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HomeMy WebLinkAbout434510 T-MOBILE US INC - INSURANCE CERTIFICATEd►coRo' CERTIFICATE OF LIABILITY INSURANCE 5/1/2015 DATE(MMIDDITYYY) 1 4/23/2014 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 be endorsed. If SUBROGATION IS WANED, 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 endomement(s). PRODUCER Lockton Companies Three City Place Drive, Suite 900 St. LOUIS MO 63141-7081 (314) 432-0500 CONTACT NAME: INC,No Exit:INC, A/C No EMAIL ADDRESS, IN ER S AFFORDING COVERAGE NAIC INSURERA: 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 Co Pittsburgh PA 19445 Nsu INSURER INSURER COVERAGES TMOBI CERTIFICATE NUMBER: 12218014 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 TR TYPE OF INSURANCE ADDL INSD SUER ivvu POLICY NUMBER POLICY EFF MMI D/YYYV POLICY UP D/YYYY LIMITS B X COMMERCOLGENERALLIABILITY CLAIM$ -MADE � OCCUR Y y RGD500025903 5/1/2014 5/12015 EACH OCCURRENCE 1000000 DAMAGE Ea oNcuvence 1,000,000 MED UP (My one rson 5,000 PERSONAL E ADV INJURY It 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY❑ JEOT FX LOC OTHER GENERAL AGGREGATE s 2,000,000 PRODUCTS - COMP/OP AGG s 2,000,000 s B B AUTOMOBILE LIABILITY ANY AUTO AUTOWNED SCHEDULED HIRED AUTOS NON-OWNED U SWNED Y Y RAD500025703 AOS RAD500025803MA 5/12014 5/12014 5/1/201$ 5/1/2015 Ee BINEDISINGLE LIMB E 2,000,000 X BODILY INJURY (Per Person) $ XXXj(j(j{}( BODILY INJURY (Per accident $ XXXX)XX Per aide DAMAGE $ XXXXXXX $XXXXXXX C C J{ UMBRELLALIAS EXCESS UAB X OCCUR CLAIMSWADE Y N 49131346 SIR applies per policy temns& conditions 5/1/2014 5/12015 EACH OCCURRENCE $ $ 000000 AGGREGATE E 5,000.000 DED I X I RETENTION$ 25,000 s XXXXXXX AFR A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORNARTNERIE%ECUTIVE YIN OFFICERIMEMBER EXCLUDED? N❑ IM]aMOry In NH) If yes descdde sneer DESCRIPTION OF OPERATIONS WI. N/A N - RWD500030102 AOS RWR500030202 WI 5/1/2014 5/1/2014 $/120I5 $/12015 PER OTH- X STATUTE E.L. EACH ACCIDENT $ 11000,000 EA. DISEASE - EA EMPLOYEE 1000000 E.L. DISEASE -POLICY LIMIT 1 1000000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (AMach ACORD 101, Additional Remarks Schedule, may be attached If more space is required) The Certificate Holder and other entities defined are additional insureds on a primary and non-contributory basis under general liability and are additional insured under automobile liability as reqquired by written contract. Waiver of Subrogation applies under general liability and automobile liability as required by written Contract. **See Attached ED orsemenLsae DN03245A - 137 N Bryan Ave, Fort Collins, CO HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12218014 AUTHORIZED REPRESENTATIVE City of Fort Collins City Managger PO Box NO 300 Laporte Avenue Fort Collins CO 80522-0580 ACORD 25 (2014101) ©1988- ORD CO The ACORD name and logo are registered marks of ACORD