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MCI-CS210614 (2)251. CERTIFICATE OF LIABILITY INSURANCE I]AT 11611 111021 Yy ��-- fffilSd�2621 THIS CERTIFICATE 1S ISSUED AS. A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE .HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NE13ATIVELY .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 l5 WAIVED, subject to the terms and conditions of the policy, certalwpokies may require an endorsement. A statement on tt1€s °1 certificate does not confer rights to the certificate holder In lleu.af.such endorsement(s). '� PRODUCER. CONTACT ,Wv Ann Risk Services Northeast, inc. EFAX New York NY office �(A1C. Nn. Fait}; CSs6) 253-712 iC. No:l: (9D0Y 363-0105 m one Liberty plaza E-MWC o 165. Broadway,. suite 3207. ADDRESS: New York NY 10006 USA INSURED verizen.Wireless its subsidiaries and Affiliated Companies one verizon way Basking Ridge N7 07920-1097 USA UVkNtAUhb CERTIFICATE NUMBER: 570 THIS IS TO CERTIFY THAT THE. POLICIES OF INSURANCE LISTED,BI INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERMOR CO CERTIFICATE MAYBE ISSUER OR MAY PERTAIN, THE INSURANCE EXCLUSIONS AND.CONDiT€ONS OF SUCH POLICIES, LIMITS SHOWN R TYPE OFfNSURANCE iNSO YJVD POLICY x I COMMERCIAL GENERAL LIABILITY I I I IT7MMT-- I CLAIMS -MADE M P ----F OCCUR GEISLAGGREGATE LIMIT APPLIES. PER: ?C POLICY❑ PRO ECT f—]LOO OTHER' OCCUR AUTOMOBILE LIABILITY ANY AUTO EACH04=19RENCE OWNED. SCHEDULED. EXCESS LEAP AUTOS ONLYAUTOS.HtFMDAUTOS CLAWS -MADE NON -PINNED AGGREGATE ONLY AUTOS ONLY INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: AiU Insurance Company 19399 INSURER e: National Union Fire ins Co of Pittsburgh 19445 INSUFIER.C: INSURER D: INSURER E: INSURER P: 0361 REVISION NUMBER: HAVE BEEN ISSUED TO. THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 7N OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS RDED BY THE POLICIES DESCRIBED HEREIN IS. SUBJECT TO ALL THE TERMS, PAVE BEEN REDUCED 13Y PAID CLAIMS. Limits shown are as requested . POLICY EFF PO[IrY-EXF R MNUODIYYY MWDDNYYYI LIMITS EACH OCCURRENrEJAMAUF PREMISES Eaoccurranc© 53:;aaa,00a MED ExP iAny bac Dotson] S10,000 PERSONAL& ADV INJURY s3, mQ.,.o0o GENERi1LAGGREGATE€3,000,000 PRODUCTS-COMP)OPAGG S3,000'000 LIMIT BODILY INJURY { F'cr person} I J BODILY INJURY (Por .accldahiy CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBEDPOLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVEHED IN ACdORDANCE wn-H THE POLICY PROVISIONS. City of Coppell AUTHORfZEDREPN ESE NTATiVE Attn: $Cott Lata 255 E. Parkway Blvd. Coppell Tx 75019 USA �e.fs�aa�d c%f'�.J9aa 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD UMBRELLALIAS OCCUR EACH04=19RENCE EXCESS LEAP CLAWS -MADE AGGREGATE DE❑ RETENTION A WORKERS COM PENSATIONAND 1639 20 06/30/Z021 06/10/2627PER STATUTE O - XER EMPLOYER&' LIABILITY YIN AOS ANY PROPRICTO R ,'. PARTNER! EX ECUTiVE .A OFFIC E RiM CMAER EKCLIX EA4 NiA. 16393206 0.6/3(}/2021 06/30/2{}.22 E'L- EACH ACCIDENT SI, OOP, 0C (MandnEory. in NH} E.L. DISEAS&EAEMPLOYEE' [,d, f yaS, describe. kinder si, 000;0{ DESCR:PTICN.OF0PERATIO NS On1ow E.L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS i LOCATIONS r VEHICLES (ACORD 101, Additional Roma rks Schedule, may Se attached if more spade is requlrud) Re.` 363 Forth Denton Tap Road Coppell TeXas 75019 Site Name ?'#62219 Coppell North The City Of Coppell is Included As An Additicaal insured (Except Workers Compensation) AS Required By written Contract.. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBEDPOLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVEHED IN ACdORDANCE wn-H THE POLICY PROVISIONS. City of Coppell AUTHORfZEDREPN ESE NTATiVE Attn: $Cott Lata 255 E. Parkway Blvd. Coppell Tx 75019 USA �e.fs�aa�d c%f'�.J9aa 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570005427365 LOC.#:. `--- ADDITIONAL REMARKS SCHEDULE Page. _ of NAMED 1N8uRED Aon Risk SerV1Ce5 ." r hEdSti Inc.. MCI COfI1fI1Gn7Cdtls7rl$ 52IViCES, LLC PO LICY N 11MB E R See Certificate Number: 5.7068775.6374. CARRIER NA1C CODE See CertifTrate Number: 570087755374 EFFECTJVECATE; ADDITIONAL REMARKS THIS.ADDITIONAL REMARKS FORM IS A SCHEDULE TO. ACORD. FORM, FORM NUM13ER: ACORD 25 FORM TITLE: Certificate nf.I,iabiiity insurance INSURER(S) AFFORDING COVERAGE I MAIC #. INWREk TN—S'U12F R INSURER INSURER AUD.I.Tr.�,'v�,r, �'CIr.ICrr s ll'.a policy below docsalot include Iilulliflfot'nwion. refer L1jile col'rc.s'p1 riding polfuy On Ihe.ACORD CCrllflCate form f& polluy 11rr1;tS'. IXR TYPE OE'iNS1111/1N<:C 7,Y'1. SUHR POl.ii_'1':h1i,1133f:H I.N817 IVvv 1'[Yi,fC.l' LFFECTIVN PRLH'.Y EXPIRATION LINIFTq DATC DATE AGTOMO6±LE LTABILTTY (AVN1/DD1YYY"1') ('F7M/l)nIVYVY] 45.943.01 06/.30/2421 65/35/2022 NH.- Primary f3 459.43o2 n6/3Q/z021 55/30/2022 NP - Excess WORKERS COMPENSATION A NIA 16393207 05/-35/?Q21 06/30/2022 NY' N/A 163.93258 n6/30/2a2:1 o6/36/zo22. wT A NIR z6393205 65/35/2627 56J35/2022 N], TX; VA �CC1RQ 707 (200910iJ Tha AC ORD narne.and 0.200 ACOR4 CORPORAnON. Aff rights reserved. foga:are ragisiered marks of ACO RD