The URL can be used to link to this page

Home My WebLink About434510 T-MOBILE USA INC - INSURANCE CERTIFICATEAC"Ro CERTIFICATE OF LIABILITY INSURANCE �.� 5/1/2019 FDATE(MM/DD/YYYY) 4/17/2018 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 CONTCT NAME: A/c, PHONNo, Ext : FAX No E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: 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 Pitts. PA 19445 INSURER D : INSURER E : INSURER F : 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDDIYYYY LIMITS 11 X COMMERCIAL GENERAL LIABILITY Y Y RGD5000259-07 5/1/2018 5/1/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR PREM PREMISES (Ea oGE TO ccurrence) 1,000,000 MED EXP (Any oneperson) 5,000 PERSONAL & ADV INJURY $ 1000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑ PE� Fx LOC PRODUCTS - COMP/OPAGG $ 2,000,000 OTHER: $ g AUTOMOBILE LIABILITY Y Y RAD5000257-07 5/1/2018 5/1/2019 COMBINED SINGLE LIMIT ccident Ea accident) $ J 000 000 BODILY INJURY (Per person) $ XXXXXXX ANY AUTO OWNED AAUTOS ONLY AUTOS I BODILY BODILY INJURY (Per accident $ XXXXXXX PROPERTY DAMAGE Per accident $XXXXXXX HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $XXXXXXX C X UMBRELLA LIAB X OCCUR Y N 28189511 5/1/2018 5/1/2019 EACH OCCURRENCE $ 5�000,000 C EXCESS LIAB CLAIMS -MADE SIR appplies per policy terms, conditions AGGREGATE $ 5 000 000 DED I X I RETENTION $ 25,000 $ XXXXXXX A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N RWD5000301-06 AOS 5/1/2018 5/1/2019 PER OTH- X STATUTE ER AANVPROPRIETOR/PARTNER/EXECUTIVE � NIA RWR5000302-06 WI 5/1/2018 5/1/2019 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 E.L. DISEASE - POLICY LIMIT is 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I 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 byy w** written contract. Waiver of Subrogation liability liability **See Attached Morsements DN03245A 137 N applies under general and automobile as required by written contract. - Bryan Ave, Fort Collins, CO LtKI II-ILAIt tIVLUtK t ANt rLLAI IVIV JCC ALLaCrimCRLS 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 RECEIVE` ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE APR 3 U 2018 City Manager's Office 1 �/7 ACORD 25 (2niswi n1 The ACORD name and logo are registered marks of ACORD All rights reserved