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Home My WebLink About434510 T-MOBILE USA - INSURANCE CERTIFICATEACORN' CERTIFICATE OF LIABILITY INSURANCE ; , 2020 L..� DATE2 M/DDfY) 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 Lockton Companies Three City Place Drive, Suite 900 St. Louis MO 63141-7081 (314) 432-0500 RE' - � CONTACT NAME: PRUITE A/C No, Ext : A/C, No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: XL Insurance America, Inc. 24554 INSURED T-Mobile US, Inc. MAY U 5 2019 1358772 Its Subsidiaries and Affiliates 12920 SE 38th Street Bellevue WA 98006 Manager'sINSURER City Office INSURER B: Greemkich Insurance Company 22322 INSURER C : National Union Fire Ins Co Pitts. PA 19445 D : INSURER E : INSURER F : COVERAGES TMOBI CERTIFICATE NUMBER: 12218014 REVISION NHMRFR• XXXXXXX I HIS IS TO GERIIFY 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 NS TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY Y Y RGD5000259-08 5/1/2019 -5/l/2020 EACH OCCURRENCE 1,000,000 CLAIMS -MADE � OCCUR E TO occur ence) PREMISES 1,000,000 (Ea $ MED EXP (Any oneperson) 5,000 PERSONAL & ADV INJURY $ 1000,000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT A I LOC PRODUCTS - COMP/OP AGG $ 2,000 000 $ OTHER: B AUTOMOBILE LIABILITY Y Y P AD,000257-08 5/1/2019 5/1/2020 Ea accident COMBINED SINGLE LIMIT $ 'J,000,000 -- X BODILY INJURY (Per person) $ XXXXXXX ANY AUTO AAUTOS ONLY AED UTOS BODILY INJURY (Per accident $ XXXXXXX AUTOS ONLY ED AUUTO ONLYY PROPERTY ,:,d. DAMAGE $ XXXXXXX $XXXXXXX C X UMBRELLA LIAB X OCCUR Y N 28295139 5/1/2019 5/l/2020 EACH OCCURRENCE $ 5,000,000 C C EXCESS LIAB CLAIMS -MADE SIR applies per policy terms & conditions AGGREGATE $ 5,000,000 DIED I X I RETENTION $25.000 $ XXXXXXX A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N RWD5000301-07 AOS 5/1/2019 5/1/2020 PER OTH- X STATUTE ER — `4 ANYPROPR IETOR/PARTNER/EXECUTIVE � N/A RWR5000302-07 WI 5/1/2019 5/1/2020 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Certificate Holder and other entities defined by written contract, statute, permit application or written agreement are additional insureds on a primary and non-contributory basis under general liability and are additional insured under automobile liability as required by written contract. Waiver of Subrogation applies under general liability and automobile liability as required by written contract. **See Attached Endorsements** DN03245A - 137 N Bryan Ave, Fort Collins, CO _ r r � -w—ni, " i19LrCLLA I ILJi\ JOG t LLQL11IIlC1W1 12218014 City of Fort Collins City Manager PO Box 580 300 Laporte Avenue Fort Collins CO 80522-0580 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 41111111, ACORD 25 (2016/03) ©198 The ACORD name and logo are registered marks of ACORD N_ All rinhts recerverf