COI - Mobilitie, LLC - Expires 2022-11-11ACOR" CERTIFICATE OF LIABILITY INSURANCE
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DATE (MM1DD/YYYY)
11/11/2021
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
Marsh Risk & Insurance Services
17901 Von Kerman Avenue, Suite 1100
CONTACT
NAME:
PHONE FAX
A/c No):
E-MAIL
ADDRESS:
(949) 399-5800; License #0437153
Irvine, CA 92614
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: National Fire Insurance Company of Hartford
20478
CN131042476-Proj-GAUW-21-22 CAGI LRO
INSURED
Mobilitie, LLC
660 Newport Center Drive, Suite 200
INSURER B :Continental Casual Company
20443
INSURER C : Continental Insurance Company
35289
INSURER D : Great American E&S Insurance Company
37532
Newport Beach, CA 92660
INSURER E : Berkley Assurance Company
39462
INSURER F :
COVERAGES CERTIFICATE NUMBER: LOS-002511064-09 REVISION NUMBER:
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
US
POLICY NUMBER
MMIDCDmYY
MM/DD�YY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
7011613127
11/1112021
11111/2022
EACH OCCURRENCE
$ 1+000,000
CLAIMS -MADE a OCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 1,000,000
MED EXP (Any oneperson)
$ 15,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
JECT LOC %(
PRODUCTS - COMP/OP AGG
$ 2,000,000
HPOLICY
$
OTHER:
B
AUTOMOBILE LIABILITY
7011617453
11/11/2021
11/11/2022
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
X HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
$
X
UMBRELLA LIAB
X
OCCUR
7011628002
11/11/2021
11111/2022
EACH OCCURRENCE
$ 25,000,000
AGGREGATE
$ 25,000,000
EXCESS LIAB
CLAIMS -MADE
DED X RETENTION $10 000
$
C
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? �N
(Mandatory in NH)
NIA
7011603259 (AOS)
7011604086 (CA)
11111/2021
1111112022
11111/2022
X1PER
STATUTE ERH
E.L. EACH ACCIDENT
1000 000
$ +
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
D
Pollution Liability
PRE3159857
11/11/2021
11/11/2022
Limit (SIR:$25,000):
5,000,000
E
Professional Liability
PCADB-50158551121
11/11/2021
11/11/2022
Limit (SIR:$25,000):
5,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Re: AGMT: A01955
The City, and its elected and appointed council members, board members, commissioners, officers and officials are included as additional insured where required by written contract with respect to General Liability
and Auto Liability.
Waiver of subrogation is applicable where required by written contract and subject to policy terms and conditions with respect to General Liability, Auto Liability and Workers Compensation.
CERTIFICATE HOLDER CANCELLATION
City of Gilroy
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
7351 Rosanna Street
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Gilroy, CA 95020
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
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01988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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