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PROOF OF INSURANCE (2018) CLOSED A 0CERTIFICATE OF LIABILITY INSURANCE I DATE CERTIFICATE 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 CONTACT Mar h USA Inc. NAM,Ei 7701sMarket Street,Suite 1100 (A/G N (AX P,,EXU7 AIC,NaG'r,,,,, St.Louis,MO 63101 E MAHLsS. Attn:ATT.CertRequest@marsh.com INSURER(S)AFFORDING COVERAGE NAC# 018566-G INSURER A:Old Republic Insurance Company 241 7 V AW-CRT-17-18 X SCha X 4 INSURED INSURER B: New Lingular Wireless PCS,LLC One AT&T Plaza INSURER C: 208 South Akard INSURER D Room 1830.06 Dallas,TX 75202 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: CHI-007317234-13 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 .... }AbOLSUBA^, PbucC EPO ` POLICYMP E LTR TYPE OF INSURANCE aIN ,�„.II POLICYNUMBER (MMIDDIYYYYI IMMIDDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY310368 06/01/2017 06/01/2018 EACH OCCURRENCE s 5,000,000 .� ., X..,, PREMISES icc�,urrfenice) „$ , DAMAGE TO ArWr:b CLAIMS-MADE OCCUR 1,000,000 MED EXP(Any one person) $ /A PERSONAL&ADV INJURY $ 5,000,000 AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 10,000,000 X. JECT LOC PRODUCTS-COMP/OP. POLICY� r raeY• u AGG � 5,000.000 II OTI1ER A AUTOMOBILE LIABILITY MwT�310367 o6/o2o17 os/o1/2016 ( 8NE SlNGLE�IMl $ Ea sr1c, enI) 5,000,000 A X ANY AUTO MWZX 310369(MI) (See Attached) 06/01/2017 06/01/2018 BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY AUTOS ONLY AUTOS INJURY(Per accident) S HIRED NON-OWNED fh a 'RTYLMAGE AUTOS ONLY AUTOS ONLY c5dv $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LAB CLAIMS-MADE AGGREGATE S DED RETENTIONS s A wORKERSCOMPENSATION MWC31037000I' 06/01/2018 X ;STATLJTF OTH- AND EMPLOYERS'LIABILITY - ER ANYPROPRIETOR/PARTNER/EXECUTIVE YIN EL EACH ACCIDENT S 5,000,000 OFFICER/MEMBER EXCLUDED? N_1 NIA (Mandatory in NH) EL DISEASE-EA EMPLOYEE S 5,000,000 If yes,describe under 5,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT s 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 Ili DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) Re:LAD095/FA#10086765/348 E.Main Street,EI Segundo,CA 90245 City of EI 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 EI 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. EI Segundo,CA 90245 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee _3vLa."Lp " @ 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 018560 LOC#: St. Louis _ ADDITIONAL REMARKS SCHEDULE Page 2 � 2 AGENCY NAMED INSURED Marsh USA Inc Newomgular Wireless PCS,LLC _______' One xTmPlaza POLICY NUMBER xonSouth Akam Room 1830.06 -_____� ________ oonou.m,o�u oxnn/sn wm0000s 111.1 EFFECTIVE DATE: — -------- AoomOmALmsMAmma THIS ADDITIONAL REMARKS FORM|mASCHEDULE roAoOnoFORM, FORM NUMBER: 25 FORM TITLE: CerUfioeteofLiability Insurance Exceoowmmors'onmpensotion wwxamom1(oo'mm Self-Insured Retentions oxxwm x500,m0.mm(except Terrorism) oxuwm $600.000.000 Terrorism Excess Automobile Liability mWZzn0369(M» Combined Single Limit $1,000.000 Self-Insured Retention m1.mm.wo ACOmo1V1 (0000m1} unouAoOmoCORPORATION. All rights reserved. The Aoomoname and logo are registered marks v,ACmRo POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED ED I ERSO OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) 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 required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — 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 additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. Your acts or omissions; or 1. All work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law;and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured, CG 20 10 04 13 ©Insurance Services Office, Inc.,2012 Page 1 of 2 MVYZY 310368 AT&T Inc. 06/0112017-06/0112018 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement;or Page 2 of 2 ©Insurance Services Office, Inc.,2012 CG 20 10 0413 MW7Y 310368 AT&T Inc. 0610112017-0610112018 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS T"IOIS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations All Persons or Organizations as Required by Written The Locations as Specified in the Written Contracts or Contract or Agreement. In no event shall the insurance Agreements. provided exceed the scope of coverage or limits as required by said contract or agreement. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II — 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 orWsnization(s) shown in the Schedule, but only Section III—Limits Of Insurance: withrespect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage"caused, In whole or in part, by required by a contract or agreermnt, the most we "your work" at the Vocation designated and will pay on behalf of the additionalinsured is the described in the Schedule of this endorsement amount of insurance: p oiformed for that additional insured and included in the "products-completed operations 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 coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 04 13 ©Insurance Services Office, Inc.,2012 Page 1 of 1 MWZY 310368 AT&T Inc. 0610112097-0610112018 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 POLICY NUMBER: MWC 310370 00 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule WHERE REQUIRED BY WRITTEN CONTRACT DATE OF ISSUE: 06-01-17 0 1983 National Council on Compensation Insurance.