CERTIFICATE OF INSURANCE (12)
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DATE (MM/DDIYY)
JOHN L. WORTHAM & SON, L.L.P.
P.O. BOX 1388
HOUSTON, TEXAS 77251-1388
12/31/2002
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
072443-00012"2004A-000048
INSURED
CMB/GWP
2/2
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 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 OFSUCHPOUCIES..LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE CMMIODIYYI DATE (MM/DDIYYI
A GENERAL LIABILITY GL4570453 01/01/2003 01/01/2004 GENERAL AGGREGATE 2,000,000
COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $ 2,000,000
CLAIMS MADE W OCCUR PERSONAL & ADV INJURY 1,000,000
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE 1,000,000
FIRE DAMAGE (Anyone fire) 100,000
MED EXP (Anyone person) 5,000
A AUTOMOBILE LIABILITY CA4575580 OX) 01/01/2003 01/01/2004
COMBINED SINGLE LIMIT
ANY AUTO CA4575579 (O/S) 01/01/2003 01/01/2004 1,000,000
X ALL OWNED AUTOS CA1468605 (MA) 01/01/2003 01/01/2004 BODILY INJURY
SCHEDULED AUTOS CA1468349 (VA) 01/01/2003 01/01/2004 (Per person)
X HIRED AUTOS BODILY INJURY
X NON,OWNED AUTOS (Per 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 UMBBELU\.EOBM
A WORKERS COMPENSATION AND WC4550237 01/01/2003 01/01/2004 X STATUTORY LIMITS
EMPLOYERS' LIABILITY WC4551896 (CALIFORNIA) 01/01/2003 01/01/2004 1,000,000
EACH ACCIDENT
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 IONAL I NSURED UNDER GENERAL AND AUTOMOB I LE
LIABILITY POLICIES WHEN REQUIRED BY WRITTEN CONTRACT BUT ONLY WITH RESPECT TO: SITE: COUNTRYSIDE / BU# 814424
~mTIfMAT~Hp~y~~::: ..
THE CITY OF CLEARWATER
ATTN: ENGR DEPT., EARL B
P.O. BOX 4747
CLEARWATER, FL 33758-47
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I 1 JAN-6am j
'CANCEttAti6.Nt:/t.\
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CITY OF CLEARWATER
PUBLIC WORKS ADMINISTRATION
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.
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AUTH1:Z:P7!TWorlham & Son efef .
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