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Century Link-CS180824CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 08!2412018 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 endorsement(s). PRODUCER NAME:y Marsh USA Inc. PHONE FAX CA License (10437153 C E • 1AJC, No): 13015th Avenue, Suite 1900 E-MAIL Seattle, WA 98101-2682 ADDRESS: Attn: SeatBe.certrequest@marsh.com / Fax: 212-948-4326 INSURERS AFFORDING COVERAGE NAIC N CN102197661-STND-ALL-18-19 cont none INSURER A: Greenwich Insurance Company 22322 INSURED INSURER B : XL Specialty Insurance Co. 37885 CenturyLink, Inc. and all subsidiaries, including but not limited to: Qwest Communications International Inc.; Embarq Corporation; INSURER C : Allianz Underwriters Ins Co 36420 Level 3 Parent, LLC and Level 3 Communications, LLC INSURER D : 100 CenturyLink Drive; Mailstop 5TS154 Monroe, LA 71203 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: SEA -003478246-39 REVISION NUMBER: 20 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DD/YYCY YY MM%DD�YY LIMITS A X COMMERCIAL GENERAL LIABILITY X RGD500033306 09/01/2018 09/01/2019 EACH OCCURRENCE $ 33000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500,000 X MED EXP (Any one person) $ 10,000 CONTRACTUAL LIABILITY PERSONAL & ADV INJURY $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 15,000,000 X POLICY PROF�] LOC JECT PRODUCTS - COMP/OP AGG $ 15,000,000 OTHER: $ A AUTOMOBILE LIABILITY RAD500033406 09/01/2018 09/01/2019 COMBINED SINGLE LIMIT Ea accident $ 21000,000 X BODILY INJURY (Per person) $ ANY AUTO Auto Physical Damage - Self Insured OWNED SCHEDULED AUTOS ONLY AUTOS X BODILY INJURY (Per accident) $ X PROPERTYDAMAGE Per accident $ HIREDX NON -OWNED AUTOS ONLY AUTOS ONLY X UMBRELLA LIAB X OCCUR ART3016558 09/01/2018 09101/2019 EACH OCCURRENCE $ 101000,000 AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ B B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N OF IC R/MEMBEREXCLUDED7ECUTIVE N (Mandatory In NH) N/A RWD500032906 AOS RWR500033006 WI RWE500033106 - WA 0910112018 09101/2018 09/01/2019 09/01/2019 09/01/2019 X IPER STATUTE I OTH. ER E. L. EACH ACCIDENT $ 100000000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 B If yes, describe under DESCRIPTION OF OPERATIONS below RWE500033206 - OH 09/01/2018 09/01/2019 I E.L. DISEASE -POLICY LIMIT $ 11000,000 C Technology E&O incl. ART3016558 09101/2018 09/01/2019 Each Claim/Aggregate 10,000,000 Cyber/Privacy Liability Retention 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) THE CITY OF COPPELL, TEXAS IS AN ADDITIONAL INSURED PER THE GENERAL LIABILITY BLANKET ADDITIONAL INSURED ENDORSEMENT AS RESPECTS THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED AS REQUIRED BY WRITTEN CONTRACT, CERTIFICATE HOLDER CANCELLATION CITY OF COPPELL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ENGINEERING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 255 PARKWAY BOULEVARD ACCORDANCE WITH THE POLICY PROVISIONS. COPPELL, TX 75019 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Cheri Garrison t AzA4^ 'i1 �q� ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY Marsh USA Inc. POLICY NUMBER CARRIER AGENCY CUSTOMER ID: CN102197661 LOC #: Seattle ADDITIONAL REMARKS SCHEDULE Page 2 of NAIC CODE NAMED INSURED CenturyLink, Inc. and all subsidiaries, including but not limited to: Qwest Communications International Inc.; Embarq Corporation; Level 3 Parent, LLC and Level 3 Communications, LLC 100 CenturyUnk Drive; Mailslop 5TS154 Monroe, LA 71203 EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance GENERAL LIABILITY Automatic Additional Insured's Primary Coverage Additional Insured as respects your interest in the operations of the Named Insured as required by contract or agreement. Coverage provided by the above General Liability policy shall be primary and is limited to liability arising out of Named Insured's ownership and/or operations. Any insurance carried by the additional insured shall not be contributory insurance. Waiver of Transfer of Rights of Recovery Against Others to Us (Waiver of Subrogation) - Any person or organization with whom you have entered into a contract or agreement, but only to the extent required by such contract or agreement. Separation of Insureds Applies. Insurance covers incidents that occur within 50' of railroad properly, any railroad exclusions have been deleted per endorsement CG2417. AUTOMOBILE LIABILITY Additional Insured as respects your interest in the operations of the Named Insured as required by written contract. Any coverage provided hereunder shall be excess over any other valid and collectible insurance available to the additional insured whether such insurance is primary, excess, contingent or on any other basis unless the contract specifically requires that this policy be primary. Lessor- Additional Insured and Loss Payee - All Lessors Waiver of Transfer of Rights of Recovery Against Others to Us (Waiver of Subrogation) - Any person or organization with whom you have entered into a contract or agreement, but only to the extent required by such contract or agreement. Separation of Insureds Applies, WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY AND EXCESS WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY (OH & WA - SELF-INSURED - $1,000,000 RETENTION) ------- Waiver of Our Right to Recover from Others (Waiver ofSubrogation) -Any person or organization with whom you have entered into a contract or agreement, but only to the extent required by such contract or agreement. EXCESSNMBRELLA Coverage applies per occurrence.Additi onal Insured as respects your interest in the operations of the Named Insured as required by contract or agreement. Waiver of Transfer of Rights of Recovery Against Others to Us (Waiver ofSubrogation) -Any person or organization with whom you have entered into a contract or agreement, but only to the extent required by such contract or agreement. Separation of Insureds Applies. COMMERCIAL CRIME -FIDELITY BOND Carrier: ACE American Insurance Company Policy Number: DONG23680075 005 Effective Dates: 03101/2018 - 03101/2019 Each Occurrence: $10,000,000 ------------------ U.S. PROPERTY --------------- Carrier: Allianz Undenvrilers Insurance Company Policy Number: ART 3016558 Effective Dales: 0311512018 - 0311512019 Limit: $25,000,000 Deductible: $25,000,000 Properly Coverage: 'All Risk' of Direct Physical Loss or Damage to All Real and Personal Property, including Boiler &Machinery, Earthquake, Flood and Wind -Replacement Cost Basis, and Business Interruption -Actual Loss Sustained. Loss Payee or mortgagee as required by written conlraculoan agreement to tha the extent of your insurable interest. Waiver of Subrogation -Any person or organization whom you have entered into a contract or agreement, but only to the extent required by such contract or agreement. Other deductibles may apply as per policy terms and conditions. 2 ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 0000467 SP 0507 -C01 -P00467 -I CITY OF COPPELL ENGINEERING DEPARTMENT 255 PARKWAY BOULEVARD COPPELL, TX 75019