Loading...
CERTIFICATE OF LIABILITY INSURANCE (1091) ACCOR"® CERTIFICATE OF LIABILITY INSURANCE DATE CERTIFICATE 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 CONTACT Marsh USA Inc. NAME: PHONE CA License#0437153 (A/C,No Ext): FAX No)7 1301 5th Avenue,Suite 1900 E-MAIL Seattle,WA 98101-2682 ADDRESS: Attn:Seattle.certrequest@marsh.com/Fax 212-948-4326 INSURER(S)AFFORDING COVERAGE NAIC# CN102197661-STND-ALL-20-21 INSURERA: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 Cc 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-003615790-08 REVISION NUMBER: 3 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICYNUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY X X RGD500033308 09/01/2020 09/01/2021 EACH OCCURRENCE $ 3,000,000 DAMAGE TO RETED CLAIMS-MADE 1XI OCCUR PREMISES (E.occurrrence) $ 500,000 X CONTRACTUAL LIABILITY MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 15,000,000 X POLICY❑ PRO JECT [:] LOC PRODUCTS-COMP/OP AGG $ 15,000,000 OTHER: $ A AUTOMOBILE LIABILITY X X RAD500033408 09/01/2020 09/01/2021 coEaMBINEDidentSINGLELIMIT $ 2,000,000 acc X ANY AUTO Auto Physical Damage-Self Insured BODILY INJURY(Per person) $ X OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident X UMBRELLALIAB X OCCUR X X U5Z000023190001 09/01/2020 09/01/2021 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED RETENTION$ $ B WORKERS COMPENSATION X RWD500032908(AOS) 09/01/2020 09/01/2021 X PER oTH- AND EMPLOYERS'LIABILITY STATUTE ER B Y/N RWR500033008(WI) 09/01/2020 09/01/2021 1,000,000 ANYPROPRIETOR/PARTN ER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) RWE500033108(WA) 09/01/2020 09/01/2021 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 B If yes,describe under RWE500033208(OH) 09/01/2020 09/01/2021 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Technology E&O incl. U5Z000023190001 09/01/2020 09/01/2021 Each Claim/Aggregate 10,000,000 Cyber/Privacy Liability Retention 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Re:Telecommunications Provider registration Start Date:5/28/2019 End Date:5/27/2020 City of Clearwater is included as Additional Insured as respects their interest in the operations of the Named Insured as required by contractor agreement regarding General Liability,Auto Liability,and Umbrella Liability. CERTIFICATE HOLDER CANCELLATION City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn:Bill Horne THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN One Clearwater Tower,6th Floor ACCORDANCE WITH THE POLICY PROVISIONS. 600 Cleveland St Clearwater,FL 33756 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Katie Stephens @ 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN102197661 LOC#: Seattle ACOOR 0 ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. CenturyLink,Inc.and all subsidiaries, including but not limited to:Qwest Communications International Inc.,Embarq Corporation, POLICY NUMBER Level 3 Parent,LLC and Level 3 Communications,LLC 100 CenturyLink Drive;Mailstop 5TS154 Monroe,LA 71203 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS 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,or by statute,law or code of ordinance. Separation of Insureds Applies. Insurance covers incidents that occur within 50'of railroad property,any railroad exclusions have been deleted per endorsement CG2417. -------------------AUTOMOBILE LIABILITY------------------- Any person or organization you are required in a written contract,agreement,statute,law or code of ordinances provided the"bodily injury'or"property damage"occurs subsequent to the executive of the contract,agreement,statute,law or code of ordinances. 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 waived prior to the"accident"or the"loss" under a contract with that person or organization,or under statute,law or code of ordinances. ---------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 Endorsement—Where required by written agreement signed prior to loss,or required by statute,law or code of ordinances executed prior to loss. -------------------EXCESS/UMBRELLA------------------- Coverage applies per occurrence.Additional 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 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. -------------------COMMERCIAL CRIME-FIDELITY BOND-------------------- Carrier:XL Specialty Insurance Company Policy Number:ELU16972420 Effective Dates:09/01/2020-09/01/2021 Each Occurrence:$15,000,000 -------------------U.S.PROPERTY-------------------- Carrier:Allianz Underwriters Insurance Company Policy Number:U5Z000023190001 Effective Dates:09/01/2020-09/01/2021 Limit$25,000,000 Deductible:$25,000,000 Property Coverage:"Al 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 contract/loan agreement to the 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. ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD