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HomeMy WebLinkAboutCOI - Clear Channel Outdoor, LLC - Expires 2021-03-31ACORD® ��. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 03/25/2020 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 USA Inc. 4400 Comerica Bank Center CONTACT NAME: Cathy Crown PHONE (210) 691-4173 a/c No): (210) 737 3584 (A/C. No. Ext): 1717 Main Street Dallas, TX 75201 E-MAIL Cath Crown marshm ADDRESS: y @ .co INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: National Union Fire Insurance Co _ 19445 CN101851261-GAWU-GAWU-20-21 GAW 1 71072 _ INSURED Clear Channel Outdoor, LLC INSURER B : American Home Assurance Company 19380 -- INSURER C : NIA N/A 8 its subsidiaries 4830 North Loop 1604 W, #111 San Antonio, TX 78249 _ INSURER 0 : Illinois National Insurance Company _ 23817 INSURER E: NIA NIA INSURER F : NIA NIA COVERAGES CERTIFICATE NUMBER: HOU-003499002-06 REVISION NUMBER: 8 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 I TYPE OF INSURANCE ADDL SUBR —� POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDDIYYYY v LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR _ GL1728871 03/31/2020 03131/2021 EACH OCCURRENCE $ 1.000,000 DA O NR�fED i PREMISES (Ea occurrence)_ $ 1 OOD,OOO MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 7'OTHER: L AGGREGATE LIMIT APPLIES PER POLICY � PRO t X I LOC JECT GENERAL AGGREGATE $ 1,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 $ A A AUTOMOBILE LIABILITY X ANY AUTO X OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED NON -OWNED AUTOS ONLY AUTOS ONLY I CA6631256 (AOS) CA6631257 (MA) 03/31/2020 03/31/2020 03/31/2021 03/31/2021 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDF1 RETENTION $ $ B D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y 1 N OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC23096116 (California) WC23096120 (Florida) Continued On Next Page 03/31/2020 03/31/2021 03131/2021 X IPER OTH- STATUTE ER E L EACH ACCIDENT 1.000,000 $ _ E L DISEASE - EA EMPLOYEE _ _ $ 1,000,000 E L DISEASE - POLICY LIMIT $ 1,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) RE: CCO-OAKLAND, CA - TRANSIT SHELTERS AT VARIOUS LOCATIONS IN THE CITY OF GILROY City of Gilroy, its City Council, comissions, officers, employees, agents and volunteers are additional insured for General Liability and Auto Liability, and such insurance is primary and non-contributory, but only to the extent of the liability assumed under written contract. Workers' Compensation coverage is evidenced for employees of the Named Insured only. Workers Compensation is evidenced for employees of the Named Insured Only. IiCK 1 IMAM 1 C r1VLUCK L:ANC:tLLA I IUN City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukheriee ,.Mm ►•:. IN4,1 RIA^4-R,c. 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101851261 LOC #: San Antonio AoCCOR L? ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED MARSH USA Inc. Clear Channel Outdoor, LLC 8 its subsidiaries 4830 North Loop 1604 W, #111 POLICY NUMBER San Antonio, TX 78249 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 Workers' Compensalion Continued: Policy Number: WC23096112 Colorado (CO), Delaware (DE), Georgia (GA), Indiana (IN), Maryland (MD), Michigan (MI), Minnesota (MN), Nebraska (NE), New Mexico (NM), Nevada (NV), New York (NY), Oregon (OR), Texas (TX) Effective Date (MM/DD/YYYY)': 03/3112020 Expiration Date (MM/DD/YYYY)': 03131/2021 Carrier: New Hampshire Insurance Company Policy Number: WC23096114 Arizona (AZ), Illinois (IL), Kentucky (KY), North Carolina (NC), New Hampshire (NH), New Jersey (NJ), Pennsylvania (PA), Virginia (VA) Effective Date (MM/DDIYYYY)': 03/31/2020 Expiration Date (MM/DD/YYYY)': 03/31/2021 Carrier: New Hampshire Insurance Company Policy Number: WC23096118 Massachusetts (MA), North Dakota (ND), Ohio (OH). Washington (WA), Wisconsin (WI), Wyoming (WY) Effective Date (MM/DDNYYY)•: 03/3112020 Expiration Date (MWDD/YYYY)': 03/31/2021 Carrier: New Hampshire Insurance