CERTIFICATE OF INSURANCE (17)
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MARS H CERTIFICATE OF I NSll'RAN CE CERTIFICATE NUMBER
, NYC-001133201-05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
MARSH USA INC, NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
1166 AVENUE OF THE AMERICAS, 40TH FLOOR POLICY, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
NEW YORK, NY 10036-2774 AFFORDED BY THE POLICIES DESCRIBED HEREIN,
, TEL: 212-345-3259 COMPANIES AFFORDING COVERAGE
FAX: 212-345-4725/4268
ATTN: VIVIAN EDWARDS COMPANY
p1042 -GTE-all-01-02 MOBIL TX VA FL A AMERICAN HOME ASSURANCE COMPANY
INSURED COMPANY
'GTE MOBILNET OF TEXAS B N/A
DBA VERIZON WIRELESS
ATTN: PAM ANDREWS COMPANY
300 MCLAWS CIRCLE, STE 201 C N/A
WILLIAMSBURG, VA 23185.5648
COMPANY
0 N/A
COVERA~ES This certificate supersedes and replaces anyprelJlously issued certificate for the policy period noted below. .'. 4
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED,
NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
- PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES, AGGREGATE
LIMIT::> ::iHUVVN MA T nrWc l5e~14 f\EBtJCCO 0'{ r ^.~B ell' 1~1i '-
-'-.- -
--'.- ---- .
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION lIM ITS
LTR DATE (MM/DDNYI DATE (MM/DDNY)
A GENERAL LIABILITY RMGL 480-5706 06/30/03 06/30/04 GENERAL AGGREGATE $ 2,000,000
-
X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $ INCLUDED
,;i I CLAIMS MADE D OCCUR PERSONAL & ADV INJURY $ 2,000,000
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 2,000,000
- $ 50,000
FIRE DAMAGE (Any one fire)
MED EXP (Anv one Derson) $ 10,000
AUTOMOBILE LIABILITY $
- COMBINED SINGLE LIMIT
- ANY AUTO
ALL OWNED AUTOS BODILY INJURY $
- (Per person)
- SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY $
- I (Per accident)
- NON-OWNED AUTOS
PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
- ,
ANY AUTO OTHER THAN AUTO ONLY:
- $
EACH ACCIDENT
-
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
---. -- A UMBRElI:Ai=oR.rvf--- --- -.- "._--. -,---- _ u ---- .-----"~- --. '-. -. AGGRE.GME. $
- _.. . - l- .- ------ .- .-- -
OTHER THAN UMBRELLA FORM $
WORKERS COMPENSATION AND I wc STATU- I I u.:rH
EMPLOYERS' LIABILITY TORY LIMITS ER
EL EACH ACCIDENT $
THE PROPRIETOR! RINCL "'~"^~"_D'" ,("v, ''''T 1$
PARTNERS/EXECUTIVE Di' i='A~E~ EM8t o'fl:E 1m IS r"'"""
OFFICERS ARE: EXCL
OTHER -u: c::l
ill JUL - I 2003 .....I
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS L....--. -.-..-
RE: COUNTRYSIDE CELL SITE. CROWN CASTLE SITE BUN #814424 CITY OF CLEARW~T~
CERTIFICATE HOLDER IS ADDITIONAL INSURED (EXCEPT ON WORK COMP) AS RESPECTS OPERATIOr S Qftj1!lt\~ We~tmlNfS ff6N'HE
EXTENT AND LIMITS REQUIRED BY CONTRACT.
"~.I(frili~~~!?:~'ili~$Ri"'" ....,i .....i'..... ..... CANCELLATION ifi">> . i. "FiF>'F..."'.'f.. .,. '..
>i'y,;/:;,;(,i:<',;'i.:. ! . """..i"
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL ---30 DAYS WRITTEN NOTICE TO THE
CITY OF CLEARWATER CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
ATTN: EARL BARRETT
ENGINEERING DEPARTMENT LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES, OR THE
P.O. BOX 4748 ISSUER OF THIS CERTIFICATE,
CLEARWATER, FL 33758-4748 MARSH USA INC.
BY: Steven Becker ~"-- b...&-
I ,I, ,.i .'."i 'iii'::> Mf"'t1i~~lQ.~~ VALID AS OF: 06/26/03 ..t...
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