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HomeMy WebLinkAboutNEW CINGULAR WIRELESS PCS, LLC (3)A-2020-117A 01 COUNG'i. SUPPLEMENT AGREEMENT (,�Wicl� ?-u- 10IRs) FA — This Supplement ("Supplement"), is approved by Licensor this 93 day of Sq4tKbeY, 20 ?-V (the date executed by all parties, referred herein as "Supplement Effective Date"). 1. Sup len anent. Licensee has submitted an application for approval to use a Municipal Facility pursuant to that certain Municipal Facility License Agreement between Licensor and Licensee dated August 25, 2020 ("Agreement"). Licensor has reviewed the application and grants approval subject to the terms of this Supplement. All of the terms and conditions of the Agreement are incorporated hereby by reference and made a part hereof without the necessity of repeating or attaching the Agreement. In the event of a contradiction, modification or inconsistency between the terms of the Agreement and this Supplement, the terns of this Supplement shall govern. Capitalized terms used in this Supplement shall have the same meaning described for them in the Agreement unless otherwise indicated herein. IF THE SUPPLEMENT IS NOT COUNTER- SIGNED BY LICENSEE AND RETURNED TO LICENSOR WITHIN 30 DAYS AFTER LICENSOR HAS GRANTED APPROVAL, THE SUPPLEMENT SHALL BE VOID AND OF NO LEGAL EFFECT. IF LICENSEE STILL WANTS TO USE THE MUNICIPAL FACILITY, LICENSEE WILL BE REQUIRED TO SUBMITA NEW APPLICATION AND ASSOCIATED FEES. 2. Licensed Area Description and Location. Licensee shall have the right to use the space on the specific Municipal Facility (the "Licensed Area") depicted in Attachment 1 attached hereto to install Equipment as further listed in Attachment 2 attached hereto. 3. Equipment. The Equipment to be installed at the Licensed Area is described and depicted in Attachment 1. 4. Term. The term of this Supplement shall commence on the Supplement Effective Date and continue for the life of the Agreement, as described in Paragraph 2 of the Agreement. 5. License Fee/Alternate License Fee. The initial fee for this Supplement shall be as follows per year: $270.00. This fee is subject to annual increase as provided in the Agreement, and is payable in accordance with the Agreement. 6. Performance Bond. The Performance Bond [circle one] is / is not covered by existing perfonmance bond. If not covered by existing performance bond, a bon is required pursuant to Section 8 of the Agreement. Miscellaneous. [Signature page follows] A-1 A-2020-117A IN WITNESS THEREOF, the parties hereto have caused this Supplement to be legally executed in duplicate, effective upon execution by both parties. Licensor: CITY OF SANTA ANA, CA By: 4 A 4L— Name: Nabil Saba Title: Executive Director Public Works Agency Date: 09/14/2020 Licensee: Accepted: eLwMM 0-q 1c,) Attachments: Attachment 1 — Licensed Area (Tustin Node 065A) Attachment 2 — Equipment List and Description A-2 Attachment 1 Licensed Area [Map showing licensed area of applicable Municipal Facility and showing proposed Equipment installation A-3 d 7 Q 0 � W ID m O ll N V 'In H a m a Q m C U.1 ui s N w C K a(D Z IDm D m C a K O N rn ^ m 5 Z 1 0 a_,1 0 A010 MALL OR 0 0 • V ¢ O i 0 Antenna: Galtronics — GQ2410-06661 Mechanical Specifications Operating Temperature W W 158-F (40'to+7VQ Antenna Weight 1631hs VA kg) Antenna Diameter 10.0'(255 mm) Antenna Height 24.9'(634 mm) Radome Material ASA RRUs: RRU-2203 — Total-3 RRU-2205 — Total-1 SHROUD W/ANTENNA: SPD: RSCAC-6533-P-120-D wanA St►ikesor6' A-7 A� H CERTIFICATE OF LIABILITY INSURANCE o0910112020DYYYY) 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(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 CONTACT US Centralized Services NAME: Marsh USA Inc. PWC.HONNo.E 866-966-4664 uc 701 Market Street, Suite 1100 E No E-MAIL Att.CertRequestl�marsh.com ADDRESS: St. Louis, MO 63101 Attn: ATT.CertRequest@marsh.com INSURERS AFFORDING COVERAGE NAIC# INSURER A: Old Republic Insurance Company 24147 CN103150778-GAW-CRT-20-21 Y Y kvt66g Y INSURED New Cingular Wireless PCS, LLC INSURER B : One AT&T Plaza INSURER C : 208 South Akard INSURER D