CERTIFICATE OF INSURANCE (10)
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: AC..I!I.~
JOHN L. WORTHAM & SON, L.L.P.
P.O. BOX 1388
HOUSTON, TEXAS 77251-1388
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
PRODUCER
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07Z443-00012-2001~ 00 0 'J
INSURED \J.\ "
CROWN CASTLE GT COMPANY, LLC
510 BERING DRIVE, SUITE 500
HOUSTON, TX 77057
DGC/GWP
1/3
COMPANY
A AMERICAN HOME ASSURANCE
COMPANY
B AMERICAN INTERNATIONAL GROUP
COMPANY
C
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/DDIYYI DATE (MM/DDIYY)
A GENERAL LIABILITY GL4570453RA 01/31/00 01/01/01 GENERAL AGGREGATE
COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG
CLAIMS MADE ~ OCCUR PERSONAL & ADV INJURY
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE
FIRE DAMAGE (Anyone fire)
MED EXP (Anyone parson)
A AUTOMOBILE LIABILITY CA4575580RA (lX) 01/01/00 01/01/01
CA4575579RA (O/S) 01/01/00 COMBINED SINGLE LIMIT
A ANY AUTO 01/01/01
X ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person)
X HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS (Par accidant)
PROPERTY DAMAGE
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE
UMBRELLA FORM AGGREGATE
OTHER THAN UMBRELLA FORM
B WORKERS COMPENSATION AND i.JC4550237 01/01/00 01/01/01 X STATUTORY LIMITS
EMPLOYERS' LIABILITY
EACH ACCIDENT
THE PROPRIETOR/ X INCL DISEASE, POLICY LIMIT
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL DISEASE - EACH EMPLOYEE
OTHER
2,000,000
2,000,000
1,000,000
1,000,000
100,000
5,000
1,000,000
1,000,000
1,000,000
1 ,000 000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS CERTI F I CATE HOLDER I S I NCLUDED AS AN ADD IT IONAL I NSURED UNDER GENERAL AND AUTOMOBILE
LIABILITY POLICIES WHEN REQUIRED BY WRITTEN CONTRACT BUT ONLY WITH RESPECT TO: COUNTRYSIDE/BU#814424
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
CITY OF CLEARWATER ..1L DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
ATTN: EARL BARRETT, ENGINEERING DEPT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
P. O. BOX 4748 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
CLEARWATER, FL 33758-4748 AUTHJED REP:L:NTW