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HomeMy WebLinkAboutCENTURYLINK INC - INSURANCE CERTIFICATEA� 1eD0 CERTIFICATE OF LIABILITY INSURANCE ATE D08/24/2018D/YYYY) 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. CA License #0437153 1301 5th Avenue, Suite 1900 Seattle, WA 98101-2682 CONTACT NAME: A'ONNo,E FAX No E-MAIL ADDRESS: Attn: Seattle.certrequest@marsh.com I Fax: 212-948-4326 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Greenwich Insurance Company 22322 CN1 02197661 -STND-ALL-1 8-19 kbh cont INSURED CenturyLink, Inc., Embarq Corporation; INSURER B: XL Specialty Insurance Co. 37885 INSURER C : Allianz Underwriters Ins Co 36420 Qwest Communications International Inc.; and All Affiliated, Subsidiary & Associated Companies Including Qwest Government Services, Inc. INSURER D : 1801 California Street, Suite 1150 INSURER E : Denver, CO 80202 INSURER F COVERAGES CERTIFICATE NUMBER: SEA-003475093-35 REVISION NUMBER: 20 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 SUBR POLICY NUMBER POLIC MMIDD/YYYY MM DDYIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X RGD500033306 09/01/2018 09/01/2019 EACH OCCURRENCE $ 3,000,000 CLAIMS -MADE � OCCUR AMA E (R NTED PREMISESS Ea occurrence $ 500,000 X MED EXP (Any one person) $ 10,000 CONTRACTUAL LIABILITY PERSONAL & ADV INJURY $ 3,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 15,000,000 POLICY ❑PRO- JECT ❑ LOC PRODUCTS - COMP/OP AGG $ 15,000,N000 $ OTHER. A AUTOMOBILE LIABILITY RAD500033406 09/01/2018 09/01/2019 COMBINED SINGLE LIMIT a Ea ccident $ 2,000,000 X BODILY INJURY (Per person) $ ANY AUTO Auto Physicai Damage - Self Insured OWNED SCHEDULED AUTOS ONLY AUTOS X BODILY INJURY (Per accident) $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR ART3016558 09/01/2018 09/01/2019 EACH OCCURRENCE $ 10,000,000 _ AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICERWEMBEREXCLUDED> ❑N (Mandatory in NH) N/A RWD500032906AOS RWR500033006 WI RWE500033106 - WA 09/0112018 09/01/2018 09/01/2019 09/01/2019 09/01/2019 X I PER OTH- STATUTE ER E.LEACHACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 B If yes, describe under DESCRIPTION OF OPERATIONS below RWE500033206 - OH 09/01/2018 09/01/2019 E.L DISEASE - POLICY LIMIT $ 1,000,000 C Technology E&O Incl. ART3016558 09/01/2018 09/01/2019 Each Claim/Aggregate 10,000,000 Cyber/Privacy Liability :1 Retention 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: P871 RENEWAL. SERVICE AGREEMENT TO PROVIDE MAINTENANCE OF EQUIPMENT & SOFTWARE FOR CUSTOMER -PROVIDED EQUIPMENT AT VARIOUS BUILDING LOCATIONS. THE CITY OF FORT COLLINS, ITS OFFICERS, AGENTS & EMPLOYEES ARE ADDITIONAL INSUREDS PER THE GENERAL LIABILITY BLANKET ADDITIONAL INSURED ENDORSEMENT AS RESPECTS THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED AS REQUIRED BY WRITTEN CONTRACT. GtK 111-IGA I t HULUtK GANGtLL.A I ION CITY OF FORT COLLINS PURCHASING 215 NORTH MASON, 2ND FLOOR P.O. BOX 580 FORT COLLINS, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Cheri Garrison mLA'e l -iG} © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN102197661 LOC #: Seattle ACO AnnITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Marsh USA Inc. NAMED INSURED CenturyLink, Inc.; Embarq Corporation; Qwest Communications International Inc.; and All Affiliated, Subsidiary & Associated Companies POLICY NUMBER Including Qwest Government Services, Inc. 1801 California Street, Suite 1111 Denver, CO 80202 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance GENERAL LIABILITY ------------------- Automatic Additional Insured's Primary Coverage Additional Insured as respects your interest in the operations of the Named Insured as required by contract or agreement Coverage provided by the above General Liability policy shall be primary and is limited to liability arising out of Named Insured's ownership and/or operations. Any insurance carried by the additional insured shall not be contributory insurance. Waiver of Transfer of Rights of Recovery Against Others to Us (Waiver of Subrogation) - Any person or organization with whom you have entered into a contract or agreement, but only to the extent required by such contract or agreement. Separation of Insureds Applies. Insurance covers incidents that occur within 50' of railroad property, any railroad exclusions have been deleted per endorsement CG2417. AUTOMOBILE LIABILITY -------------------- Additional Insured as respects your interest in the operations of the Named Insured as required by written contract. Any coverage provided hereunder shall be excess over any other valid and collectible insurance available to the additional insured whether such insurance is primary, excess, contingent or on any other basis unless the contract specifically requires that this policy be primary. Lessor - Additional Insured and Loss Payee - All Lessors Waiver of Transfer of Rights of Recovery Against Others to Us (Waiver of Subrogation) - Any person or organization with whom you have entered into a contract or agreement, but only to the extent required by such contract or agreement. Separation of Insureds Applies. --------- WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY AND EXCESS WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY (OH & WA - SELF -INSURED - $1,000,000 RETENTION) ------- Waiver of Our Right to Recover from Others (Waiver of Subrogation) - Any person or organization with whom you have entered into a contract or agreement, but only to the extent required by such contract or agreement. ------------------- EXCESS/UMBRELLA ------------------- Coverage applies per occurrence.Additional Insured as respects your interest in the operations of the Named Insured as required by contract or agreement. Waiver of Transfer of Rights of Recovery Against Others to Us (Waiver of Subrogation) - Any person or organization with whom you have entered into a contract or agreement, but only to the extent required by such contract or agreement. Separation of Insureds Applies. ------- ------------ COMMERCIAL CRIME - FIDELITY BOND — Carrier: ACE American Insurance Company Policy Number: DONG23680075 005 Effective Dates: 03/01 /2018 - 03/01 /2019 Each Occurrence:$10,000,000 -------------------- U.S. PROPERTY ------------------- Carrier: Allianz Underwriters Insurance Company Policy Number: ART 3016558 Effective Dates: 03/15/2018 - 03/15/2019 Limit: $25,000,000 Deductible: $25.000,000 Property Coverage: "All Risk" of Direct Physical Loss or Damage to All Real and Personal Property, including Boiler & Machinery, Earthquake, Flood and Wind - Replacement Cost Basis, and Business Interruption - Actual Loss Sustained. Loss Payee or mortgagee as required by written contract/loan agreement to the the extent of your insurable interest. Waiver of Subrogation - Any person or organization whom you have entered into a contract or agreement, but only to the extent required by such contract or agreement. Other deductibles may apply as per policy terms and conditions. ACORD 101 (2008/01) r+u F1911LS ICSCIvuu. The ACORD name and logo are registered marks of ACORD