The URL can be used to link to this page

Qwest-CS101111c KL] CERTIFICATE OF LIABILITY INSURANCE =DATE D/YYY1) 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 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: 13015th Avenue, Suite 1900 PHONE FAX Seattle, WA 98101 E-MAIL EM' A/C No Atb: Kathy Hadd 206 214 3119 Fax: 206 214 3483 ADDRESS: PRODUCER 100429- QCC- GAW -10 -11 CU TOMER ID #: coot none INSURER(3 AFFORDING COVERAGE NAIC # INSURED National Union Fire Ins Co Pittsburgh PA QWEST COMMUNICATIONS COMPANY LLC INSURER A : r9 19445 1801 CALIFORNIA STREET, SUITE 1150 INSURER e : Insurance Company Of The State Of PA 19429 DENVER, CO 80202 COVERAGES THIS INDICATED. CERTIFICATE EXCLUSIONS INSR LTR A CERTIFICATE IS TO CERTIFY THAT THE POLICIES NOTWITHSTANDING ANY REQUIREMENT, MAY BE ISSUED OR MAY AND CONDITIONS OF SUCH TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR OF PERTAIN, POLICIES. AD L JN§R X INSURANCE SUBR Am NUMBER: SEA- LISTED BELOW HAVE BEEN TERM OR CONDITION OF ANY THE INSURANCE AFFORDED BY LIMITS SHOWN MAY HAVE BEEN POLICY NUMBER GL4360920 001642750 -11 ISSUED TO CONTRACT THE POLICIES REDUCED BY MM%DDY EFF 1010112010 THE INSURED OR OTHER DESCRIBED PAID CLAIMS. REVISION NUMBER: 18 NAMED ABOVE FOR THE DOCUMENT WITH RESPECT HEREIN IS SUBJECT TO POLICY PERIOD TO WHICH THIS ALL THE TERMS, MM/DD EXP 10101/2011 LIMBS EACH OCCURRENCE $ 1,000,000 DAMAGE O RENT D PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 A A 't A PRO- POLICY F7 JFrT F1 LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS CA3916620 (AOS) CA3976621(CT) CA3976622 (MA) CA3976623 (VA) 1010112010 10101/2010 10/0112010 10/01/2010 10/0112011 10/01/2011 10/01/2011 10/01/2011 $ X X COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 BODILY INJURY (Per person) p ) $ BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS X X PROPERTY DAMAGE (Per accident) $ X $ SELF - INSURED FOR APD UMBRELLA LUAB EXCESS LU16 OCCUR CLAIMS -MADE EACH OCCURRENCE $ DEDUCTIBLE AGGREGATE $ RETENTION $ $ B B B B A A DESCRIPTION THE CITY INTEREST WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Workers' Compensation/EL XS Workers' CompensationlEL OF OPERATIONS / LOCATIONS / VEHICLES OF COPPELL, TEXAS IS AN ADDITIONAL INSURED IN THE OPERATIONS OF THE NAMED INSURED N/A (Attach AS ACORD PER THE REQUIRED WCO26149624 (AOS) WCO26149625 (CA) WCO26149626 (FL) WCO26149627 TX ( ) WCO26149628 (MA ND OH WI WY) XWC1192341(WA) 101, Additional Remarks Schedule, GENERAL LIABILITY BLANKET ADDITIONAL BY WRITTEN CONTRACT. 10/01/2010 10/01/2010 10/01/2010 10/01/2010 10/0112010 10/01/2010 If more space Is INSURED 10/01/2011 10/01/2011 10/01/2011 10/01/2011 10/01/2011 10/01/2011 required) ENDORSEMENT X WC STATU- OTH- E.L. EACH ACCIDENT $ 11000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 Each Acc/Emp /Policy Lima Excess of $1,000,000 SIR $1,000,000 $1,000,000 AS RESPECTS THEIR CERTIFICATE HOLDER CANCELLATION CITY OF COPPELL ENGINEERING DEPARTMENT 155 PARKWAY BOULEVARD :OPPELL, TX 75019 ACORD 25 (2009/09) 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. Cheryll L. Koch A:2,a.— ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD