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22-0615_VERIZON WIRELESS_Preliminary NoticeHolder Identifier : 7777777707070700077761616045571110767716017305557207542137772516310073640567047331120762515002076001307433500373275112071623331725323300754722616313776607250154213375020076727242035772000777777707000707007 7777777707070700073525677115456000727510443033402007330510030271531077714044347771230753776275253310107033326352062111071232363531720000713223735216311007033226253073110077756163351765540777777707000707007Certificate No :570093604276CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/15/2022 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. PRODUCER Aon Risk Services Northeast, Inc. New York NY Office One Liberty Plaza 165 Broadway, Suite 3201 New York NY 10006 USA PHONE (A/C. No. Ext): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # (866) 283-7122 INSURED 23035Liberty Mutual Fire Ins CoINSURER A: 33600LM Insurance CorporationINSURER B: 42404Liberty Insurance CorporationINSURER C: INSURER D: INSURER E: INSURER F: FAX (A/C. No.):(800) 363-0105 CONTACT NAME: Los Angeles SMSA LP dba Verizon Wireless 1095 Avenue of the Americas New York NY 10036 USA COVERAGES CERTIFICATE NUMBER:570093604276 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.Limits shown are as requested POLICY EXP (MM/DD/YYYY) POLICY EFF (MM/DD/YYYY) SUBR WVD INSR LTR ADDL INSD POLICY NUMBER TYPE OF INSURANCE LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR POLICY LOC EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG X X X X GEN'L AGGREGATE LIMIT APPLIES PER: $5,000,000 $5,000,000 $10,000 $5,000,000 $5,000,000 $5,000,000 XCU Coverage is Included A 06/30/2022 06/30/2023TB2691550588142 PRO- JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON-OWNED AUTOS ONLY BODILY INJURY ( Per person) PROPERTY DAMAGE (Per accident) X BODILY INJURY (Per accident) $1,000,000A06/30/2022 06/30/2023 AOS AS2-691-550588-132A 06/30/2022 06/30/2023 NH - Primary TL2-691-550588-182A 06/30/2022 06/30/2023 NH - Excess COMBINED SINGLE LIMIT (Ea accident) AS2-691-550588-122 EXCESS LIAB OCCUR CLAIMS-MADE AGGREGATE EACH OCCURRENCE DED UMBRELLA LIAB RETENTION E.L. DISEASE-EA EMPLOYEE E.L. DISEASE-POLICY LIMIT E.L. EACH ACCIDENT $1,000,000 X OTH- ER PER STATUTEB06/30/2022 06/30/2023 AOS WC5691550588082B 06/30/2022 06/30/2023 $1,000,000 Y / N (Mandatory in NH) ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED?N / AN WI, MN WORKERS COMPENSATION AND EMPLOYERS' LIABILITY If yes, describe under DESCRIPTION OF OPERATIONS below $1,000,000 WA569D550588092 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Site Name: Capistrano Depot, Site Address: 32400 Paseo Adelanto, San Juan Capistrano, CA, GL: 265625, NG: 171505. City of San Juan Capistrano is included as Additional Insured with respect to the General Liability and Automobile Liability policies. The General Liability and Automobile Liability policies shall apply as Primary Insurance to each Additional Insured listed herein. Where permitted by law, the Named Insured parties listed herein waive all rights against City of San Juan Capistrano listed herein for recovery of damages to the extent these damages are covered by the above-referenced General Liability and Automobile Liability policies, and, as further limited by written contract between the parties. The above-referenced General Liability policy shall cover the tort liability of the Certificate Holder assumed under the underlying CANCELLATIONCERTIFICATE HOLDER AUTHORIZED REPRESENTATIVECity of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano CA 92675 USA ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AGENCY CUSTOMER ID: ADDITIONAL REMARKS SCHEDULE LOC #: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:ACORD 25 FORM TITLE:Certificate of Liability Insurance EFFECTIVE DATE: CARRIER NAIC CODE POLICY NUMBER NAMED INSUREDAGENCY See Certificate Number: See Certificate Number: 570093604276 570093604276 Aon Risk Services Northeast, Inc. 570000027366 ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSURER INSURER INSURER INSURER INSURER(S) AFFORDING COVERAGE Page _ of _ NAIC # Los Angeles SMSA LP TYPE OF INSURANCE POLICY NUMBER LIMITS WORKERS COMPENSATION C WA769D550588072 06/30/2022 06/30/2023 MA N/A ADDL INSD INSR LTR SUBR WVD POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) ACORD 101 (2008/01)© 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD agreement between parties for which the certificate has been issued. FORM TITLE:FORM NUMBER: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, ADDITIONAL REMARKS EFFECTIVE DATE: CARRIER NAIC CODE POLICY NUMBER Aon Risk Services Northeast, Inc. NAMED INSUREDAGENCY LOC #: 570000027366AGENCY CUSTOMER ID: © 2008 ACORD CORPORATION. All rights reserved. See Certificate Number: See Certificate Number: The ACORD name and logo are registered marks of ACORD 570093604276 570093604276 ACORD 25 Certificate of Liability Insurance Additional Description of Operations / Locations / Vehicles: ACORD 101 (2008/01) ADDITIONAL REMARKS SCHEDULE Page _ of _ Los Angeles SMSA LP