CERTIFICATE OF INSURANCE (11)
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::/:::::::::.:::::::::::.:::::......:::~:::/:t~~Rlg~:~m:~!f~.:.,~Nt'0l{~m~:::.:~:m:/:::.:J:~:SMf,M)ljf0U.~~Ft~~}}\/}~:~~~///:~/::/~:H)~}~://:::}~~~~}::(/((::::::::::::::::':':' H 12/18/00
PRODUCER 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
DATE IMM/DD/yYI
JOHN L. WORTHAM & SON, L.L.P.
P.O. BOX 1388
HOUSTON, TEXAS 77251-1388
.' 072443 - 000 12 - 2002A - 000035
INSURED
LAWIGWP
1/2
COMPANY
A AMERICAN HOME ASSURANCE
CROWN CASTLE GT COMPANY, LLC
510 BERING DRIVE, SUITE 500
HOUSTON, TX 77057
COMPANY
B
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 DOCUMENTWITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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 --------- --- IlATEIMM1PDNYl H _ IlATEJMMLPONYI - . -~ ,_._---~. ,-
A GENERAL LIABILITY GL4570453RA 01/01/01 01/01/02 GENERAL AGGREGATE 2,000,000
COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $ 2,000,000
CLAIMS MADE [iJ OCCUR PERSONAL & ADV INJURY 1,000,000
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE 1,000,000
FIRE DAMAGE IAny one fire) 100,000
MED EXP (Anyone person) 5,000
A AUTOMOBILE LIABILITY CA4575580RA (TX) 01/01/01 01/01/02
COMBINED SINGLE LIMIT
A ANY AUTO CA4575579RA (O/S) 01/01/01 01/01/02 1,000,000
X ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person)
X HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS IPer accident)
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
A WORKERS COMPENSATION AND ~WC455Q.2J.7' QJ/01/01... _ _OJ/Ql/O~__ X STATUTORy l)MITS
'-'i- EMJ5I1)YEIWUABTLifY -----_._,,---
WC4551896 (CALIFORNIA) 01/01/01 01/01/02 EACH ACCIDENT 1,000,000
THE PROPRIETOR/ X INCL DISEASE - POLICY LIMIT 1,000,000
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL DISEASE. EACH EMPLOYEE 1,000,000
OTHER
DESCRIPTION OF OPERATIONS/lOCATIONSNEHICLES/SPECIALlTEMS CERTI FICA TE HOLDER I S I NCLUDED AS AN ADD IT 10NAL I NSURED UNDER GENERAL AND AUTOMOB I LE
LIABILITY POLICIES WHEN REQ Y WITH RESPECT TO: SITE: COUNTRYSIDE I BU#814424
CITY Of CLEARWt, TER
THE CITY OF CLEARWATER FLO IDAPlJBUC WORKS ADMiNISiRATlO"J
ATTN: EARL BARRETT, ENGINEERING DEPT.
P.O. BOX 4748
CLEARWATER, FL 33758-4748
t??iANca;tAfION:/))
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAil
~ 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.
AlfTH1;Z:7TWo,.tkam & ~n cf.cf. .
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