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HomeMy WebLinkAboutNEW CINGULAR WIRELESS PCS, LLC (13)INSURANCE ON FILE A-2020-117 K WORK MAY PROCEED UNTIL INSURANCE EXPIRES (9•Iav- CLERK OF COUNCIL DATE SUPPLEMENT AGREEMENT p-.Pw00) CyVonfW561'-�f?"This Supplement ("Supplement'), is approved by Licensor this 13 day of ApkiL,202L (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 Licensee dated July 8, 2029("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 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(a)snot covered by existing performance bond. If not covered by existing performance bond, a bond is required pursuant to Section 8 of the Agreement. 7. Miscellaneous. [Signature page follows] A-1 A-2020-117K IN WITNESS THEREOF, the parties hereto have caused this Supplement to be legally executed in duplicate, effective upon execution by both parties. Accepted: Licensor: CITY OF SANTA ANA, CA By: �A 9�aI",(" Name: Nabil Saba, P.E. Title: Executive Director Public Works Agency Date: 03/30/2022 Licensee: By: 4-4v- �c- Name: MA Title: AT?r AgEA (AAtQAGlER Date: 01-1),-22 Attachments: Attachment 1 — Licensed Area (STANA Node_007) 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 >r - V G L a p m o ?. In e= � J 9 m z L Ij t m � • O 0 p o O h I 3 3 O rl y'�' • lS tii/MI115 � I U Ey __ - ... - o • • • ,.:. r„i.. uii... ra;.nos s • • d x i 15 T3M(llc 15 T3MO15 l • 3 ATTACHMENT i CONTINUED ATT GAMMA NU OMNI ANTENNA ATT RRU'S INSIDE SHROUDS NEW REPLACEMENT LIGHT POLE RELOCATED SIGNAGE NEW PULL BOXES ALONG EXISTING LANDSCAPE AREA "1; 11111 111f II 'Ji i;�lil f lli,l'CIII '_ h Illllllllil _- A-5 ATTACHMENT Equipment List: Antenna- GQ2414-B6770 KS p]tamM xcyn au-eezmw x/'[nMeaW "Wa@��.WAL [M<ye.r�Mua ,SOvatl[S1n rrA. (1) RRU 4415 (1) RRU-4449 Antenna mount and radio shroud: O�CUAFVFA4 (1) 1 4411 (1) M NL W!@AW311 &A9U0 lr i b 'M awi le.mrw MOIW`E@A' 1[P 6 s+aQmEtcwt vac r(I) vmeus- % 12) P U rpm GPlEyWfMn sFAaW e�nr �ga�sl SM PEPJLEffHT GD'CICt (M EA Wh [O l SIEEIG` -�V T A18i 9.L�6E ..t S w AYp. JW AT FOP me mus ELEVATION'"' 9�D Equipment Shroud: (1) at each side (274otal) SPD: (1) RSCAC-1333-PH-240 RSCAC-1333-PH-240 4.6.[ 18.01, mo Francine R. Digitally signed by Francine a. Villareal \/illarc�l Dare: 2021.07.01 16.4711 ACC �® CERTIFICATE OF LIABILITY INSURANCE DATE oslzuu s12021 """ zozl 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 Marsh USA Inc. 701 Market Street, Suite 1100 St. Louis, MO 63101 CONTACT Marsh U.S. Operations PHONE Pen, 866-966-4664 A� Ne . A MESS. AtLCenRequest@marsh.com INSURERS AFFORDING COVERAGE NAICR INSURER A: Old Republic Insurance Company 24147 CN103150778-GAW-CRT-21-22 N Y kv166g Y INSURED New Cingular Wireless PCS, LLC INSURER B : INSURER C : One AT&T Plaza 208 South Akard Room 1820 INSURER 0: INSURER E: Dallas, TX 75202 INSURER F : COVERAGES CERTIFICATE NUMBER: CHI-009523130-119 RFVIIQIr1N NIIMRFR. 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 ADDLSUBR INSD Me POLICYNUMBER POLICYEFF MMIDDNYYY) POLICYEXP (MMIDDrYYYy LIMITS A X COMMERCIAL GENERAL ABILITY CLAIMS -MADE F OCCUR MWZY 31363621 0610112021 06/0112022 EACH OCCURRENCE $ 2,000,000 DAMAGETOREN ED PREMISES Ea occurrence $ 1.000,000 MED EXP (Any one person) $ NA PERSONAL &ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ PRO- JECT LOC GENERALAGGREGATE $ 10,000,000 PRODUCTS - COMPIOP AGG $ 2,000.000 S OTHER: A AUTOMOBILE LIABILITY MWTB31363521 06/0112021 0610112022 COMBINED SINGLE LIMIT Ea accitlent $ 1.000,000 X BODILY INJURY (Per person) S ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident) ( I $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident) $ UMBRELLAUAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOWPARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA MWC 313638 21 (AOS) 0610/ 06/01/2022 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE S 1,000,000 (Mandatory in Ni Dyes, IPTIONescribe under DESCRIPTION rude, OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 A Excess Workers'Compensadon/ MWXS 313639 21 (OH,WA) 06101/2021 06/0112022 EL Each Accident I 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 1D1, Additional Remarks Schedule, may be aneched if more space Is required) Re: City of Santa Ana Municipal Facilities License Agreement. The City of Santa Ana, its officers, officials, employees and volunteers islare included as Additional Insured under the General Liability policy but only with respect to the requirements of the contract between the Certificate Holder and the Insured. Waiver of Subrogaben is provided for General Liability, 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 non-contributory with this Insurance. Contractual Liability under the General Liability but only to the extent dictated by policy terms, exclusions, and conditions. 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 ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. RhkMmrgatmdDlvieWt �0. fRvIEwED is APPRW®BY: @ 1988-2016 ACORD C g �t Sirit]11t-4; �,� R ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Risk Management Analyst ACORO® L i AGENCY CUSTOMER ID: CN103150778 LOC #: St. Louis 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 Gallas, TX 75202 CARRIER NAILJCODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Excess Workers' Compensation-MWXS 31363921 (OH -WA) Self Insured Retentions OH & WA - S500,000.000 (except Terrorism) OH & WA - $600,000.000 Terrorism (2008/01) © 2008 ACORD C R, vLCGco d The ACORD name and logo are registered marks of ACORD Rifk Management Anaysr POLICY NUMBER:MWZY 313636 21 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s Locations Of Covered Operations All Persons or Organizations as Required by Written The Locations as specked in the written contracts or Contract or Agreement. agreements. In no event shall the insurance provided exceed the scope of coverage or limits required by said contract or reement. Ea Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contractor agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. x 10ek MurgemadDMelnn [RrvieuD 6 nAPPaovD Br. