HomeMy WebLinkAboutCRICKET COMMUNICATIONS INC - INSURANCE CERTIFICATE (7)A�� a DATE (MMIDD/YYYY(
CERTIFICATE OF LIABILITY INSURANCE 05/092017
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 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 CONTACT
Marsh USA Inc. NAME:
701 Market Street, Suite 1100 (A/CO. No. Ext� _ FAX
AIC,No);__
St. Louis. MO 63101 E-MAIL
Attn: ATT.CertRequest@marsh.com ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC S
018566-GAW-ACQ-17-18 CMald INSURER A: Old Republic Insurance Company 24147
INSURED INSURER B :
Cricket Communications, Inc.
One AT&T Plaza INSURER C :
208 South Akard Street, Room 1830.06 INSURER D :
Dallas. TX 75202 — -
INSURER E:
CnvFRArrFC cFRTIFICATF NI IMRFR• CHI-006159107-10 RFVISInN N11MRFR:
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
POLICY EFF
MM/DDIYYYY
POLICY EXP
MM/DDIYYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
MWZY 310368
06/01/2017
06/01/2018
EACH OCCURRENCE
$ 3,000,000
rx
CLAIMS -MADE OCCUR
AMAGE
PREM SESOEa oNcur RETEante
$ 1,000,000
MED EXP (Any one person)
$ N/A
PERSONAL & ADV INJURY
$ 3,000,000
GENT AGGREGATE LIMIT APPLIES PER.
GENERAL AGGREGATE
$ 10,000,000
POLICY �1 PRO JECT u LOC
X u
PRODUCTS - COMP/OP AGG
$ 3,000,000
$
OTHER
A
AUTOMOBILE LIABILITY
MWTB 310367
06/01/2017
06/01/2018
COMBINED SINGLE LIMIT
Ea accident)
$ 3,000,000
BODILY INJURY (Per person)
$
A
X ANY AUTO
MWZX 310369 (MI) (See Attached)
06/01/2017
06/01/2018
BODILY INJURY (Per accident)
$
ALL OWNED SCHEDULED
AUTOS — AUTOS
NON OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE
Per accident
$
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
_
DIED RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE Y�
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
N / A
MWC 310370 00
06/01/2017
06/01/2018
X STATUTE OERH
E.L. EACH ACCIDENT
$ 3,000,000
E L DISEASE - EA EMPLOYE
$ 3,000,000
E L. DISEASE - POLICY LIMIT
$ 3,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
A
Excess Workers' Compensation /
MWXS 310371 (OH -WA)
06/01/2017
06/01/2018
EL Each Accident / EL Disease 1,000,000
Employers' Liability
See Second Page
EL Disease -Policy Limit 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE FNL-004D, City Park Site Address: 137 N. Bryan, Fort Collins, CO.
!`COTILIP`ATC unl ncD (^AAIf GI I ATIf111kl
City of Fort Collins
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
PO Box 580
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Fort Collins, CO 80522-0580
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Manashi Mukherjeet-
U 1UtW-LU14 AIrUKU UUKVUKA I IUrv. All rlgnrs reserveci.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
4COR"
AGENCY CUSTOMER ID: 018566
LOC #: St. Louis
ennirintiei 09:RAA LCQ cru=ni li c
AGENCY NAMED INSURED
Marsh USA Inc. Cricket Communications, Inc
One AT&T Plaza
POLICY NUMBER 208 South Akard Street, Room 1830.06
Dallas, TX 75202
CARRIER NAIC CODE
EFFECTIVE DATE:
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, - -
FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance
txcess WorKerst omp,
Self -Insured Retentions
OH & WA - $500,000,0(
OH & WA - $600,000,0(
Excess Automobile Liat
Combined Single Limit
Self -Insured Retention -
ACORD 101 (20081
Penn 7 of 0