CERTIFICATE OF INSURANCE (24)
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ICtARSHUSAINC. .... .""<;"';""'" , . ..' '. ". ." .. ..... ......:.<
.":CERTIFICATE', QF' INSURANCE CERTIFICATE NUMBER
;} :...;,,'..;>&ij.L . . . .' NYC-001133201-01
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
MARSH USA (NEW YORK) NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
ATTN: JANET NORMAN POLICY, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
1166 AVENUE OF THE AMERICAS AFFORDED BY THE POLICIES DESCRIBED HEREIN.
NEW YORK, NEW YORK 10036-2774 COMPANIES AFFORDING COVERAGE
(212) 345-5029 COMPANY
01042 -GTE-all-01-02 MOBIL TX VA FL A AMERICAN HOME ASSURANCE CO
INSURED COMPANY
"GTE MOBILNET OF TEXAS B NIA R1=rc/I.fer-,
DBA VERIZON WIRELESS - .... '-'
ATTN: PAM ANDREWS COMPANY
300 MCLAWS CIRCLE, STE 201 C NIA 1111 . n _
WILLIAMSBURG, VA 23185-5648 ",,'U T-V '''In
COMPANY
D NIA Oil""", "
.eOVE~r.;.e,$ ";,\ Thiscertlflcate 6UP('lrsede$~replacesany previously issued certificate for the policy period 'notedb$'ow~2'~F\(jaMf2N
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, LIMITS SHOWN
MAY HAVE BEEN R~DUCED BY PAID CLAIMS,
CO TYPE OF INSURANCE POUCY NUMBER POLICY EFFECTIVE POLICY EXPIRATION UMITS
LTR DATE (MMIDDIYYI DATE (MMIDDIYYI
A GENERACUABIUTY RMGL 61245 92 __.~~cc- 07/01/01 .' '06/30/02 --- .--- $- ,. --1 o,obO~(iO()
- GENERAL AGGREGATE
X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMPIOP AGG $ INCLUDED
." I CLAIMS MADE o OCCUR PERSONAL & ADV INJURY $ 1,000,000
- OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (Anyone fire) $ 50,000
MED EXP (Anv one """""'\ $ 10,000
AUTOMOBILE UABILlTY $
- COMBINED SINGLE LIMIT
- ANY AUTO
- ALL OWNED AUTOS BODILY INJURY $
SCHEDULED AUTOS (Per person)
-
- HIRED AUTOS BODILY INJURY $
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
GARAGE UABILlTY AUTO ONLY - EA ACCIDENT $
-
ANY AUTO OTHER THAN AUTO ONLY: I.-;J.~.~. .' ".'
-
I-- EACH ACCIDENT $
AGGREGATE $
EXCESS UABIUTY EACH OCCURRENCE $
R UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM $
WORKERS COMPENSATION AND I T~~'; L~J,~s I TH, ""'" ':7-- ....
EMPL-GV€RS'-LlABlU-TY ., I ER <'.>
EL EACH ACCIDENT $
THE PROPRIETOR! RINCL EL DISEASE-POLICY LIMIT $
PARTNER~ECUTWE EL DISEASE-EACH EMPLOYEE $
OFFICERS ARE: EXCL
rOffiER
DESCRIPTION OF OPERATlONSILOCATlONSNEHICLESISPECIAL ITEMS (UMITS MAY BE SUBJECT TO DEDUCTlBLES OR RETENTIONSI
RE: COUNTRYSIDE CELL SITE,
CERTIFICATE HOLDER IS ADDITIONAL INSURED (EXCEPT ON WORK COMP)AS RESPECTS OPERATIONS OF THE NAMED INSURED TO THE
EXTENT AND LIMITS REQUIRED BY CONTRACT.
el:~I'Ft~~l'ED~,(;).~9E~ . ...... ':. .".......,. CANCELlATION .,.. ......... ,.'......r.........;i........... .....
.'
SHOULD ANY OF THE POlICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL ---1D DAYS WRITTEN NOTICE TO THE
CITY OF CLEARWATER CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
P.O. BOX 4748
CLEARWATER, FL 34618-4748 c..L~I~ LIABILITY OF ANY KINO UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES,
A TTN: crr " MAI4A5[R C.l~
'"J:: A,~ 7 MARSH USA INC,
CLC~ BY: Maryann Brainard ~l>'~
I i...>..>i....i.i VAUD.A$iOF;1l6129101
I '. ........ MM 1 (9199)
ITIONALIN,F'ORMAftOIN'
,.',.., DATE (MMIDDIYYI
"NYC~OQ1J33201~01 06/29/01
COMPANIES AFFORDING COVERAGE
PRODUCER
MARSH USA (NEW YORK)
ATTN: JANET NORMAN
1166 AVENUE OF THE AMERICAS
NEW YORK, NEW YORK 10036-2774
(212) 345-5029
01042 -GTE-all-01-02
MOBIL TX
VA
COMPANY
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COMPANY
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FL
COMPANY
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COMPANY
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INSURED
"GTE MOBILNET OF TEXAS
DBA VERIZON WIRELESS
A TTN: PAM ANDREWS
300 MCLAWS CIRCLE, STE 201
WILLIAMSBURG, VA 23185-5648
Cancellation Clause
Any cancellation or any material change adversely affecting the governments' interest shall not be effective
1) for such period as the laws of the state in which this contract is to be performed prescribe or
2) until 30 days after ther insurer or the contractor gives written notice to the contracting officer whichever period is longer.
CER1IFIC.b.T~'I'I:(>t.PER
CITY OF CLEARWATER
P.O. BOX 4748
CLEARWATER, FL 34618-4748
ATTN: CITY MANAGER
INCLUDES COPYRIGHTED MATERIAL OF ACORD CORPORATION WITH ITS PERMISSION.