ACORD® DATE(MMDDAYM
CERTIFICATE OF LIABILITY INSURANCE 06/19/2024
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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
SUBROGATION IS WAIVED, subject to
ertificate does not confer rights to the certificate holder in lieu of such endorsements) COMEACT Holder Identifier
Aon Risk Services Northeast, Inc.
New York Ny Office (NC. No. Ext: 866) 283-7122
One Liberty Plaza
165 Broadway, Suite 3201
New York NY 10006 USA
INSURERS) AFFORDING COVERAGE NAIC #
INSURED INSURER A: LM Insurance Corporation 33600
Verizon Wireless its Subsidiaries INSURER B: Liberty Insurance Corporatior 42404 and Affiliated Companies INSURER C: Liberty Mutual Fire Ins Co 23035 one verizon Way
Basking Ridge NJ 07920-1097 USA INSURER D:
INSURER E:
[INSURER F:U
CERTIFICATE NUMBER: 570106528111 REVISION NUMBER:
100307202 80 50203
XCOMMERCIAL GENERAL LIABILITY TB2691550588144 EACH OCCURRENCE $2,000,000 CLAIMS-MADE X/OCCUR $2,000,000
$10,000
$2,000,000
GEN L AGGREGATE LIMIT APPLIES PER: $2,000,000
7 PRO- LOC
X POLICY | $2,000,000 570106528111
I JECT
OTHER:
AUTOMOBILE LIABILITY AS2-691-550588-124 06/30/2021 06/30/2025 CaGEnSINGLE LIMIT $1,000,000 AOS
X ANY AUTO AS2-691-550588-134 /30/2024 06/30/2025 BODILY INJURY (Per pers OWNED. ] SCHEDULED NH - Primary DILY INSURE Per accide
AUTOS TL2-691-550588-184 06/30/2024 06/30/2025 PROPERTY DAMAGE Certificate No :
NON-OWNED
ONLY AUTOS ONLY NH - Excess (Per accident)
UMBRELLALIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE
DED RETENTION
WORKERS COMPENSATION AND WA569D550588094 06/30/2024|06/30/2025 PER STATUTE OTH
EMPLOYERS' LIABILITY AOS
Y/N 06/30/2024 06/30/2025 ELL EACHACGIDENT $1,000,000
N N/ A WC5691550588084
WI, MN E.L. DISEASE-EA EMPLOYEE $1,000,000
SO PERATIONS below. E.L. DISEASE-POLICY LIMIT $1,000,000 it cat tos red with respect,
APPROVED AS TO FORM
CCHE
CERTIFICATE HOLDER CANCELLATION BY MICHAELE GATES
SHOULD ANY OF THE ABOVE DESCRIBED POORE ATTOREED BEFORE THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Suite 300
Aon Rist Services Northeass Ina
1988-2015 ACORD CORPORATION. All rights reserved
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000027366
LOC#:
ACORD
ADDITIONAL REMARKS SCHEDULE page _ of -
AGENCY NAMED INSUREO
Aon Risk Services Northeast, Inc. verizon wireless its subsidiaries
POLICY NUMBER
See Certificate Number: 570106528111
CARRIER NAIC CODE
See Certificate Number: 570106528111 EFFECTIE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC#
INSURER
INSURER
INSURER
INSURER
ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORL certificate form for policy limits
POLICY POLICY
TYPE OF INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION LIMITS DATE
WORKERS COMPENSATION
N/A WA769D550588074 06/30/2024 06/30/2025
MA
ACORD 101(2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: TB2-691-550588-144 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s) Location(s) Of Covered Operations
City of Huntington Beach, its officers, elected or Per the contract appointed officials, employees, agents and volunteers.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply:
with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage" occurring after:
caused, in whole or in part, by:
1. All work, including materials, parts or equipment
1. Your acts or omissions; or furnished in connection with such work, on the
2. The acts or omissions of those acting on your project (other than service, maintenance or behalf; repairs) to be performed by or on behalf of the in the performance of your ongoing operations for additional insureds) at the location of the the additional insured(s) at the location(s) covered operations has been completed; or designated above. 2. That portion of "your work" out of which the However: injury or damage arises has been put to its
intended use by any person or organization
1. The insurance afforded to such additional other than another contractor or subcontractor insured only applies to the extent permitted by engaged in performing operations for a principal law; and as a part of the same project.
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to provide
for such additional insured.
CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 Policy Number TB2-691-550588-144 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s) Location And Description Of Completed Operations The City of Huntington Beach, its officers, elected or Per the contract appointed officials, employees, agents and volunteers
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III - Limits Of Insurance:
with respect to liability for • "bodily injury" or
If coverage provided to the additional insured is
"property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance:
performed for that additional insured and included
in the "products-completed operations hazard". 1. Required by the contract or agreement; or However: 2. Available under the applicable limits of
1. The insurance afforded to such additional insurance; insured only applies to the extent permitted by whichever is less. law; and This endorsement shall not increase the
2. If coverage provided to the additional insured is applicable limits of insurance. required by a contract or agreement, the
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 •
AON
Lisa Lefler, MBA, CPCU, ARM
Sr. Vice President - Casualty
(347) 839-1409 Cell
[email protected]
July 3, 2024 VIA EMAIL
Re: Verizon Communications Inc etal
General Liability & Auto Liability Policies
Liberty Mutual Fire Insurance Company
Policy TB2-691-550588-144 - GL
Policy AS2-691-550588-124 - Auto
Effective June 30, 2024
Dear Sir/Madame:
Verizon's General Liability & Auto Liability policies include ISO endorsements (see attached) which grant primary and non-contributory status to any additional insureds as required by contract.
Since these are ISO endorsements, they cannot be modified. Like most ISO endorsements, ISO did not include a place for carriers to include any policy information.
CG 20 01 12 19 - GL
CA 0 449 11 16 - Auto
Should you have any questions about the insurance on these policies or endorsements, please feel free to contact me at 347839 1409 or at [email protected].
Very truly yours,
Lisa Leffer
Aon Risk Services Northeast, Inc
One Liberty Plaza
165 Broadway
New York, NY 10006
COMMERCIAL GENERAL LIABILITY
CG 20 01 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY -
OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the
contrary:
Primary And Noncontributory Insurance
additional insured.
This insurance is primary to and will not seek
contribution from any other insurance available to
an additional insured under your policy provided
(1) The additional insured is a Named Insured
under such other insurance; and
CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Policy Number TB2-691-550588-144
Issued by Liberty Mutual Fire Insurance Company
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NOTICE OF CANCELLATION AND NON-RENEWAL
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART
GARAGE COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
MOTOR TRUCK CARGO COVERAGE PART
OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART
PRINTERS LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
SPECIAL PROTECTIVE AND HIGHWAY LIABILITY POLICY - NEW YORK
WAREHOUSEMAN'S LEGAL LIABILITY COVERAGE PART
We will not cancel or non-renew this policy or make changes that reduce the insurance afforded by this policy until written notice of cancellation, non-renewal or reduction has been mailed or delivered to those scheduled below at least
a) 10 days before the effective date of cancellation, if we cancel for non-payment of premium; or days before the effective date of the cancellation, non-renewal or reduction if we cancel or reduce the insurance afforded by this policy for any other reason.
NAME ADDRESS
Per schedule on file with the Company Per schedule on file with the Company LIM 02 01 12 11 © 2011, Liberty Mutual Group. All rights reserved. Page 1 of 1 Policy Number: AS2-691-550588-124
Issued By: Liberty Mutual Fire Insurance Co.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NOTICE OF CANCELLATION TO THIRD PARTIES
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE PART
MOTOR CARRIER COVERAGE PART
GARAGE COVERAGE PART
TRUCKERS COVERAGE PART
EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART
SELF-INSURED TRUCKER EXCESS LIABILITY COVERAGE PART
COMMERCIAL GENERAL LIABILITY COVERAGE PART
EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
Schedule
Name of Other Person(s)/ Email Address:
Organization(s):
Cer Schedule on file with the Com schedule on file with the A. Ire cancel holy for cheat le yaman as on of paid at mil in the ready B. This advance email notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy.
All other terms and conditions of this policy remain unchanged.
LIM 99 02 08 11 © 2011, Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission.
NOTICE OF CANCELLATION TO THIRD PARTIES
A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule below by email as soon as practical after notifying the first Named Insured B. This advance email notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the Schedule
Name of Other Person(s) / Organization(s): Email Address:
Per Schedule on file with
Verizon Communications, Inc.
All other terms and conditions of this policy remain unchanged.
Issued by LM Insurance Corporation 27243
For attachment to Policy No. WA5-69D-550588-094 Effective Date Premium $ Issued to Verizon Communications Inc. Endorsement No.
WC 99 20 74 © 2016 Liberty Mutual Insurance Page 1 of 1 Ed. 12/01/2016