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CERTIFICATE OF INSURANCE (18) .. ...,1,:i!'::i:;:..!A....1~.H "'1,;;,'1"'1";1": ~..' " ,,It;IFlel:r:li!o~F:IN,Sl:iR~grl~::.' ~~~~~~~~~;~~~~;6 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES DESCRIBED HEREIN, COMPANIES AFFORDING COVERAGE PRODUCER MARSH INC. 1166 AVE OF THE AMERICAS NEW YORK, NY 10036 1042 -GTE-all-04-05 MOBIL TX VA FL COMPANY A AMERICAN HOME ASSURANCE COMPANY INSURED 'GTE MOBILNET OF TEXAS DBA VERIZON WIRELESS ATTN: PAM ANDREWS 300 MCLAWS CIRCLE, STE 201 WILLIAMSBURG, VA 23185-5648 COMPANY B N/A COMPANY C N/A COMPANY D N/A CC)_E""tl~$4\!l,;;l~tn.!<.', ThiscettlfiCate~iJ~$j.~~"'~,.niil~$lyjlssl.l~t~J:tij(~tef()rthe, pdlieY.!~el'iodnoted 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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION L1M ITS DATE (MM/DDNYI DATE (MM/DDNY) . . 06/30/04 06/30/05 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ INCLUDED PERSONAL & ADV INJURY $ 2,000,000 EACH OCCURRENCE $ 2,000,000 $ 50,000 $ 10,000 COMBINED SINGLE LIMIT $ BODILY INJURY $ (Per person) BODILY INJURY $ (Per accidenl) I PROPERTY DAMAGE $ AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT AGGREGATE EACH OCCURRENCE AGGREGATE -- -~." -----_.,---- --- _.u___________ EL DISEASE-POLICY LIMIT EL DISEASE.EACH EMPLOYEE $ A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE [K] OCCUR OWNER'S & CONTRACTOR'S PROT RMGL 480-6326 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY ANY AUTO THE PROPRIETOR! PARTNERS/EXECUTIVE OFFICERS ARE: o HER .INCL EXCL EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND -eMf>LOYERS' Umm:rrr DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS RE: COUNTRYSIDE CELL SITE - CROWN CASTLE SITE BUN #814424 CERTIFICATE HOLDER IS ADDITIONAL INSURED (EXCEPT ON WORK COMP) AS RESPECTS OPERATIONS OF THE NAMED INSURED TO THE EXTENT AND LIMITS REQUIRED BY CONTRACT. CERl'.'I'!!~IW~!H~liJ;fJlR ~ '''. " ' ..'"", c. ~:~I!=t:l;.A TION! CITY OF CLEARWATER ATTN: EARL BARRETT ENGINEERING DEPARTMENT P.O, BOX 4748 CLEARWATER, FL 33758-4748 SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL ---3D DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES, OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC. BY: Steven Becker ~\w.. b...... VALID AS OF: 05/17/04 PRODUCER MARSH INC, 1166 AVE OF THE AMERICAS NEW YORK, NY 10036 212-345-6000 CERTIFICATE NUMBER NYC-000588652-02 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES DESCRIBED HEREIN. COMPANIES AFFORDING COVERAGE ELL -PRIME-180-04-05 COMPANY A AMERICAN HOME ASSURANCE COMPANY INSURED VERIZON WIRELESS PERSONAL COMMUNICATIONS LP DBAVERIZON WIRELESS 180 WASHINGTON VALLEY ROAD BEDMINSTER, NJ 07921 COMPANY B N/A COMPANY C N/A COMPANY ON/A C.<lVfaR"'GES ,l: 'ii'h;. 0 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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION D!\TE{M""'I)DI'~.)'1 DA!.EJM,.,IDDN'Q. L1M ITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE [8] OCCUR OWNER'S & CONTRACTOR'S PROT RMGL 480-6326 06/30/04 06/30/05 GENERAL AGGREGATE PRODUCTS - COMP/OP AGG PERSONAL & ADV INJURY EACH OCCURRENCE COMBINED SINGLE LIMIT $ 2,000,000 $ INCL. $ 2,000,000 $ 2,000,000 $ 500,000 $ 10,000 $ $ $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON.OWNED AUTOS BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT AGGREGATE EACH OCCURRENCE AGGREGATE EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS. COMPENSATION AND EMPI:OYERS'1.1ABILI1T - THE PROPRIETOR! PARTNERS/EXECUTIVE OFFICERS ARE: OTHER INCL EXCL EL EACH ACCIDENT EL DISEASE-POLICY LIMIT EL DISEASE-EACH EMPLOYEE $ DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS THE CERTIFICATE HOLDER IS ADDED AS AN ADDITIONAL INSURED AS RESPECT TO THEIR INTEREST IN THE INSURED'S TWO (2) EXISTING RADIO COMMUNICATIONS TOWERS AT THE CITY'S N,E. WATER POLLUTION CONTROL PLANT, 3290 S.R. 580 AND McMULLEN BOOTH RD AND 1400 YOUNG STREET, AND ONE (1) WATER TANK LOCATED AT KINGS HWY RECREATION CENTER, 1751 KINGS HWY (#085109-2) cc: GIGI PLATT @ PRIMECO COMMUNICATIONS L.P" FAX (813) 615-4902 CITY OF CLEARWATER ATTN: SUSAN STEPHENSON, CITY CLERK P.O, BOX 34618 CLEARWATER, FL 34618 SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCEllED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WIll ENDEAVOR TO MAil --3.0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAil SUCH NOTICE SHAll IMPOSE NO OBLIGATION OR lIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES, OR THE ISSUER OF THIS CERTIFICATE, MARSH USA INC, BY: Steven Becker JICf\w-.. b...... VALID ASOF:05/18/04 ;;,}~;-;,' :(:,t::"":; ~:q:I<::t'~<~ ;,:", '