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HomeMy WebLinkAboutNEW CINGULAR WIRELESS PCS, LLC (5)INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES APR 2 8 2021 _ b• t • 1.011 CLERK OF COUNCIL DATE: 0 * VWN (1) (Sylvia Robles) b5 SUPPLEMENT AGREEMENT A-2020-117C This Supplement ("Supplement'), is approved by Licensor this 2S day of ' (qrCjq 2021 (the date executed by all parties, referred herein as "Supplement Effective Date"). 1. Supplement. Licensee has submitted an application for approval to use a Municipal Facility pursuant to that certain Municipal Facility License Agreement between Licensor and i,iwu�cc uawu rcui uaiy 1 �, �VcI t r rlrruienL ). raccnsur pas revrewea me appuearlon ana 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 terms 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 SUBMIT A 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 on is / snot covered by existing performance bond. If not covered by existing performance bond, a bond is required pursuant to Section 8 of the Agreement. Miscellaneous. [Signature page follows] A-1 A-2020-117C 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:�- Name: Nabil Saba Title: Executive Director Public Works Agency Date: 03/04/2021 Licensee: Accepted: Ala—. 'e Ovnt4ec4 Llm6ih Name: Ua Title: OA o Date: '3)1Z S Attachments: Attachment 1 - Licensed Area (TUSTN 64) 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 FEW i ro V O • � a O .v. U '� m -O � N � • N DR an :r.i 0 z 0 N i :,.;i • �zri w 1S A311311a �. d x - i m a N n • r � w � m Cd N Q M N W C _ .711 „i. h F • I d c W ZC Ze W �v Z zC < V O e C Q L Antenna- Galtronics — GQ2410-06661 RRUs: SPD: RRU-2203 — Total-3 RRU-2205 — Total-1 !' RSCAC-6533-P-120-D Strikesorb' u u _ . flSCBCdS}}P4Xn0 SHROUD W/ANTENNA: MA Cgnalryr9nNE,irvmne 9. Francine R. Villareal wuaai mre. mm.wnr nwmmw CERTIFICATE OF LIABILITY INSURANCE I DATE 09101112020Drcrnl 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. 1 If SUBROGATION 15 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer riahts to the certificate holder in lieu of such endorsemeri PRODUCER Marsh USA Inc. 701 Markel Street, Suite 1100 St. Louis, MO 63101 Alin: ATT.CedRequest@marsh.mm INSURED New Cingular Wireless PCS, LLC One AT&T Plaza 208 South Akard Room 1820 Dallas, TX 75202 US Centralized Services 866-966-0664 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 ADDL INSD SUER WVD POLICY NUMBER POLICY EFF MNIDD POLICY EXP MMIDDIYYYY LIMITS A X COMMERCUILGENERALLMBIL CLAIMS -MADE Fx_1 OCCUR MWZY 31363620 0610112020 0610112021 EACH OCCURRENCE $ 2,000000 PREMISES Ea emavenrs $ 1,000,000 MED EXP (Any one Person) S NIA PERSONAL &ADV INJURY $ 2.000000 GEN'L AGGREGATE LIMITAPPLIES PER: X POLICY ❑ PE,CO7 LOC GENERAL AGGREGATE S 10,000,000 PRODUCTS-COMPIOPAGG IS 2,000,000 $ OTHER: A A AUTOMOBILE X LIABILITY ANY AUTO MWrTB 31363520 MWZX 31363720 Mill 06101/2020 06101/2020 06101/2021 06/0112021 COMBINED SINGLE LIMIT Ea accident $ 1,000A00 BODILY INJURY (Per Person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident], P( $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE S EXCESS LIM CLAIMS -MADE DED RETENTION $ A WORKERS COMPENSATION ANO EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNEWEXECUTIVE QFFICEWMEMBEREXCLUDED? ❑N (Mandatory In NH) NIA MWC 31363820 (ADS) I 06/01/2021 X PER OTH- STATUTE ER E.L. EACH ACCIDENT S 1,000,000 E.L. DISEASE - EA EMPLOYEE 5 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT S 1,000,000 A Excess Workers' Compensation 1 MWXS 31363920 (OH,WA) 06101020 06/01/2021 EL Each Accident I EL Disease 1,0DOGDO 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 Irmo,. apace is required) Re 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 Lability and Automobile Liability policies but only with respect to ale requirements of the contract between the Cedificate Holder and the Insured. Waiver of Subrogation is provided for General Liability, Automobile Liability and Workers' Compensation as required by written 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 nonconnibutory, with this insurance. 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. rMi RLk MingeeodtXWaim I�vrt-s i Mrrto�®8r- 01988.2016 ACORD C ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD tut Marragerrny Aruyer AGENCY CUSTOMER ID: CN103150778 LOC #: St. Louis ADDITIONAL REMARKS SCHEDULE AGENCY Marsh USA Inc. POLICY NUMBER CARRIER FORM NUMBER: 25 FORM TITLE: Excess Workers' Compensation -MWXS 31363920 (OH -WA) Sad Insured Retentions OH & WA-$500,000.000 (except Terrorism) OH & WA-$600,000,000 Tenobsm Excess Automobile Liability- MWZX 31363720 (MI) Contained Single UmiL $1.000,000 Sel Insured Retention - $1.000,000 NAIC CODE NAMED INSURED New Cingular Wireless PCS, LLC One AT&T Plaza 208 South Akard Room 1820 Dallas, TX 75202 EFFECTIVE DATE: Page 2 of 2 ACORD 101 (2008101) © 2008 ACORD C1 IMIT F"*O�K �_ I1:LlaunE The ACORD name and logo are registered marks of ACORD �&eansge.ravw hr�ysr 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 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 specilied 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 mat nclice of cancellation to the person or organization sham in the schedule above. We wit mail such notice to the address shown in the schedule above at least the number of days sham for cancellation in the schedule above before the effective date of cancellation. Risk PIL0280510 r c�®� VI 313636 20 AT&T Inc. 06/01/2020 - 06/0112021