CERTIFICATE OF LIABILITY INSURANCE (6)A? °® CERTIFICATE OF LIABILITY INSURANCE F?ATE
)
(
Page 1 of 3 031
3112009
PRODUCER 877-945-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Willis HRH HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
26 Century Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. O. Box 305191
Nashville, TN 372305191 INSURERS AFFORDING COVERAGE NAIC#
INSURED CROWN CASTLE INTERNATIONAL CORP. INSURERA:Federal Insurance Company 20281-005
See Attached Named Insured List
i
00 INSURERB:New Hampshire Insurance Co . 23841-000
1220 Augusta Dr- Su
te 5
Houston, TX 77057 INSURERC:
INSURER D:
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.
INSR DD'
OWN TYPEOFINSURANCE POLICY NUMBER DATE MEFFECTIVY
_1 POTICYEXPIRATION
_K LIMITS
A GENERAL LIABILITY 70210228 4/1/2009 4/1/2010 EACHOCCURRENCE $ 1,000,000
X COMMERCIAL_GENERAL.LIAB.I.LIT_Y_ -__.._..- I DAMAS El NTEO
_.PREMES-.Eao......... -
$ 1 0.0-0 0.00-
CLAIMS MADE X OCCUR MED EXP (Any one person) $ 51000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOPAGG $ 2,000,000
X POLICY PREC? F7 O LOC
A AUT OMOBILE LIABILITY 70210229 4/1/2009 4/1/2010 COMBINED SINGLE LIMIT
(Ea accident) $ 1,000,000
X ANY AUTO
ALL OWNED AUTOS BODILY INJURY
$
SCHEDULEDAUTOS (Perporson)
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Per accident) $
PROPERTYDAMAGE
(Per accident) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S
ANYAUTO OTHERTHAN EAACC $
AUTO ONLY: AGG S
B EXCESS/UMBRELLA LIABILITY 61844483 4/1/2009 4/1/2010 EACH OCCURRENCE S 5 000, 000
X OCCUR FICLAIMS MADE AGGREGATE S 5,000,000
$
DEDUCTIBLE $
RETENTION $ $
A WOgKERSCOMPENSAT1pN
' 71710698 4/1/2009 4/1/2010 X 1 11 TORYLIIMIT OER
ANDEMPLOYERS
LIABILITY Y/N
..ANY.P_ROPRIETOR/PARTNER/EXECUTIVE-?.. E.L. EACH ACCIDENT .. $ . -.1 000 0.00.-
OFFICER/MEMBER EXCLUDED?
(Mandatary in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000
describe under
If yes,
E
SPECIAL PROVISIONS below
SP E.L. DISEASE - POLICY LIMIT $ 11000.000
OTHER
DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
RE: COUNTRYSIDE / BU#814424
See Attached:
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
THE CITY OF CLEARWATER FLORIDA
ATTN: EARL BARRETT
ENGINEERING DEPT R RESENTATIVES.
,
.
P.O. BOX 4748 A ORIZEDR P E TIVE•
CLEARWATER, FL 33758-4748 U
ACORD 25 (2009/01) Co11:2657644 Tp1:907331 Cert:12297469 ®1988-200"CORDCORPORATION. AII rights reserved.
The ACORD name and logo are registered marks of ACORD
W
ll CERTIFICATE OF LIABILITY INS DATE
i
is URANCE Page z of 3 03131
/2009
PRODUCER 877-945-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Willis HRH HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
26 Century Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. 0. BOX 305191
Nashville, TN 372305191 INSURERS AFFORDING COVERAGE NAIC#
INSURED CROWN CASTLE INTERNATIONAL CORP. INSURERA:Federal Insurance Company 20281-005
See Attached Named Insured List
1220 Augusta Dr
Suite 500 INSURER B: New Hampshire Insurance Co. 23841-000
.
Houston, TB 77057 INSURERC:
INSURER D:
INSURER E:
n y?yn?n,alIVIYa/4Vl,A IIVIY.7/Y CnII,LC.7/CAI,LU.^,IVIY.7 AUYCL Ci C LPVPfSR'.MCMIlbrtUTALrnuvi6IUIYb
Certificate Holder is included as an Additional insured under the General, Automobile, and Excess
Liability policies as required by written agreement and only with respect to the liability arising
out of the operations performed by or on behalf of the Named Insured.
The General, Automobile, Excess Liability, and workers Compensation policies include a Waiver of
Subrogation in. favor of- .the.. Certificate Ho.lder_ when re_qui.red.._by. wri.tten._contrac.t but. always subj-ect
to the policy terms- condi£ions and exclusions.
L:o11:Zbb'/b44 Tpl:907331 Cert:12297469
Page 3 of 3
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized
representative or producer, and the certificate holder, nor does it affirmatively or negatively amend,
extend or alter the coverage afforded by the policies listed thereon.
ACURU25(2009/01) Coll:2657644 Tpl:907331 Cert:12297469
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