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PROOF OF INSURANCE (2017) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 05/18/2016 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. NAmnY PHONE FAX 701 Market Street, Suite 1100 (AIG..N9, Ex0; .... ....... . ......... ........ ....._ ... INP I R9)............ ........................- St. Louis, MO 63101 E-MAIL Attn: ATT.CertRequest@marsh.com RR99AS """""' °' INSURER(Sj AFFORDING COVERAGE NAIC # 018566-GAW- CRT -16 -17 X SCha X INSURER ..ERA: Ol _ any ....... _.. _........... n _ .. __... RER A , d Republic Insurance Company 24147 INSURED New Cingular Wireless PCS, LLC ER B _._ _.m._. -------- One AT &T Plaza rNSURER c 208 South Akard INSURER D s. Room 2731 ..... .._. ...... ...... ....... ......._ Dallas, TX 75202 wsueR E COVERAGES CERTIFICATE NUMBER: CHI - 005618171 -05 REVISION NUMBER: 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 ...... TYPE OF INSURANCE............_.... 'Uat .. ...... ............. - LTR POLICY NUMBER POLICY EFF POLICY EXPT ............. ......,,,, ....., IMMIDDrYYYY MMIDD/YYY-j LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY 307524 06/01/2016 06/01/2017 EACH OCCURRENCE $ 5,000,000 X iYAMAGE 16) EN�''0tJ ...... �. .. 1,000,000 CLAIMS -MADE .. OCCUR ,. SES (Ea occurrer ce) PREMI.. _ ..._ $ ..�........ �... --------------- —_ ......._ . XP (An one erson) MEDE....... Zµ..,P $ N/A PERSONAL & ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 PRO- X., POLICY � PRO II LOC PRODUCTS CO MPIOP AG, G $ 5 000,000 OTHER: $ A AUTOMOBILE LIABILITY ...._._,.. MWTB 307523 06/01/2016 .06/0112017 COMBINED SINGLE LIMIT 1,Ea, accldent� $ 5,000,000 A X ANY AUTO MWZX 307525 (MI) See Attached 06/01/2016 06/01/2017 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS BODILY INJURY (Per accident) $ .,, ... ,AUTOS NON -OWNED F °ROP( Fi1Y tYAMAGt $ HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXC SS LIAB CLAIMS -MADE AGGREGATE DED RETENTION $ A WORKERS COMPENSATION MWC 307526 00 06/0112016 0610112017 X PE O1 H AND EMPLOYERS' LIABILITY YIN! 4TR ...- . *. AT TF R .�1 .... ,�..... �� ...,._..... .. ....� . . ...... ..... ?ECUTIVE � OFFICER /MEMBER/ EXCLUDED N, N/A.............. w.,........, .,.$.....,..,..,............, ..,,..,,...........5'000'000,. (Mandatory in NH) E L. DISEASE EA EMPLOYEE, i $ describe under DESCRIPTION OF OPERATIONS below E L OI$LAd POLICY LIMIT $ 5,000,000 A Excess Workers' Compensation / MWXS 307527 (OH -WA) 06101/2016 06101/2017 EL Each Accident I EL Disease 1,000,000 Employers' Liability See Second Page 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) Re: LAD095 /FA #10086765/ 348 E. Main Street, El Segundo, CA 90245 City of El Segundo (Landlord), its officials, and employees are included as Additional Insured under the General Liability and Automobile Liability policies but only with respect to the requirements of the contract between the Certificate Holder and the Insured. Waiver of Subrogation is provided for Workers' Compensation, as required by written contract and allowable by law. CERTIFICATE HOLDER CANCELLATION City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Deputy City Clerk I; City Clerk's Office – Mona F. Shilling THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE 1 of Marsh USA Inc. Manashi Mukherjeea �n oea ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 018566 LOC #: St. Louis " ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Marsh USA Inc. ......... ......... POLICY NUMBER CARRIER NAIC CODE NAMED INSURED New Cingular Wireless PCS, LLC One AT &T Plaza 208 South Akard Room 2731 Dallas, TX 75202 EFFECTIVE DATE: ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL, LIABILITY CG 20 10 4413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSD D -- OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON, O ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL. GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured n(s) tior �� � � Location(s)Of Covered Operations All Persons or Organizations as Required by Written Contract or The Locations as Specified in the Written Contracts or Agreements Agreement. In no event shall the insurance provided exceed the scope of coverage or limits required by said contract or agreement. Information rea iii-ed to Heel ua t ills Schedule, if not shown �, � ,m �+ � awn in the Declarations. ..�... _.._.w.. _.....own abave,�will be shown _ ,. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or or,g �rtlr itirrn(s) shown in the Schedule, but only with respect to liability t'or° „bodily injury " "proporty damage" or "personal and advertising injury " caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations For the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. It coverage provided to the additional insume d is required by a contract or agreement, the insurance afforded to such additional irn,aunud will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 MWZY 307524 AT&T Inc. 06/01/2016 - 0610112017 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 @-, Insurance Services Office, Inc., 2012 CG 20 10 0413 MWZY307524 AUT Inc. 06/01/2016.06101 /2017 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART �� n -4111 Name Of Additional Insured Person(s) Location And Description O# Completed Operations All Persons or Organizations as Required by Written The Locations as Specified In the Written Contracts or Contract or Agrearnent. In no event shalt the insurance Agreements. provided exceed the scope of coverage or limits as required by said contract or agreement. Information to c rr� lc t this cliedt le, if not shown above, will be shown in the Declarations, A. Section 13 — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person {s} or, additional insureds, the following is added to organization(s) st°iown in the Schedule, but ()rtly Section III — Limits Of Insurance; with respect to liability for "bodily inluty " or, If coverage provided to the additional insured is ""Properly darnago" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the ir.rr:ation designated and will pay on behalf of the additional insured is the doscfted in the Scheduie of this endorsetrsent amount of insurance: pcsrformed for that additional 'insured and included in the ""producls- cornpleted opt,, - rations 1. Required by the contract or agreement; or hazard ", 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the applicable by law; and Limits of Insurance shown in the Declarations. 2. if ors ve,rage provideA to the additional insured is ;,eq pirest by a contract or agreement, the insurance afforded to such addifiermal insured will not be broader than that which you are require;.cf by the contract or agreement to provide for such additional insured. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 MWZY 307524 Ara r ►nc. 06/09/2076 - 0610112017 E 1. * � � � - •` WC 124 (4 -84) WC 00 0313 This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 06/01/2016 at 12:01 A.M. standard time, forms a part of (GATE) Policy No. MWC307526 00 of the Old Republic Insurance Company (NAME OF INSURANCE COMPANY) issued to AT &T Services, Inc. Premium a o ed Representative We have the right to recover our payments frorn anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization narned in the Schedule This agreement applies only to the extent that you perforrn work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule Where Required By Written Contract WC 124 (4 -84) WC 00 03 13 Copyright 1983 Rlatiorml Comidl on Compensation insurance Page 1 of 1