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Home My WebLink About434510 T-MOBILE US INC - INSURANCE CERTIFICATE (3)AcoRIDO' CERTIFICATE OF LIABILITY INSURANCE 7D.TE(MM/DD/YYYY) 16*_� 5/1/2018 1 4/19/2017 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,.conditiQ {�f the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate',holder id id such endorsement(s). PRODUCER Lockton Companies Three City Place Drive, Suite 900 MAY 1 2017 St. Louis MO 63141-7081 (314) 432-0500 C City Manager's O{�I I ICC CONTCT NAME: PHONE _TTAT 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. 1358772 Its Subsidiaries and Affiliates 12920 SE 38th Street INSURER B : Greenwich Insurance Company 22322 INSURER C: National Union Fire Ins CO Pitts. PA 19445 INSURER D Bellevue WA 98006 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 (MM/DDIYYYYI LIMITS B X COMMERCIAL GENERAL LIABILITY Y Y RGD5000259-06 5/1/2017 5/l/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR DAMAGE REM PREMISES (Ea occurrrence) $ I,000,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY❑ JJECT X� LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER B AUTOMOBILE LIABILITY Y Y RAD5000257-06 5/1/2017 5/l/2018 COMBINED tSINGLE LIMIT $ 7,000,000 X BODILY INJURY (Per person) $ XXXXXXX ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident $ XXXXXXX AUTOS ONLY AUUT0 ONLYY (Pe�accdentDAMAGE $ XXXXXXX $XXXXXXX C X UMBRELLA LAB X OCCUR Y N 28189156 5/1/2017 5/l/2018 EACH OCCURRENCE S 5,000,000 C EXCESS LIAB CLAIMS -MADE SIR applies per policy AGGREGATE $ S,000,OOO C terms & conditions DED I X I RETENTION $25,000 $ XXXXXXX A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N RWD5000301-05 AOS 5/1/2017 5/1/2018 PER OTH- X STATUTE ER AAN PROPRIETORY/N ECUTIVE 7 N / A RWR5000302-05 WI 5/1/2017 5/1/2018 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMSERi 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 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 CERTIFICATE HOLDER CANCELLATION See Attachments 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 (2016/031 The ACORD name and logo are registered marks of ACORD All rinhts resPrvPr1