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Home My WebLink AboutCENTURYLINK INC - INSURANCE CERTIFICATE (5)A`COR�® V CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 08/23/2017 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 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 CONTACT NAME: PHONE FAX /c No. Ertl: (A/c, No): E-MAIL ADDRESS: 1301 5th Avenue, Suite 1900 Seattle, WA 98101-2682 Attn: Seattle.certrequest@marsh.com / Fax: 212-948-4326 A 3913-ST_ND-GAWW-17-18 kbh cunt INSURERI AFFORDING COVERAGE NAIC # INSURER A: Greenwich Insurance Company 22322 _ INSURED CenturyLink, Inc.; Embarq Corporation, INSURER 8 : XL Specialty Insurance Co. 37885 Qwest Communications International Inc.; INSURER C : INSURER D : and All Affiliated, Subsidiary & Associated Companies including Qwest Government Services, Inc. 1801 California Street, Suite 1150 INSURER E : INSURER F : Denver, CO 80202 CnVFRAGFS CERTIFICATE NUMBER: SEA-003475093-26 REVISION NUMBER: 19 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 SUER POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X RGD500033305 09/01/2017 09/01/2018 EACH OCCURRENCE $ 1,000,000 f CLAIMS -MADE LX OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 — MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 PRO ❑ LOC POLICY E]JECT N $ OTHER A AUTOMOBILE LIABILITY RAD500033405 09/01/2017 09/01/2018 COMBINED SINGLE LIMIT Ea accident g 2,OOQ000 BODILY INJURY (Per person) $ X ANY AUTO Auto Physical Damage - Self Insured BODILY INJURY (Per accident) $ X OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETORlPARTNERlEXECUTIVE OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) N/A RWD500032905AOS RWR500033005 WI 09/01/2017 09101/2018 09/01/2018 H X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ If yes, describe under DESCRIPTION OF OPERATIONS below B XS Workers' Compensation/EL RWE500033105 - WA 09/01/2017 09/01/2018 Excess of 1,000,000 SIR 1,000,000 B XS Workers' Compensation/EL RWE500033205 - OH 09/01/2017 09/01/2018 Excess of 1,000,000 SIR 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I 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. CERTIFICATE HOLDER 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 (rit.tAVk 41 !gaAA+-� V 1y2fS-ZU11f AGUKU L:UKF'UKA I IVIV. All rlgnLs reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD