CERTIFICATE OF INSURANCE (8)
---A OORDTM
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYY)
12/23/2004
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.
PRODUCER
JOHN L. WORTHAM & SON, L.P.
P.O. BOX 1388
HOUSTON, TEXAS 77251-1388
068386-190-394
gwp - tprentic
INSURERS AFFORDING COVERAGE
INSURED
CROWN CASTLE ATLANTIC LLC
510 BERING DRIVE, SUITE 500
HOUSTON, TX 77057
INSURER A:. American Home Assurance Company
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
COVERAGES
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.
II~f: TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
A~ ~NERA!=LIABIlITY .. GL4570453 .. ~ ~~ .~ u_ ,_ ~1/01l2005 .... 01/01/2006 EACH OCCURRENCE $ 1,000,000
t/ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE tAnv one fire) $ 100,000
I CLAIMS MADE [L] OCCUR MEDEXP/AnvoneDe~onl $ 5,000
- PERSONAL & ADV INJURY $ 1,000,000
- GENERAL AGGREGATE $ 2,000,000
~'L AGGRnE LIMIT AnS PER: PRODUCTS - COMP/OP AGG $ 2,000,000
t/ POLICY ~~gT LOC
A ~TOMOBILE LIABILITY CA4575579 AUTO - AOS 01/01/2005 01/01/2006 COMBINED SINGLE LIMIT 1,000,000
CA1468349 AUTO - VA $
A ANY AUTO 01/01/2005 01/01/2006 (Ea accident)
- CA4575580 Auto - TX 01/01/2005 01/01/2006
A ~ ALL OWNED AUTOS CA 1468605 AUTO - MA 01/01/2005 01/01/2006 BODILY INJURY
$
A SCHEDULED AUTOS (Per person)
-
~ HIRED AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accident)
~GE LIABILITY AUTO ONLY- EA ACCIDENT $
ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG $
~ESS LIABILITY EACH OCCURRENCE $
OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
A WORKERS COMPENSATION AND WC455.1896.CA --..--, 01/01/2005 01/01/2006_ 0/ I T~~JlJf\J,~~ I IOJ~-I$
EMPLOYERS' LIABILITY WG4550237 AOS 01/01/2005 01/01/2006 1,000,000
A E.L EACH ACCIDENT $
E.L DISEASE - EA EMPLOYE $ 1 ,000,000
E.L DISEASE - POLICY LIMIT $ 1,000,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CERTIFICATE HOLDER IS INCLUDED AS AN ADDITIONAL INSURED UNDER GENERAL AND AUTOMOBILE LIABILITY POLICIES WHEN REQUIRED BY
WRITTEN CONTRACT BUT ONLY WITH RESPECT TO: SITE: COUNTRYSIDE / BU#814424
CERTIFICATE HOLDER I I ADDITIONAL INSURED: INSURER LETTER: CANCELLATION (BELOW & SEE REVERSE)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF
THE CITY OF CLEARWATER FLORIDA ANY KIND UPON THE ISSUER, ITS AGENTS OR REPRESENTATIVES.
ATTN: EARL BARRETT, ENGINEERING DEPT.
P.O. BOX 4748 AUTHORIZED REPRESENTATIVE
CLEARWAT1ER, FL 33758-4748 JOHN L WORTHAM & SON, LP.
ACORD 25-S (7/97)
@ACORDCORPORATION 1988