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MCI-CS180621�1 ® CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) F 06I21/2018 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 Aon Rl sk Services Northeast, Inc. New York NY Office CONTACT NAME: (ac No. Ext): (866) 283-7122 (A/C. No.: (800) 363-0105 E-MAIL ADDRESS: 199 water Street New York NY 10038-3551 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: National union Fire Ins CO Of Pittsburgh 19445 MCImetro Access Transmission services Corp. 1095 Avenue of the Americas INSURERS: New Hampshire Insurance Company 23841 INSURER C: American Home Assurance Co. 19380 INSURER D: Illinois National Insurance Co 23817 New York NY 10036 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570071847389 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE D INSD SUB WVD POLICY NUMBER PO C EFF MMIDD P C MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY GL EACH OCCURRENCE $1,000,000 CLAIMS -MADE X❑ OCCUR DAMAGE TO RENTED $2,000,000 PREMISES Ea occurrence MED EXP (Any one person) $10,000 X XCU Coverage is Included PERSONAL &ADV INJURY $1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY ❑ PRO ❑ LOC JECT PRODUCTS-COMP/OPAGG $2,000,000 OTHER: A AUTOMOBILE LIABILITY CA 461-15-19 ADS 06/30/2018 06/30/2019 COMBINED SINGLE LIMIT $1,000,000 Ea accident BODILY INJURY (Per person) A X ANY AUTO CA 461-15-20 06/30/2018 06/30/2019 INJURY (Per accident) OWNED SCHEDULED MABODILY A AUTOS ONLY AUTOS CA 461-15-21 06/30/2018 06/30/2019 PROPERTY DAMAGE HIREDAUTOS NON -OWNED ONLY AUTOS ONLY VA Per accident A See Next Page 06/30/2018106/30/2019 UMBRELLA LIAB EACH OCCURRENCE AGGREGATE EXCESS LIAB HOCCUR CLAIMS -MADE DED RETENTION B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN Y PROPRIETOR/ PARTNERI EXECUTIVE ANXE OFFICERIMEMBEREXCLUDED? LI] (Mandatory In NH) NIA WC014590551 AOS WC014590550 CA 06/30/2018 06/30/2018 06/30/2019X 06/30/2019 STATUTE ETH - E.L. EACH ACCIDENT $1,000,000 E.L. E.L. DISEASE -FA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Named Insured Includes: MCImetro Access Transmission Services Corp. dba Verizon Access Transmission Services. RE: To Work in the Public Right-of-way. City of Coppell is included as Additional Insured with respect to the General Liability policy. CERTIFICATE HOLDER CANCELLATION IIIIIII� W_ ti SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE y� EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Coppell AUTHORIZED REPRESENTATIVE Attn: Scott Lata ;a_255 E. Parkway Blvd. �. Coppell TX 75019 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000027366 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk services Northeast, Inc. NAMED INSURED MCImetro Access Transmission POLICY NUMBER See Certificate Number: 570071847389 'CARRIER See Certificate Number: 570071847389 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSR LTR TYPEOFINSURANCE INSURER(S) AFFORDING COVERAGE NAIC # INSURER POLICY EFFECTIVE DATE MM/DD/YYY INSURER LIMITS INSURER AUTOMOBILE LIABILITY IN A CA 774-22-65 NH - Primary 06/30/2018 06/30/2019 A CA 774-22-66 NH - EXCOSS 06/30/2018 06/30/2019 WORKERS COMPENSATION D N/A wc014590552 FL 06/30/2018 06/30/2019 B N/A wc014590553 ME 06/30/2018 06/30/2019 B N/A wc014590549 N7,NY,TX,VA 06/30/2018 06/30/2019 B N/A wc014590554 MA,ND,OH,WA,WI,WY 06/30/2018 06/30/2019 ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPEOFINSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YYY SURER LIMITS ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPEOFINSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YYY POLICY EXPIRATION DATE MM/DD/YYY LIMITS AUTOMOBILE LIABILITY A CA 774-22-65 NH - Primary 06/30/2018 06/30/2019 A CA 774-22-66 NH - EXCOSS 06/30/2018 06/30/2019 WORKERS COMPENSATION D N/A wc014590552 FL 06/30/2018 06/30/2019 B N/A wc014590553 ME 06/30/2018 06/30/2019 B N/A wc014590549 N7,NY,TX,VA 06/30/2018 06/30/2019 B N/A wc014590554 MA,ND,OH,WA,WI,WY 06/30/2018 06/30/2019 ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL 461-16-07 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 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 Name Of Additional Insured Person(s) Or Organization (s): Any person or organization whom you become obligated.to_inciude as an. additional insured -as a. result -of -any contract or agreement you have entered into. 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 include as an additional insured the person(s) or organization(s) 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 omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 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. B. 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. CG 20 26 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 0