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HomeMy WebLinkAboutCOI - Lumen Technologies, Inc. - Expires 2027-09-01SHOULD 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 09/01/2026 09/01/2027 09/01/2026 X B 15,000,000 RWR5000330-14 (WI) Y 22322 USZ00113025 10,000,000 A Y C 25,000,000 09/01/2027 B X Fireman's Fund Indemnity Corporation Technology E&O incl. 09/01/2026 CN102197661-STND-ALL-26-27 Y 1,000,000 37885 . 09/01/2027 SEA-003796977-17 09/01/2026 X 15,000,000 08/20/2026 X 09/01/2027 RWE500033214 (OH) 7 Y 5,000,000 09/01/2027 Cyber/Privacy Liability 3,000,000 X Retention X 1,000,000 1,000,000 A 09/01/2027 09/01/2026 09/01/2026 X 09/01/2027 11380 RAD500033414 Each Claim/Aggregate 10,000 09/01/2026 RWD5000329-14 (AOS) RWE500033114 (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. 100 CenturyLink Dr. Qwest Corporation; Level 3 Communications, LLC and CenturyLink Communications, LLC Monroe, LA 71203 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 RGD5000333-14 XL Specialty Insurance Co. N Gilroy, CA 95020 City of Gilroy 7351 Rosanna Street 09/01/2026 Auto Physical Damage - Self Insured B 2,000,000Y Y CONTRACTUAL LIABILITY X X C 10,000,000 09/01/2027 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. Separation of Insureds Applies. Insurance covers incidents that occur within 50’ of railroad property, any railroad exclusions have been deleted per endorsement CG2417. 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 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 statute, law or code of ordinance. be contributory insurance. -------------------- GENERAL LIABILITY -------------------- agreement, but only to the extent required by such contract or agreement. Other deductibles may apply as per policy terms and conditions. organization, or under statute, law or code of ordinances. 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 Basis, and Business Interruption - agreement, statute, law or code of ordinances. -------------------- COMMERCIAL CRIME - FIDELITY BOND -------------------- -------------------- AUTOMOBILE LIABILITY -------------------- 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 Deductible: $1,000,000 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. Effective Dates: 09/01/2026 - 09/01/2027 -------------------- EXCESS/UMBRELLA -------------------- 2 Seattle Certificate of Liability Insurance Policy Number: USZ00113025 Monroe, LA 71203 Actual Loss Sustained. Lessor - Additional Insured and Loss Payee - All Lessors Carrier: XL Specialty Insurance Company Carrier: Fireman's Fund Indemnity Corporation 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. Each Occurrence: $15,000,000 ------- WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY AND EXCESS WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY (OH & WA - SELF-INSURED - $1,000,000 RETENTION) ---- Deductible: $25,000,000 Policy Number: ELU212286-26 Effective Dates: 09/01/2025 - 09/01/2028 25 Automatic Additional Insured’s Primary Coverage 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 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 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, and all subsidiaries, including but not limited to: Lumen Technologies, Inc. Qwest Corporation; Level 3 Communications, LLC and CenturyLink Communications, LLC 2 CN102197661 100 CenturyLink Dr. Limit: $25,000,000 -------------------- U.S. PROPERTY --------------------