CERTIFICATE OF INSURANCE (3)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYY)
12/01/2003 12/01/2002
PRODUCER LOCKTON INS.AGENCY OF DALLAS, INC. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
717 N. HARWOOD, LB#27 HOLDER. THIS CERTIFICATE DOES NOT ~F=M~~,~;",~~T~~Pn?R
DALLAS TX 75201 ALTER T' ,- A"'_ AFFORDED BY TH W.
214-969-6700 INSURERS AFFORDING COVERAGE
INSURED Cingular Wireless, LLC INSURER A: Pacific Emolovers Insurance Comnanv
1024339 5565 Glenridge Connector, Suite 1800 INSURER B: 'T 1 Inion Fir~ T ~"
Atlanta GA 30342 INSURER C :
COVERAGES GO
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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
- 1!:FFECTIVE - - --- - ~ - --~ .._" -. ---'-"
iT" TYPE OF INSURANCE POLICY NUMBER LIMITS
~NERAL LIABILITY EACH OCCURRENCE 'I; 1 000 000
A X COMMERCIAL GENERAL LIABILITY HDOG20579274 ] 2/0 1/2002 12/01/2003 FIRE DAMAGE (Anyone fire) 'I; XXXXXXX
I CLAIMS MADE [X] OCCUR MED EXP (Anv one oerson) t Excluded
PERSONAL & ADV INJU~lY 'I; 1 000 000
GENERAL AGGREGATE t 10 000 000
n'L AGGREn LIMIT APfl PER: PRODUCTS - COMP/OP AGG 'I; 1 000 000
POLICY ~,s,9.,: LOC
~OMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000
A ~ ANY AUTO ISAH08003701 ALL STATES 12/01/2002 ]2/01/2003 (Ea accident)
~ ALL OWNED AUTOS BODILY INJURY XXXXXXX
$
SCHEDULED AUTOS (Per person)
f---
~ HIRED AUTOS BODILY INJURY XXXXXXX
$
NON-OWNED AUTOS (Per accident)
~
PROPERTY DAMAGE $ XXXXXXX
(Per accident)
RRAGE LIABILITY AUTO ONLY - EA ACCIDENT $ XXXXXXX
ANY AUTO NOT APPLICABLE OTHER THAN EA ACC 'I; XXXXXXX
AUTO ONLY: AGG t XXXXXXX
EXCESS LIABILITY EACH OCCURRENCE $ 5,000,000
B t::r OCCUR D CLAIMS MADE TBD ] 2/01/2002 ] 2/0 1/2003 AGGREGATE $ 5 000 000
R ~ UMBRELLA 'I; XXXXXXX
DEDUCTIBLE FORM ~ XXXXXXX
RETENTION $ 'I; XXXXXXX
-., 7....- ___ _'_ ___,. h___ ____ - '-- W(RC435()~f200 AOS' '.' ........,. ] 2/0 1 /2002 ] 2/0 1/2003 X~STl\TU: r T~!H-
WORKERS COMPENSATION AND ITnov I ""T"
A EMPLOYERS' LIABILITY SCFC43503248 WI ] 2/0] /2002 ] 2/0 1 /2003 EL EACH ACCIDENT $ LOOO 000
EL DISEASE - EA EMPLOYEE 'I; ] 000 000
EL DISEASE - POLICY LIMIT $ 1 000 000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
GROUND CELL SITE NAME: TAM 440-062, I LOCATION: 3290SR 580 AT MCMULLEN BOOTH ROAD, CLEARWATER, FLORIDA CERTIFICATE
HOLDER IS INCLUDED AS ADDITIONAL INSURED AS RESPECTS TO GENERAL LIABILITY.
CERTIFICATE HOLDER I I ADDITIONAL INSURED' INSURER LETTER: CANCELLATION
1402769 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF CLEARWATER-CITY MANAGER DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
PO BOX 4548
CLEARWATER FL 34618-4748 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE /1(, Q 0 '5 ~~ h
I
ACORD 25-S (7/97) @ACORD CORPORATION 1988