Company Workers Compensation is evidenced for employees of the Named Insured Only. Certificate Holder included as additional insured on General Liability and Auto Liability, but only with respect to liability that arises out of the acts or omissions of the Named Insured; or, to the extent of the liability assumed by the Named Insured under written contract. The Auto Liability policy is primary, but only with respect to liability that arises out of the acts or omissions of the Named Insured; or, to the extent of the liability assumed by the Named Insured under written contract. The General Liability policy is primary and non-contributory, but only with respect to liability that arises out of the acts or omissions of the Named Insured; or, to the extent of the liability assumed by the Named Insured under written contract. Waiver of subrogation is applicable with respect to General Liability, Auto Liability, and Workers' Compensation policies where required by written contract and subject to policy terms and conditions. In the event coverage is cancelled for any statutorily permitted reason, other than nonpayment of premium, advanced written notice will be mailed or delivered to person(s) or entity (ies) according to the notification schedule shown below. Per the most current schedule maintained by Marsh USA, Inc. and furnished to AIG no less than 45 days prior to the effective date of cancellation. Number of Days Notice of Cancellation: 30. In the event coverage is cancelled for any statutorily permitted reason, other than nonpayment of premium, advanced written notice will be mailed or delivered to person(s) or entity (ies) according to the notification schedule shown below: Per the most current schedule maintained by Marsh USA, Inc. and furnished to XL Catlin Insurance no less than 45 days prior to the effective date of cancellation. Number of Days Notice of Cancellation: 30. ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AtC40RIDO CERTIFICATE OF LIABILITY INSURANCE D03/2512020DIYYYY) 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 USA Inc. 4400 Comerica Bank Center CONTACT Cathy Crown NAME:PHONE (210) 691-4173� Noll: (210) 737 3584 EMAIL Crown Cath marsh.com ADDRESS* Cathy.Crown@marsh.com 1717 Main Street Dallas, TX 75201 INSURERS AFFORDING COVERAGE NAIC.# INSURER A: National Union Fire Insurance Co 19445 CN101851261-GAWU-GAWU-20-21 GAW 1 INSURED Clear Channel Outdoor, LLC INSURER B : American Home Assurance Company 19380 INSURER C : NIA N/A & its subsidiaries 4830 North Loop 1604 W, #/111 San Antonio, TX 78249 INSURER D : Illinois National Insurance Company 23817 INSURER E : N/A N/A INSURER F : NIA N/A COVERAGES CERTIFICATE NUMBER: HOU-003498622-06 REVISION NUMBER: 7 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 SUBR POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY � OCCUR GL1728871 03/31/2020 03/31/2021 EACH OCCURRENCE $ 1,000,000 T R N DAMCLAIMS-MADE PREM PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FI PRO JECT F LOC GENERAL AGGREGATE $ 1,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 $ OTHER A A AUTOMOBILE LIABILITY X ANY AUTO CA6631256 (AOS) CA6631257 (MA) 03/31/2020 03/31/2020 03/31/2021 03/31/2021 EO MBBIINIEDiSINGLE LIMIT $ 1.000,000 BODILY INJURY (Per person) $ X OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAR DED RETENTION $ $ B D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC23096116(Califomia) WC230961203/31/2020 (Florida)( ) Continued On Next Page 03131/2021 03/3112021 X IPER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) REFERENCE: Bus Shelters Certificate Holder is an additional insured for General Liability and Auto Liability, but only to the extent of the liability assumed under written contract. Workers' Compensation coverage is evidenced for employees of the Named Insured only. C.CK 111-MoA I C MULLICI'C t:ANt+tLLA I IUN City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee j�t�,,a�o,�•: ��„tc.