Room 1820 Dallas TX 75202 INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER: CHI-009523130-05 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 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 ADOL SUER POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERALLIABILITY MWZY 31363620 06/01/2020 0610112021 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE -XI OCCUR DAPRMAGE TO RENTED EMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ NIA PERSONAL& ADV INJURY $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 10,000,000 POLICY JET LOC X PRODUCTS -COMPIOP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY MWT831363520 06101/2020 0610112021 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 A X ANY AUTO Mi 31363720(MI) 06/01/2020 06/0112021 BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DIED I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y / N OFFCEWMEMBEREXCLU ED ECUTIVE (Mandatory in NH) NIA 131363820(ADS) 0610112020 0610112021 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 8 yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ 1,000,000 A Excess Workers' Compensation I MWXS 31363920 (OH,WA) 06101/2020 06101/2021 EL Each Accident / EL Disease 1,000,000 Employers' Liability See Second Page EL Disease -Policy Limit 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re I City of Santa Ana Municipal Facilities License Agreement City of Santa Ana, its council members, officers, and employees islare included as Additional Insured under the General Liability and Automobile Liability policies but only with respect to the requirements of the contract between the Certificate Holder and the Insured. Waiver of Subrogation is provided for General Liability, Automobile Liability and Workers' Compensation as required by wdtlen contract and allowable by law. This insurance is primary with respect to the interest of the Additional Insured and any other insurance maintained by Additional Insured is excess and noncontdbutory with this insurance, CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Risk Management Division THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza, 4th floor ACCORDANCE WITH THE POLICY PROVISIONS, Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. a RisltTlanagenlmt DivisionREVIEWED & APPROV®BY: rJ 19118-2016 ACORD C %�± c`-awr. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD' Rnk Management analyst AGENCY CUSTOMER ID: CN103160778 LOC #: St. Louis ACORO® L—/ ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMEDINSURED Marsh USA Inc. New Cingular Wireless PCS, LLC One AT&T Plaza 208 South Akard POLICY NUMBER Room 1820 Dallas, TX 75202 CARRIER NAIL CODE EFFECTIVE PATE: REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate Of Liability Insurance Excess Workers' Compensation -MWXS 31363920 (OH -WA) Self Insured Retentions Of & WA-$500,000,000 (except Terrorism) OH & WA - $600,000,000 Terrorism Excess Automobile Liability - MWZX 31363720 (MI) Combined Single Limit - $1,000,000 Self Insured Retention - $1,000,000 01 (2008/01) © 2008 ACORD The ACORD name and logo are registered marks of ACORD +e, Nuemougemer¢ultwoR + ' REVIEwED&APPRwm Br hlii LL111111 F-++cw;.,.a �Q, VaLtiuL '. ® Risk Management Analyst IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CANCELLATION PROVIDED BY US SCHEDULE Number of Days Notice of Cancellation: 30 Person or Organization: All persons or organizations as required by written contract or agreement. Address: The addresses as specified in the written contracts or agreements. Provisions If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, and a number of days is shown for cancellation in the schedule above, we will mail notice of cancellation to the person or organization shown in the schedule above. We will mail such notice to the address shown in the schedule above at least the number of days shown for cancellation in the schedule above before the effective date of cancellation. _ Risk Manag mt DiWefan P I L 028 05 10 REVIEWED S APPRWED BY. ® Risk Management Analyst NAtAnv 111azt; 7n GTZT ins ntim i nn?n_ nFrni inn-, 1