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 MW Risk Management Analyst MWZY 313636 21 AT&T Inc. 06/01/2021 - 06/01/2022 C. With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following is added to insurance; Section III — Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the applicable required by a contract or agreement, the most we limits of insurance. will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or Rlsk Mulitganenti DM&kn REVIEWED & APPRavm Br. Page 2 of 2 © Insurance Services Office, Inc., 2018 lag Risk Management Analyst MWZY 31363621 AT&T Inc. 06101/2021 - 06/0112022 01 POLICY NUMBER:MWZY 313636 21 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations All Persons or Organizations as Required by Written The Locations as specified in the written contracts or Contract or Agreement. agreements. In no event shall the insurance provided exceed the scope of coverage or limits required by said contract or a reement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for"bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contractor agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement: or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. RWeMurgemndIXWlon ��� $1't' RenEweofi APPRovD ar �SYI.l11E.La �n.cw.v.e �. V.IL�nr�.L '. CG 20 37 12 19 ©Insurance Services Office, Inc., 2018 RURManagementAnayer MWZY 313636 21 AT&T Inc. 06/01/2021 - 06/0112022 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED AMENDMENT -PRIMARY AND NON-CONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM As respects any person(s) or organization(s) included as an additional insured and with whom you have agreed in a written contract, agreement or permit to provide primary insurance on a non-contributory basis, this insurance will be primary to and non-contributing with any other insurance available to such person(s) or organization(s). In no event shall the insurance provided exceed the scope of coverage or limits required by said contract or agreement. G L 739 042 0612 RIAMwagenadDMdan Risk Management Analyst MWZY 31363621 AT&T Inc. 0610112021 - 06101/2022 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS This endorsement modifies the notice of cancellation of insurance provided hereunder by adding the fallowing: A. In the event this policy is cancelled for any permissible reason, other than for nonpayment of premium, we shall endeavor to pmvide advance written notice of cancellation to certificate holders set out in the schedule on file with the Company, after notifying the first Named Insured of such cancellation. Notice of cancellation to certificate holders may be made by any commercially reasonable means, including mail, electronic mail, facsimile transmission or courier service. B. This advance written notification of a cancellation of coverage is intended as a courtesy only. Our failure to provide such advance written notification will not extend the policy cancellation date, nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. RIO,MuaganadWdon Rene&m&APwavm Sr PIL 029 10 10 Ruk Management Anatpt �- MWTB31363521 AT&T Inc. 06t0112021 - 06/01 /2022 00 IL 10 (12106) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS This endorsement modifies the notice of cancellation of insurance provided hereunder by adding the following: A. In the event this policy is cancelled for any permissible reason, other than for nonpayment of premium, we shall endeavor to provide advance written notice of cancellation to certificate holders set out in the schedule on file with the Company, after notifying the first Named Insured of such cancellation. Notice of cancellation to certificate holders may be made by any commercially reasonable means, including mail, electronic mail, facsimile transmission or courier service. 8This advance written notification of a cancellation of coverage is intended as a courtesy only. Our failure to provide such advance written notification will not extend the policy cancellation date, nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. RhkMa»ganentDtvidon H� REvEwED&APPRov®BY: 8 f Kc P. V.IL� PIL 029 10 10 '2�mw Risk Management Angst MWZY 31363621 AT&T Inc. 06/01/2021-06/012022 00 OLD REPUBLIC INSURANCE COMPANY WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY POLICY NOTICE OF CANCELATION TO CERTIFICATE HOLDERS ENDORSEMENT This endorsement modifies the notice of cancelation of insurance provided hereunder by adding the following: A. In the event this policy is canceled for any permissible reason, other than for nonpayment of premium, we shall endeavor to provide advance written notice of cancelation to certificate holders set out in the schedule on file with the Company, after notifying the Insured first named in item 1 of the Information Page of such cancelation. Notice of cancelation to certificate holders may be made by any commercially reasonable means, including mail, electronic mail, facsimile transmission or courier service. B. This advance written notification of a cancelation of coverage is intended as a courtesy only. Our failure to provide such advance written notification will not extend the policy cancelation date, nor negate cancelation of the policy. All other terms and conditions of this policy remain unchanged. .ta+.ee Risk MtmogatadDMdm nq REMeMM& A"RovM Sr. WC 99 03 64 (03111) sI P2. V�lLtnul Page 1 of 1 00 Risk Management Analyst