MCI-CS210614® CERTIFICATE OF LIABILITY INSURANCE
DATE(MMraONYYY)
U11472D21
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 DOESNOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: It th.a certificate holder is an ADD ITI0NAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If
SUBROGATION[S WAIVED,' subject to the terms and conditions. of the policy, certain policies may require:an endorsement. A statement on this
cart ificate'does not confer rights to the certificate holder in lieu of such endorsementm,
ARODUCER
Aon Risk services Northeast, Inc.
New York IVY Office
CONTACT
NAME:
PHONE
(AC. No. Ext):. [8667 283-7122 0.0 No.: ($0Q} 353-a1Qs
One Liberty Plaza
165 6roadway,. Suite 3201
E-MAIL
ADDRESS:
Clew York NY 10006 USA.
INSURER{S) AFFORDING COVERAGE MAIC #
INSURED
IINSURER A-. A1U. insurance Company 19399
MdMetrb Access Transmission
Serv.ice,s Corp.
1095 Avenue. of The.Americas
INSURERS,,. National Union Fire Ins Co of Pittsburgh 1944.5
INSURER C:
New York NY 10035 USA
INSURER D;
1NSURER E;
IN5UREFi P;
MED ERP IArlq qne persow S 10 , 000
(;VVEhtAUft-i LiEH IIFIOATE NUMBEH: tIUMS(t62(14 REVISION NUMBER:
THIS IS TO. CERTIF=Y THAT THE POLICfES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FCR THE POLICY PERIOD
INDICATED... NOTWITHSTANDING.ANY REQUIREMENT, TE14M OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUES] .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
LTA
TYPE OF INSURANCE
:INSD
WVD
POLICY NUMBER
MMIDD7YYYY .
M3r oDIYYY
LIMITS.
9
X COMMERCIAL GENERAL LIABILITY
EACHOCGt1RRENCE S1,000.006
CLAMS-tAAOE k� OCCUR
PREMSES Ea dccuran, 12,000,()0()*
MED ERP IArlq qne persow S 10 , 000
X XO.J.Uovoraw IS lrwiuded
PERSONAL& ADV INJURY $1,000.,:}00
GEN'LAGGREGATELIMIT APPOESPER!
GENERALAGGREGAM $2,000,000
]( POLICY❑PRO- LDC
JECT
PAODucisS COMPIOPAGG. $2.;000,000
DTHEA:
e
AUTOMOBILE LIABILITY
4594298
ADS
06/3.0/2021.06/30/20Z2
.COMBINED SINGLE LIMIT $1, 000, 000
re id nr
SO DI LYINJJOY tPer porsw
a
X ANYAUTO
4594299
06/30(202106/.30/2022
a.
OVVNED SCHEDULED
AUTOS ONLY AU10S
i1RED.AUTOS iJON•OWNED
ONLY AUTOS ONLY
MA
4594340
VA'
06/30/2021
06/30/2022
BO IN LYINJLIRYIperaCEdo l
PAOpERTYOAMAGE.
aer accidenil
a
See Next Page
06/30/2021
06/30/2022
UMBRELLALIAB
OCCUR
EA CIHOGCURRE'NCE
EXCESS LIAR
CLANIS7MAOE
AGGREGATE
DEO I JIMTENT1.00
A
A
WORKERS CCMPENSATIONAND
EMPLOYERS' LIABILITY YIN
ANY PAPPR(MR 11 PARTNER t E(FGUTIVE ❑
PfFICERIMEMUEREXCLUDEe? N
(Mandatory In NH)
sDESC[.yyDS. Rd dC5cft'hNR undor
IO0r OPERATIONS holnw
NIA
1830259
AOS
163.93206
CA
U 0 2021
06/30/2021
06/30/2022
06/30/2622
.x OTH-
PER STATUTE
ER
I=.L. EAOH ACCIDENT $1,000.000
E. L. DIS EASE -EA EMPLOYEE 51,000,000
E.LbISEAS E -POLICY LIMIT $1'.0 00, 000
DESCRIPTION OF:OPERATIONSILOCATIONS.! VEHICLES (AC ORD 101, AUdIVonal Remarks Schedule; may ho illtached If room Apoco isrequlredy
Named Insured Includes: mumetrn Access Tran smission.servites carp . dba.VerriZon Access Transmission services.. RE: To work in
the Public Right -of -Way. city of CoppelI is.in.Cluded 45 Additi:Ona l.znsur•ed with respect to tlie.Gene ral LiabiIity policy.
CERTIFICATE HOLDER
CANCELLATION
ti a
�.a
SHOULD ANY Or THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE; THEREOF, NOTICE WILL BE :DELIVERED IN ACCORDANCE. WITH THE -
POLiCY RR0VISIONS.
Via=
City of Coppell AUTHORIZE 0 8 EPRE 9 ENTATIVE
Attn: SCUtt yLata. �.:
CPPPel 7 DTX 1 191 LISA
. .�'jL
®1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
j
W
POLICY NUMBER, GL 172-88-98
COMMERCIAL GENERAL LIABILITY
CG 20 26 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name .Of Additional Insured. Person(s) Or Organizatiort(s)-
ANY PERSON OR ORGANIZATION WHOM YOU BECOME OBLIGATED TO .INCLUDE AS AN ADDITIONAL
INSURED AS A RESULT OF ANY CONTRACTOR AGREEMENT YOU HAVE ENTERED INTO.
Information required to complete this Schedule, if not shown above, will be shown 1n the Declarations:..
A. Section II — Who Is An Insured is arnended 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 ornissions 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
CG 20 26 12 19
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 insuranceafforded 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;.
whichever is less.
This endorsement shall not increase the.
applicable limits of insurance.
0 Insurance Services Office, Inc.., 2018.
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