITY Y Y RGD5000259-06 EACH OCCURRENCE S 1,000,000 CLAIMS -MADE© OCCUR DAMAGE TO RENTED 1,000,000 $ 000 D EXP (Any onePerson) PERSONAL & ADNJURV 1,000.000 GEHL AGGREGATE LIMITAPPLIES PER PRO. GENERAL AGGREGATE is 2000000 PRODUCTS-COMP/OPAG L000000 POLICY❑ X� LOC 5 —EECT OTHER', B AUTOMOBILE LIABILITY Y Y RAD5000257-06 5/1/2017 5/1/2018 COMBINccdED SINGLE LIMIT rEaX $ 2.000.000 an BODILY INJURY (Per person) $ 1(XNC)M ANY AUTO BODILY INJURY (Per ecimm e XXX)CXXX OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY AST03 ONLY PROPERTY DAMAGE $ XXXXXXX $XXXXXXX I I C X UMBRELLA LIAB X OCCUR Y N 5/1/2017 5/1/2018 EACH OCCURRENCE $ 5000000 C G EXCESS LIAR CLAIMS -MAD �28189156 SIR applies per policy terms & conditions AGGREGATE $ 5,000,000 DED X RETENTION $25000 $XXXXXXX A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN N RWD5000301-05 ADS 5/1/2017 5/l/2018 X I sTTAN1E OTH- ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEM BER EXCLUDED, N/A RVVR5000302-05 W1 5/1/2e17 5/1/2018 EL EACH ACCIDENT s 1000000 (Mentleroryln NH) E1, DISEASE - EA EMPLOYEE 1000000 ET DISEASE -POLICY LIMIT 1,000,000 DESERIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Re an arks Schedule, may us attached If more space Is required) **SEE ATTACHED ENDORSEMENTS** THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS AND REPRESENTATIVE ARE NAMED AS ADDITIONAL INSUREDS ON A PRIMARY AND NON-CONTRIBUTORY BASIS UNDER NE AL LIABILITY AND ARE ADDITIONAL INSUREDS UNDER AUTOMOBILE LIABILITY AS REQUIRED BY WRITTEN CONTRACT. WAIVER OF SUBROGATION APPLIES UNDER GENERAL LIABILITY AND AUTOMOBILE LIABILITY AS REQUIRED BY WRITTEN CONTRACT. �\. SHOULD ANY OF THE ABOVE N THE EXPIRATION DATE HEREOF, NIOTICE WILL BEBED POLICIES TDEL�IVERED IN BEFORE ((..,�\i\(a ACCORDANCE WITH THE POLICY PROVISIONS, 14677732 -:% AUTHORIZED REPRESENTATIVE OTY OF SANTA ANA Q ATTN: SILVIA CUEVAS 20 CIVIC CENTER PLAZA M-23 SANTA ANA CA 92701 ACORD 25 (2016/03) I no AL.UKU name and logo are registered marks of ACORD