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PROOF OF INSURANCE (2019) CLOSED DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/2112018 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(les)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 end'orsernent(s). PRODUCER CONTACT Marsh USA Inc NAME PHONE Market Street,Suite 1100 (n/ MQ, Ext): FAX No): St Louis,MO 63101 E'MA.IL Attn:ATT CertRequest@marsh com ADr'>R"*5 iNSURFR(S)AFFORDING RAGL t NAIC# .OVL, 018566-GAW-CRT-18-19 X SCha X INSURER A:Old Republic Insurance Company 24147 INSURED INSURER B: New Cingula,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-007317234-14 REVISION NUMBER; u 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. ITR TYPE OF INSURANCE ADbL tiUl rt POLICY NUMBER IMM'/'41YYYY6 ,. ML001Y Ili. . OLDUOY EFF POLICY y^ � LIMITS XLIABILITY MWZY 313636 06101/2018 06/01/2019 EACH OCC RREN�en v) $ 5,000,000 A X COMMERCIALLAIMS-MADE �GENERAL OCCUR 1,000,000 MED EXP yArtiy one persouia $ N/A PERSONAL&ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 X POLICYPE 0 D LOC PRODUCTS-COMP/OP AGG $ 5,000 000 A AUTOMOBILE LIABILITY COMBINE=D SINGLE LIMIT ,000 MWTB 313fi35 0610112018 0610112019 (Fa acc oent) A X ANY AUTO MWZX313637 MI 06/01/2018 06/01/2019 $ 5,000 ( ) BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PRO,f-i DAMAGE $ AUTOS ONLY AUTOS ONLY (Pet accident) $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED Y �RETENTION$ $ A WORKERS COMPENSATION MAC 313636 00 0610112018 )lib,,T26" X 1 PER I OTH- . STATUTE OFFICER/MEMBER RIETO REXCLUD E N, L EACHACCIIENT FR N/A $ 5,000,000 (Mandatory MBER XCLUD/EXECUTIVE LOYERS'LIABILITY YIN E L DISEASE EA EMPLOYEE NH) g 5,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE POLICY LIMIT $ 5,000,000 A Excess Workers'Compensation/ MWXS 313639 (OH,WA) 06/01/2018 06/01/2019 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,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 Subropation is provided for Workers'Compensalion,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 Mt/Iu�rat wae�l @ 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) 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 NAMED INSURED Marsh USA Inc New Cingular Wireless PCS,LLC ............----...............I.......... ...... ....................... .......................... .......... One AT&T Plaza POLICY NUMBER 208 South Akard Room 1830.06 CA" R,RI.,E,R........................ .......................................... NAIC CODE Dallas,TX 75202 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: �q�rtiEicatepf L a�ility Insurance , __ .......................................................... ............... ...................... .................. .............................. Excess Workers'Compensation-MWXS 313639(OH-WA) Self-Insured Retentions 011&WA-$500,000,000(except Terrorism) 01-1&WA-$600,000.000 Terrorism Excess Automobile Liability-MWZX 313637(MI) Combined Single Limit-$1,000,000 Self-insured Retention-$1,000,000 ACORD 101 (2008/01) 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL IIS - OWNERS, L. SS S OR CONTRACTORS - SCHEDULED PERSON 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 The locations as Specified in the Written Contract or Contract or Agreement. In no event shall the insurance Agreements. 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 2. If coverage provided to the additional insured is include as an additional insured the person(s) or required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured with respect to liability for "bodily injury", "property will not be broader than that which you are damage" or "personal and advertising injury" required by the contract or agreement to caused, in whole or,it) part, by. provide for such additional insured. 1. Your acts or omissions; or B. With respect to the insurance afforded to these 2. The acts or omissions of those acting on your additional insureds, the following additional behalf; exclusions apply: in the performance of your ongoing operations for This insurance does not apply to 'bodily injury" or the additional insured(s) at the location(s) .'property damage"occurring after: designated above. 1. All work, including materials, parts or However: equipment furnished in connection with such work, on the project (other than service, 1. The insurance afforded to such additional maintenance or repairs) to be performed by or insured only applies to the extent permitted by on behalf of the additional insured(s) at the law; and location of the covered operations has been completed; or CG 20 10 04 13 O Insurance Services Office, Inc., 2012 Page 1 of 2 MWZY313636 AT&T Inc. 06/01/2018-06/01/2019 2. That portion of "your work" out of which the If coverage provided to the additional insured is injury or damage arises has been put to its required by a contract or agreement, the most we intended use by any person or organization will pay on behalf of the additional insured is the other than another contractor or subcontractor amount of insurance: engaged in performing operations for a 1. Required by the contract or agreement; or principal as a part of the same project. 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 —Linfits Of Insurance: whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 L0 Insurance Services Office, Inc., 2012 CG 2010 0413 MYVZY 313636 A T&T Inc. 0610112016-0610112019 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES O CONTRACTORS COMPLETED OPERATIONS This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL 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 Location as Specified in the Written contract or contractor Agreement. In no evnet 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. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the 'products- completed operations hazard". CG 20 37 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 MWZY 313636 AT&T Inc. 06/01/2078-06/01/2019 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 POLICY NUMBER: MWC 313638 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: 06-01-18 1983National Council un Coffip&nsation On uranc&.