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Qwest-CS060517++.t CERTIFICATE' ©F INSURANCE CERTIFICATE NUMBER SEA- 000403012 -07 PRODUCER THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY AND CONFERS Marsh USA Inc. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE The Financial Center POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE 1215 Fourth Avenue, Suite 2300 AFFORDED BY THE POLICIES DESCRIBED HEREIN. Seattle, 98161 -1095 COMPANIES AFFORDING COVERAGE Attn: Kathy by B. Hariri 206 613 -2625 Fax: 206 613 -2516 COMPANY WLCI - QCC- GAW -06 -07 cont KBH cg2026 A NATIONAL UNION FIRE INS CO OF PA INSURED COMPANY QWEST COMMUNICATIONS CORPORATION B INSURANCE COMPANY OF THE STATE OF PA 1801 CALIFORNIA STREET, SUITE 1150 COMPANY DENVER, CO 80202 C AMERICAN HOME ASSURANCE COMPANY COMPANY D COYRAGS' This certit(cate'supersedes end replaces any previousty issued .certificate for the pricy period noted below. 14 THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CID LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE (MM /DDNY) DATE (MM /DDNY) A GENERAL LIABILITY SEE ATTACHED 04/01/06 10/01/07 GENERAL AGGREGATE $ 2,000,000 COMMERCIAL GENERAL LIABILITY X PRODUCTS - COMP /OP AGG $ 2,000,000 CLAIMS MADE OCCUR PERSONAL& ADV INJURY $ 1,000,000 EACH OCCURRENCE $ 1,000,000 OWNER'S & CONTRACTOR'S PROT FIRE DAMAGE (Any one fire) $ 1,000,000 MED EXP (Any one person) $ 5,000 A AUTOMOBILE LIABILITY SEE ATTACHED (AOS) 04/01/06 10/01/07 A COMBINED SINGLE LIMIT $ 2,000,000 X ANY AUTO SEE ATTACHED TX (TX) 04/01 /06 10/01 /07 A ALL OWNED AUTOS SEE ATTACHED (VA) 04/01/06 10/01/07 BODILY INJURY $ SCHEDULED AUTOS (Per person) HIREDAUTOS X BODILY INJURY $ `; NON -OWNED AUTOS (Per accident) X SELF - INSURED FOR PROPERTY DAMAGE $ UTO PHYSICAL DAMAGE GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ B WORKERS COMPENSATION AND SEE ATTACHED /AOS) EMPLOYERS' 04/01!06 10!01/07 X W ATU- LIABILITY B SEE ATTACHED (CA) TORY LIIv11TS ER 04/01/06 10/01/07 EL EACH ACCIDENT $ 1,000,000 A THEPROPRIETOR/ INCL SEE ATTACHED (OR) PARTNERS/EXECUTIVE 04/01/06 10/01/07 EL DISEASE - POLICY LIMIT $ 1,000,000 B FL SEE ATTACHED OFFICERS ARE: EXCL (FL) 04/01/06 10/01/07 EL DISEASE -EACH EMPLOYEE $ 1,000,000 OTHER A Workers' Compensation SEE ATTACHED (ND,OH,WI) 04/01/06 10/01/07 Each Accident/Employee $1,000,000 A Workers' Compensation SEE ATTACHED (WV,WY) 04/01/06 10/01/07 Each Accident/Employee $1,000,000 C Excess Workers' Compensation ISEE ATTACHED (WA) 04/01/06 10/01/07 Excess of SIR Shown Above $1,000,000 DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /SPECIAL ITEMS THE CITY OF COPPELL, TEXAS IS AN ADDITIONAL INSURED AS RESPECTS THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED AS REQUIRED BY WRITTEN REGARDING GENERAL LIABILITY COVERAGE. CERTIFICATE HQCbER CANCELLATION SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 3.0 DAYS WRITTEN NOTICE TO THE CITY OF L ENGINEERRING ING D EPARTMENT DEPARTMENT CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 255 PARKWAY BOULEVARD LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES, OR THE COPPELL, TX 75019 ISSUER OF THIS CERTIFICATE. MARSH USA INC. BY: Cheryl[ L. Koch MM1'(3 102) VALID AS OF: 05/18/06 PRODUCER Marsh USA Inc. The Financial Center 1215 Fourth Avenue, Suite 2300 Seattle, WA 98161 -1095 Attn: Kathy B. Harid 206 613 -2625 Fax: 206 613 -2516 I QWLCI - QCC- GAW -06 -07 cost KBH cg2026 INSURED QWEST COMMUNICATIONS CORPORATION 1801 CALIFORNIA STREET, SUITE 1150 DENVER, CO 80202 POLICY TERM 4/1/06 TO 10/1/06 General Liability Policy #GL3917172 Automobile Liability: Policy #CA3780043 (All Other States) Policy #CA3780042 (Texas) Policy #CA3768494 (Virginia) Workers' Compensation: Policy #WC4778329 (All Other States) Policy #WC4777998 (California) Policy #WC4778330 (Oregon) Policy #WC4778331 (Florida) Policy #WC4778332 (North Dakota, Ohio, Wisconsin, West Virginia, Wyoming) Excess Workers' Compensation Policy #XWC4778869 (Washington) POLICY TERM: 10/1/06 TO 10/1/07 General Liability Policy #GL3948924 mobile Liability: ;y #CA3818306 (All Other States) Policy #CA3817587 (Texas) Policy #CA3817586 (Virginia) Workers' Compensation: Policy #WC6611392 (All Other States) Policy #WC6611389 (California) Policy #WC6611390 (Oregon) Policy #WC6611391 (Florida) Policy #WC6611393 (North Dakota, Ohio, Wisconsin, West Virginia, Wyoming) Excess Workers' Compensation Policy #XWC6611394 (Washington) CITY OF COPPELL ENGINEERING DEPARTMENT 255 PARKWAY BOULEVARD COPPELL, TX 75019 COMPANY E COMPANY F COMPANY G COMPANY H MARSH USA INC. BY Cheryll L. Koch DATE (MMIDDNY) SEA - 000403012 -07 05/18/06 COMPANIES AFFORDING COVERAGE ,/j �/ a4 _ POLICY NUMBER: GL3917172 (411106 - 10/1/06) COMMERCIAL GENERAL LIABILITY GL3948924 (10 /1/06 - 10/1/07) CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Section II - Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zations) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you_ CG 20 26 07 04 C ISO Properties, Inc., 2004 Page 1 of 1 C