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HomeMy WebLinkAboutCOI - Lumen Technologies, Inc. - Expires: 2026-09-01SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY B 09/01/2025 09/01/2026 09/01/2025 X B 15,000,000 RWR500033013 (WI) Y 22322 USZ00113025 10,000,000 A Y C 10,000,000 09/01/2026 B X Fireman's Fund Indemnity Corporation Technology E&O incl. 09/01/2025 CN102197661-STND-ALL-25-26 Y 1,000,000 37885 .... 09/01/2026 SEA-003796977-11 09/01/2025 X 15,000,000 08/26/2025 X 09/01/2026 RWE500033213 (OH) 7 Y 5,000,000 09/01/2026 Cyber/Privacy Liability 3,000,000 X Retention X 1,000,000 1,000,000 A 09/01/2026 09/01/2025 09/01/2025 X 09/01/2026 11380 RAD500033413 Each Claim/Aggregate 10,000 09/01/2025 RWD500032913 (AOS) RWE500033113 (WA) X USZ00113025 500,000 The City of Gilroy, its officers, officials, and employees are included as Additional Insured as respects their interest in the operations of the Named Insured as required by contract or agreement regarding General Liability and Auto Liability. and all subsidiaries, including but not limited to: Lumen Technologies, Inc. CenturyLink Communications, LLC Qwest Corporation; Level 3 Communications, LLC and Monroe, LA 71203 100 CenturyLink Dr. 3,000,000 Greenwich Insurance Company X CA License #0437153 MARSH USA LLC. Seattle, WA 98101-2682 1301 5th Avenue, Suite 1900 Attn: Seattle.certrequest@marsh.com / Fax: 212-948-4326 RGD500033313 XL Specialty Insurance Co. N Gilroy, CA 95020 City of Gilroy 7351 Rosanna Street 09/01/2025 Auto Physical Damage - Self Insured B 2,000,000Y Y CONTRACTUAL LIABILITY X X C 10,000,000 09/01/2026 Y ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: MARSH USA LLC.� � per endorsement CG2417. � 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 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 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, or by by the additional insured shall not be contributory insurance.� -------------------- GENERAL LIABILITY --------------------� �� 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 � � 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” Effective Dates: 09/01/2025 - 09/01/2026� 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 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 � prior to loss.� -------------------- COMMERCIAL CRIME - FIDELITY BOND --------------------� $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 2 Seattle Certificate of Liability Insurance 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. Each Occurrence: $15,000,000� 100 CenturyLink Dr.� under a contract with that person or organization, or under statute, law or code of ordinances.� Limit: $25,000,000� to the executive of the contract, agreement, statute, law or code of ordinances.� 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 Deductible: $1,000,000� � Carrier: XL Specialty Insurance Company� -------------------- AUTOMOBILE LIABILITY --------------------� � Carrier: Fireman's Fund Indemnity Corporation� required by such contract or agreement. Separation of Insureds Applies. � Property Coverage: "All Risk" of Direct Physical Loss or Damage to All Real and Personal Property, including Boiler & Machinery, Earthquake, Flood and Wind - Replacement Cost � 25 Policy Number: ELU205909-25� Automatic Additional Insured’s Primary Coverage� Basis, and Business Interruption - Actual Loss Sustained.� Deductible: $25,000,000� Lessor - Additional Insured and Loss Payee - All Lessors � � and all subsidiaries, including but not limited to:� Lumen Technologies, Inc.� Qwest Corporation; Level 3 Communications, LLC and� Monroe, LA 71203 ------- WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY AND EXCESS WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY (OH & WA - SELF-INSURED - Policy Number: USZ00113025 � 2 CN102197661 CenturyLink Communications, LLC� -------------------- U.S. PROPERTY --------------------� -------------------- EXCESS/UMBRELLA --------------------� Effective Dates: 09/01/2025 - 09/01/2026