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Century Link-CS2009016001969 SP 0401 -C01 -P019094 CITY OF COPPELL ENGINEERING DEPARTMENT 255 PARKWAY BOULEVARD COPPELL, Tx 75019 ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MMID DfYYYY) U8012020 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 T14E 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 SUSROGATION 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 endorsernent(s). PRODUCER Marsh USA Ik, CA' Ucense #0437153 1301 5th Avenue, Suite 1960 Sealtle, WA 90101-2592 CONTACT NAMEI PHONE. W. FAX'. [ . ..No, Egg `----'" E-MAIL ADDRESS:. __ _. -µw--__-••- — —�.T Attn: Seattle.i erlreques@cnarsh.Cam 1 F& 21.219484326 INSURER(SIAFFQRDING COVERAGE _ NAfC #. INSURER A:: Greenwlch:lnstitance Com ap ny — T 22322 CN102197661•STND-ALL--20.21 cont mm none INSURER CenturyVii k, €nC. and all .subsidiaries; INSUR! R 9 ; Xt SpeCialtylnsUranGeCo. 37885 .__. _ _ INSURER c; Allianz Underwriters Ins Co3.6420 including but not 1€mited to:,.Qmst Cornmuniolions Intemabairal Inc-, Embarg Corporation; Level 3 Parent: LLC and Lev O Comm rlimfions, LLC 100 CenhtyLink Drive; MailStop 5TS154 INSURER p : _..m. _. _•• ._....._• •_._ — Monroe, LA 11203 INSURER E-. INSURER F. COVERAGES CERTIFICATE NUMBER: SEA -003478246=50 RFVIStnm A imni=R- 20 THIS IS TO ,CERTIFY THAT THE POLICIES OFINSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE. FOR TETE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY.CONTRAC.T OR. OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY RERTAw, 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_ W L7R TYPE OF INSURANCE AQOL SUER POLICYNi1Mf3ER IPO ICY FF Y Mk9IDOYlYEXP YYY _LIMITS....�..._•_..•.-•.w_..._.....�._ A X' COMMERCIALGENERALLIABILJTY � CLAIMS-MAgE n OCCUR x Katie. S*fiens RGD500033308 0910912020 0910.112021 EACH OCCURRENCE $ 3,000,000 DAMAGE Td: RNTE.4�'.'.m.m.. PREMISE_ TOR occurrence _.... •_.,•_•. $ 5il0.ao0 EXP {Roy one persnrfj -.e -......_ _.. $ 10,000 __....._� X. CONTRACTUAL LIABILITYMEa -- PERSONAL & ADV INJURY S 3.0.00,000 GENERAL AGGREGATE v .._.r PRODUCTS - COMPIOP AGG S` — 1.5,0D0,Off0 ...._.r.-,..........._... �J,00U,OOU . $. GEN'LAGGREGATE LIMIT APPLIES PER.. • X POLICY F— PRO- C_] i_'...._ JECT LOC -- $......... _........ OTHER:_-._._...._,._._._._. A AUTOMOeILELIAswtY RA0540033408. 09N112020 0910112021 COMBINED. SINGLE LIMIT (Ea $. .2,006,000 X ANY AUTO Auto Physical Damage.- Self Insured BODILY INJURY (Per.persar)} $. X OWNED SCHEDULER AUTOS ONLY AUTOS BODILY INJURY (per accidem) $ �� k HIRED,X NON -OWNED AUTOS -ONLY AUTOS ONLY PROPER7Y.DAMAGE Per eccadenl $. . X LIMBRELLALIAII X. OCCUR 02000023190001 09101/2026 09/0112021 EAOH OCCURRENCE $ 10,000;000 AGGREGATE-..____..._M....$._..,.._•......-�` 16.066,ROO EXCESS LIAR _...^ CLAIMS -MADE . DEI] RLZENTION $ _._._.._._._..__._.., : �__..........._..._._.......... B. B .B B WORKERSCOMPENSATION ANDEMPLOYERS' LlgeiL}TY YIN ANYPROPRIETOPJPARTt7ERIEXECUT.IVE OFFICERWEMSEREXCLUDED? [Mandatory in NHI If yes, describe under DESCRIPTION OF ❑PERATIQN5bel aw NIA RVVD600032908 (ADS) RWR500033008 (WI) RWE506033108 (WA) RWE500033208 (OH) .. 0910112020 6910112020 09101!2020 09101/2021 0910112021 091011202.1. 0910112021•__... PER 'TH- STATUTE ER `- E,L. EACH ACCIDENT —� .$ 1.006,060 ._._.........................._..... E. DISEABE -EA iMPLOYEE ._..--- $ 1,004,066 _ E.L DISEASE -POLICY LIMIT �$� 1,000,00.0 C Techndogy E&O incl. U5Z000023190001 0910`112020 0910112021 Each Clain Aggregate 10,60.0,000 CybedPrivacy.Uabilily Retention 5,000,000 DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES IAC 0RD 101; Additlohal Remarks Schodule, may be. attached, If more space is requirad] THE CITY OF:COPPELL, TEKAS IS AN ADDITIONAL INSURED PER THE GENERAL: LIABILITY BLANKETADDITIONAL INSURED ENDORSEMENT AS RESPECTS THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED AS. REQUIRED BY WRITTEN CONTRACT, CERTIFICATE HOLDER r.Amnr-i i A71nm CITY OF COPPELL ENGINEERING DEPARTMENT S14OULD ANY OF THE ABOVE= DESCRIBED POLICIES BE CANCELLED BEFORE. THE. EXPIRATION DATE THER2 OF, NOTICE WELL BE DELIVERED. IN 255 PARKWAY BOULEVARD ACCORDANCE WITH THE POLICY PROVISIONS. COPPELLTX 7.5019 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Katie. S*fiens ©1988-2016 ACORD CORPORATION. All nights reserved. ACORD 25 (20113103) The-ACORD name.and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN 102197661 LOC #: Seattle ADDITIONAL REMARKS SCHEDULE Page '2 of 2 .AGENCY NAMED INSURED Marsh USA Ino: Centurybitk, Inc arid all subsidiaries, Including bul,not:limiled 10: i0 vesl Communications. International IncRnbafq Corporation; .i_evel'3 Farertl, I.LC:and Level 3Commurrications, LLC POLICY NUMBER 