CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
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June 4, 2001
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Lockton Insurance Agency of Dallas
717 N. Harwood, Lock Box 27
Dallas, TX 75201
Phone: 214-720-3445
Fax: 214-969-6779
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATES DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
COMPANY
A
Liberty Mutual
INSURED
COMPANY
B
RECEIV
National Union Fire
BELLSOUTH MOBILITY LLC
CINGULAR WIRELESS, LLC
5565 GLENRIDGE CONNECTOR, SUITE 1401
ATLANTA, GA 30342
COMPANY
C
JUN 1 2 '001
COMPANY
D
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.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE (MM/DDIYY) DATE (MM/DDIYY
A GENERAL LIABILITY RG2-691.{)04179.{)21 6/1/01 6/1/02 GENERAL AGGREGATE $ 10,000,000
OMMERCIAL GENERAL LIABILITY PRODUCTS.COMP/OP AGG $ 1,000,000
CLAIMS MADE o OCCUR. PERSONAL & ADV. INJURY $ 1,000,000
OWNERS' & CONTRACTOR'S PROT. EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (Any One Fire) $
AGGREGATE PER LOCATION ED. EXP. (Any One Person) $
A AUTOMOBILE LIABILITY All Other States 6/1/01 6/1/02 OMBINED SINGLE LIMIT $ 2,000,000
X ANY AUTO AS2-691-004179-011
ALL OWNED AUTOS OH Only ODIL Y INJURY $
SCHEDULED AUTOS AS2-691-004179'{)51 Per Person)
HIRED AUTOS ODIL Y INJURY $
NON-OWNED AUTOS Per Accident)
ROPERTY DAMAGE $
GARAGE LIABILITY UTO ONLY. EA ACCIDENT
ANY AUTO THER THAN AUTO ONLY.
EACH ACCIDENT
AGGREGATE
B EXCESS LIABILITY RMGL 6123525 6/1/2001 6/1/2002 5,000,000
X ..LJIv1BRE:UAFQRM .' 5,000,000
OTHER THAN UMBRELLA FORM
A ORKERS COMPENSATION AND All Other States 6/1/01 6/1/02
WA2-69D.{)04179.{)41
EMPLOYERS' LIABILITY WI Only
HE PROPRIETOR! INCL. WC2-691.{)04179.{)31 EL DISEASE, POLICY LIMIT
ARTNERS/EXECUTIVE
FFICERS ARE: EXCL. EL DISEASE - EA EMPLOYEE
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
GROUND CELL SITE NAME: TAM 440-062.1
LOCATION: 3290SR 580 AT MCMULLEN BOOTH ROAD, CLEARWATER, FLORIDA
CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED AS RESPECTS TO GENERAL LIABILITY.
f.RiIS.@tE flQl!DEIt;:"
,[CANCELLATION
CITY OF CLEARWATER-CITY MANAGER
PO BOX 4548
CLEARWATER, FLORIDA 34618-4748
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CC.' ~(51<" C;;Ef'l - 5'vc )
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL..1Q
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY
KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
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