CERTIFICATE OF INSURANCE (16)
~:arsh USA Inc
12/19/2002 11:08
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?RODUCER
MARSH USA INC,
1166 AVENUE OF THE AMERICAS, 40TH FLOOR
NEV\lYORK, NY 10036-2774
TEL: 212-345-3259
FAX 212-345-4725/" 268
ATTN: VIVIAN EDWJ,RDS
01 C42 -GTE-alI-Ol.{)2 MOBIL 1)( VA
CERTlFI ::ATE IIIUMBER
NYC.()I11133201.()4
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND (:ONFERS
NO RIGHTS UPOIII THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
POLICY. THIS CERTIFICATE DOES NOT AMEIIID. EXTEND OR AlTER THE CXVERAGE
AFFORDED BY THE POLICIES DESCRIBED HEREIN.
COMPANIES AFFORDING COVERAGE
FL
COMPfoNY
A ZURICH AMERICAN INS,CO
! INSURED
-GTE MOBILNETOF TEXAS
DBA VERIZON WIRE LESS
A TIN: PAM ANDRE NS
300 MCLAVIIS CIRCL E, STE 201
WILLIAMSBURG, VI< 23185-5648
Ca.1P foNY
B NIA
CCMP />NY
C
C~PiWY
D
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T~S IS TO CERTIFY THAT PCICIES OF INSJRiWCE DESCR 3::D HEREIN HAVE 3EEN ISSUED TO THE INS.JRED NNvlED HEREIN FOR THE PQICY PERIOD INJICATED
~CT\~nHsrANDING ANY REQUI (EMENT, TERI0 OR CG'iDT C". 0= ANv CGNTRi\CT OR OT"ER JOCL"!;,,",T '!\'T~ RE.'iP",CT TO V'HCH T"II' C~RfIF;Ci\TE 1'!1/\Y 8" I &31;Ec OR ,~W
o=qTi\If\:, THE INSJRA'JCE A-=,=( l,:~mED 3Y THE POL,C::$ u~SCR a,::::o HEREiN ,S S~..BJ~CT TO .~ 1_ TH=' T~,;:'/~:':; \-:\-:._\ "J,T ,T-,:; tV~) FXCi, LjSOr~3 a= SUCH FGLiC:=:S AG\ ;Rt=C.,!\TF
~'I,~TS 9-10VItN MAY HAVE BEEN REDUCED 3v P AD CAliS
TYPE OF IIIISURANCE
i POLICY IIIUMBER
I
GLO 2984372.()O
POLICY EFFECTIVE POLICY EXPIRATION
DATE (I<1~lIDD.IYY) DATE (MMIDDrfY)
LIMITS
I A 'GEIIIERAL LIABILITY
i ~....'.'..'.X.'..'...'.:.i.'..:.'. COMMERCIAl.. GENERAL LABILITY
+;3: CLAlMSM!lDE D OCCUR
O/\/NER'S & CQlJTRACTOf; 'S PROT
----....-
Ii
, AUTOMOBILE LIABILITY
06/30102
06130/03
Gi=NFRAI. AGGREGATi=
$ 2,000,000
$ INCLUDED
$ 2,000,000
$ 2,000,000
---- ------
$ 50,000
$ 10,000
$
PRODUCTS.C~PIOP AGG
PER3:JNN & ADVINJURY
EACH OCCURRENCE
FIRE D!IIItIAGE (Any one~re)
MED EXP (Any Ole p...son)
C~BINED SNGLE LIMIT
iWY AUTO
AlL O/\/NED AUTOS
&:HEDULED AUTOS
HIRED AUTOS
NO\I-OWNED AUTOS
BODILY INJURY
(Per p...son)
$
BODILY INJURY
(Per accident)
$
PROPERTY D!lMAGE $
,----'
I ; UMBRELLA FORM
, OTHER THAN L~i3RELLA 1 ~
I~'ORKERS COMPEIIISATIOIII AN)
E'~? LOVE RS' LIABILITY
1.-------.,-..-.-..
I I
AUTO ONI Y - EA ACCIDENT $
OTHER THAN AUTO ONLY
EACH ACCIDENT $
-.-.-......-...-------- - -----_.-._'--._-
AGGREGATE $
EACH OCCURRFNCF $
~~;~;-~~;--_._- $----------
:I
!'NY AUTO
EXCESS LIABILITY
T'-IE PROPRIETORI
PARTNERSlEXECUTIVE
OFFICERS ARi=
T R
EL DISEASE.pQICY LIMIT $
EL DISEASE-€ACH EMPLOYEE $
INo..
EXCl
DE3CRIPTI01II OF OPERATlONSlLOCHIOIIISIVEHICLESISPEClAlITEMS
RE: COUNTRYSIDE CELL SITE -CROWN CASTLE SITE BUN #814424
CERTIFICATE HOLDER IS A['DITIONAL INSURED (EXCEPT ON VVORK COMP) AS RESPECTS OPERATIONS OF THE NAMED INSURED TO THE
EXTENT AND LIMITS REQUI ~ED BY CONTRACT.
CITY OF CLEARWA1ER
ATTN: EARL BARRETT
ENGINEERING DEPIIRTMENT
P,O, BOX 4748
CLEARWATER, FL 3 3758-4748
9iQULD ANY OF nE ~OLlCI=S ~ESCRI~ED HEREIN BE CANCaLEO BEFORE THE EXPIRATION DATE THERECF.
THE INSJRER AFFOR.JING COVERAGE WU_ ENDEAVCR TO ttMlL ---3.0 DAYS WRITTE'Ii NOTICE TO THE
CERTIFICATE l.tCl.-\)ER. N!lftEO HEREIN 3l1T FAILURE TO M.-.IL SUCH NOTice SHAI..L IMPOSE IJO OBlIGA.TION OR
LIABILITY OF ANYKINJ UPON THE IN3.JRER. AFFORDING COIERAGE, ITS AGENTS OR REPRES::NTATIVES OR THE
ISSUER OFTHSC=:RTlFICAT'=
MARSH USA INC.
BY: Sleven Becker
I
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