100. CenturyLtrtk.Drue; Madtstop.5TS154 Monroe, LA .71203 CARRIER NAI C CODE . EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS. FORM IS A SCHEDULE TO ACORD FORM, FORK! NUMBER; 25. FORM TITLE: Certificate .of Liability Insurance. GENERAL LIABILITY. .AulornaticAdd itionat Insured's Primary Coverage Additional Ensured as respects your interest in the .operations of the blame¢ Insured as required by contract or agrsemept: Cove rag e. provided by Ihb above Ceneral.Oobillty pulicy shall be. primary and is limited to liability Msing nut of Ahmed Insurrvl's ewnersaip andloropaalions. Any insurance carried by the addit onA insured shalt not be conlributary insurance. Waive raf Transfer of Rights of Recovery Against alhers to Us (Waives of Subtopalion) - any per Drwganizat[on with whow ynu.have enlefed into a contract orapreemen1. or oy statute, law. or code of ordinance. Separation of Insureds Applies. Insurance covers incidents tWtoccur within 50'o I railroad property; any miroad exc.Iu5ions have been delered :per endorserne.nf CG2.41 T, AUTOMOBILE LIABiLIFY Any .persan'or arganiz ion you are'.requlied in a wfilten cor lract, agreement. stalule, law or code of ordinances provided iho 'bodily injury` or 'property damage" ocwirs subsequent to the executive of the conlr4l; agres mlenL.slatute, law or code of nrdlnances. Lessor- Additional Insured and: Loss Payee: 811 Lessors Waiver of Transfer of Righls of Recovery Againsl Others to. Us (Waileraf Subrogauon) Any person or organization wilh'whom you have.waived prior to the'accidenr or the. 'loss' under a wit Vad with that person ovorganizattdn,. Gr under statute, dao; or curie of ord'unanoes- WORKERS' COMPENSATION AND EMPLOYER'S UA.f31LITY AND EXCESS WORKERS'.COMPENgATION AND EMPLOYER'S LIAB1.L1TY (OH & WA - SELF-INSURED - $1,000,006 RETENTION) -- -- Waiver of Our Riohl to Recover from others Endorsement -Where required by wntten agieemerit signed prior to loss, or required by statute, lav cantle of ordinances executed. prior to loss. Coverage applies per aecmfenee: Additidrtal Insured as respects your interest in the.Dpsratiorls of. the Namad -lasured as rerluir�d by contract or.ngreeinenl- Waiver of Transfer al Rights of Recovery. Against Others.to Us (Waiver of Subfogation) - Any person or organization with whom.you have entered in lo a ccri tact or agreement,. but ori[y to the eztenl required by: such darltract or agreement: Separation of Insureds Applies. -------- COMMERCIAL. CRIME-FIDEiTY.BOND --- ------ — Carrier: XL specialty Insu force Company Polley Number. ELU 16972.420 Effeclive Dates: ON10020. 0 910 1 12 02 1 Each Occurrence: $1006.660 . _ •----.U.S_ PROPERTY --_.._..-.... Camier: Allianz Underwriters Insurance Company. Policy. No mber. UV00002 3 1 90061 Effective Dates: 09012020.- ON. 112021 Limit: $25,000,�QO Deductible' $25,000,000. Properly:.Coveraga:'Alt Risk" of birect.Physical Loss or Damage to All Real and -Pe roorial Properly; int jading Bailer & Machinery, Eadhgaake, Flood and Wind - Replacement Cost Basis, and Rosiness Inlerrup4m -Actual Lass Sustained. Lass Payee dr mortgagee: as required by wfiiten.contractldpan agreemeatla Ihe.the exlenlot your insurable interest: Waiver of Subrogation - Any person or orga tdzation whom you have entered into a contract or agreement, but only to the extent. required by such oonlfaet or agreement.,Olher deductibles may apply as per polio}+ terms and oondilionL AL:UML) 107 [200S1U1.j © 2008 ACORD CORPORATION. All rights.reserved. The ACORD dame and logo are registered marks of ACORD Dear.Cerbfjcate:i 61der: As many companies have moved to a: reinate working erMronment, Mai IIhg Certificates of Insurance to.a physicat address can cause unnecessary delays in-Prov€di ng. you pr.00.f. of insurance. To streamline de] ivery acid i ri an effart to support our fi rrh's comhi itme nt to sustainability, goingforward, we world like tad istribvte your Ce.rtificat!�s of Insurance electronically4f possible. We are kindly requesting Ce.rtifirate Hol ders provide us ars ernaii address where sive can deIivei .your COI ire the future. Please.send your response to- U50 erations.email marsh corn and -provide the.fail.owi.ng informati€ n so that the can. expediite.your C01 delivery. Certifi te:f#.(.5hown below Insured Name — e;g.:.ABC-1234567,s1 -b!). * E -Mail for future :delivery: For undeliverable email addresses'.Our system is ConfE tired to automatiCal Iy red rest the Certificate for deljveryvta € SP5: Lastly; i.fydu no longer need this C©f please respond:to US012erations. emafl!2marsh..rom with the Certificate num.€ber and we will inactive the record in our system to avoid future automatic defiver .. Thqnk. you. US Operations,Marsh USA, -Inc..