�ute_ ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101851261 LOC #: San Antonio ACo ADDITIONAL REMARKS SCHEDULE ko.�. Page 2 of 2 AGENCY NAMED INSURED MARSH USA Inc. Clear Channel Outdoor, LLC & its subsidiaries 4830 North Loop 1604 W, #111 POLICY NUMBER San Antonio, TX 78249 CARRIER NAIC CODE EFFECTIVE DATE: I N a i't f_lii:t-'7 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers' Compensation Continued: Policy Number: WC23096112 Colorado (CO), Delaware (DE), Georgia (GA), Indiana (IN), Maryland (MD). Michigan (MI). Minnesota (MN). Nebraska (NE), New Mexico (NM). Nevada (NV). New York (NY), Oregon (OR), Texas (TX) Effective Date (MWDD/YYYY)': 03/31/2020 Expiration Date (MM/DD/YYYY)*: 03/31/2021 Carrier: New Hampshire Insurance Company Policy Number: WC23096114 Arizona (AZ), Illinois (IL), Kentucky (KY). North Carolina (NC). New Hampshire (NH), New Jersey (NJ), Pennsylvania (PA), Virginia (VA) Effective Date (MM/DDYYYY)*: 03/31/2020 Expiration Date (MM/DD/YYYY)': 03/31/2021 Carrier: New Hampshire Insurance Company Policy Number: WC23096118 Massachusetts (MA), North Dakota (ND), Ohio (OH), Washington (WA), Wisconsin (WI), Wyoming (WY) Effective Date (MM/DD/YYYY)*: 03131/2020 Expiration Date (MM/DDYYYY)*: 03/31/2021 Carrier: New Hampshire Insurance Company Workers Compensation is evidenced for employees of the Named Insured Only Certificate Holder included as additional insured on General Liability and Auto Liability, but only with respect to liability that arises out of the acts or omissions of the Named Insured; or, to the extent of the liability assumed by the Named Insured under written contract. The Auto Liability policy is primary. but only with respect to liability that arises out of the acts or omissions of the Named Insured; or, to the extent of the liability assumed by the Named Insured under written contract. The General Liability policy is primary and non-contributory, but only with respect to liability that arises out of the acts or omissions of the Named Insured; or, to the extent of the liability assumed by the Named Insured under written contract. Waiver of subrogation is applicable with respect to General Liability, Auto Liability, and Workers' Compensation policies where required by written contract and subject to policy terms and conditions. In the event coverage is cancelled for any statutorily permitted reason, other than nonpayment of premium, advanced written notice will be mailed or delivered to person(s) or entity (ies) according to the notification schedule shown below. Per the most current schedule maintained by Marsh 'USA, Inc. and furnished to AIG no less than 45 days prior to the effective date of cancellation. Number of Days Notice of Cancellation: 30. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORL7® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 03/25/2020 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 Cathy Crown NAME' y MARSH USA Inc. 4400 Comerica Bank Center IA"ON o. Ext): (210) 691-4173 ac . No): (210) 737 3584 E-MAIL Cath Crown marsh.com ADDRESS: y 1717 Main Street Dallas, TX 75201 INSURER(S) AFFORDING COVERAGE NAIC # _ INSURER A: National Union Fire Insurance Co 19445 CN101851261-GAWU-GAWU-20-21 GAW 521 _ 71072 INSURED Clear Channel Outdoor, LLC INSURER B : American Home Assurance Company 19380 INSURER C : N/A NIA & its subsidiaries INSURER D : Illinois National Insurance Company 23817 4830 North Loop 1604 W, #111 San Antonio, TX 78249 INSURER E: NIA NIA INSURER F : N/A NIA COVERAGES CERTIFICATE NUMBER: HOU-003498745-06 REVISION NUMBER: 10 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 SUBR POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DDIYYYY _ LIMITS A X COMMERCIAL GENERAL LIABILITY GL1728871 03131/2020 03/31/2021 EACH OCCURRENCE $ 5,000,000 CLAIMS -MADE M OCCUR PREMISES Ea occurrence $ 5,000,000 MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 5,000,000 GEN'L _ AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY L] PRO a LOC JECT PRODUCTS - COMP/OP AGG $ 5,000,000 _ $ OTHER A AUTOMOBILE LIABILITY CA6631256 (AOS) 03/31/2020 03131/2021 COEa aBINEeDISINGLE LIMIT $ 2,000,000 A X ANY AUTO CA6631257 (MA) 03/31/2020 03131/2021 BODILY INJURY (Per person) $ X OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ B D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y ! N OFFICER/MEMBER EXCLUDED? �N (Mandatory in NH) NIA WC23096116 (California) WC23096120 (Florida) 0313112020 03131/2021 03131/2021 X PER OTH- STATUTE ER E L EACH ACCIDENT $ 1,000,000 E L DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below Continued On Next Page E L DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) REFERENCE: Bus Shelters Certificate Holder is an additional insured for General Liability and Auto Liability, but only to the extent of the liability assumed under written contract. Workers' Compensation coverage is evidenced for employees of the Named Insured only. Workers' Compensation coverage is evidenced for employees of the Named Insured only. Workers' Compensation coverage is evidenced for employees of the Named Insured only. RE: CCO-OAKLAND, CA - TRANSIT SHELTERS AT VARIOUS LOCATIONS IN THE CITY OF GILROY t;LK I IrIC:A 1 L MULUtK t;ANL;LLLA 1 IUN City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjeem�.�Aea 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101851261 LOC #: San Antonio ACOSPR ADDITIONAL REMARKS SCHEDULE L Page 2 of 2 AGENCY NAMED INSURED MARSH USA Inc. Clear Channel Outdoor, LLC & its subsidiaries 4830 North Loop 1604 W, #111 POLICY NUMBER San Antonio, TX 78249 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 Workers' Compensation Continued: Policy Number: WC23096112 Colorado (CO), Delaware (DE), Georgia (GA), Indiana (IN), Maryland (MD), Michigan (MI), Minnesota (MN), Nebraska (NE), New Mexico (NM), Nevada (NV), New York (NY), Oregon (OR), Texas (TX) Effective Date (MM/DDIYYYY)*: 03/31/2020 Expiration Date (MMIDDNYYY)*: 03/31/2021 Canner: New Hampshire Insurance Company Policy Number: WC23096114 Arizona (AZ), Illinois (IL), Kentucky (KY), North Carolina (NC), New Hampshire (NH), New Jersey (NJ), Pennsylvania (PA), Virginia (VA) Effective Date (MM/DDNYYY)*: 03/3112020 Expiration Date (MM/DD/YYYY)*: 03/3112021 Carrier: New Hampshire Insurance Company Policy Number: WC23096118 Massachusetts (MA), North Dakota (ND), Ohio (OH), Washington (WA), Wisconsin (WI), Wyoming (WY) Effective Date (MM/DDNYYY)*: 03/31/2020 Expiration Date (MMIDDNYYY)*: 03/31/2021 Carrier: New Hampshire Insurance Company Workers Compensation is evidenced for employees of the Named Insured Only. Certificate Holder included as additional insured on General Liability and Auto Liability, but only with respect to liability that arises out of the acts or omissions of the Named Insured; or, to the extent of the liability assumed by the Named Insured under written contract. The Auto Liability policy is primary, but only with respect to liability that arises out of the acts or omissions of the Named Insured; or, to the extent of the liability assumed by the Named Insured under written contract. The General Liability policy is primary and non-contributory, but only with respect to liability that arises out of the acts or omissions of the Named Insured; or, to the extent of the liability assumed by the Named Insured under written contract. Waiver of subrogation is applicable with respect to General Liability, Auto Liability, and Workers' Compensation policies where required by written contract and subject to policy terms and conditions. In the event coverage is cancelled for any statutorily permitted reason, other than nonpayment of premium, advanced written notice will be mailed or delivered to person(s) or entity (ies) according to the notification schedule shown below. Per the most current schedule maintained by Marsh USA, Inc. and furnished to AIG no less than 45 days prior to the effective date of cancellation. Number of Days Notice of Cancellation: 30. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD