CERTIFICATE OF LIABILITY INSURANCE (7)
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CERTIFICATE OF LIABILITY INSURANCE F ATE(MM/DD/YYYY)
06/1$/2009
PRODUCER
AOn Risk Services Northeast, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
New York NY Office AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
199 Water Street CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
New York NY 10038-3551 USA COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC#
PHoNE• 866 283-7122 --(847) 953-5390
INSURED INSURER A: National union Fire Ins Co of Pittsburgh 19445 ••
cellco Partnership INSURERS: New Hampshire Ins Co 23841
d/b/a Verizon wireless ro
One Verizon way INSURER C: Illinois National Insurance Co 23817
Basking Ridge N] 07920-1097 USA ro
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INSURER D: i.
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INSURER E: q
VnVF.RA(,F.C SIR anDl-iPs nPr terms and rnnditionc of the nnlirv "?
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWFFHSTANDING
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 LIMFfS SHOWN MAY HAVE BEEN REDUCED 13Y PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED
INSR ADDT1
LTR INSRII TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
ATF: MMIDn/YVV nATF. MMmn
A ERALLIABILITY 0907415 06/30/2009 06/30/2010 EACH OCCURRENCE $1,000,000
x COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S 2 , 000 , 000
F PREMISES (Ea occurrence)
CLAIMS MADE M OCCUR MED EXP Any one person 10 , 000
x XCU Included
PERSONAL & ADV INJURY
S1,000,07
GENERAL AGGREGATE $2,000,000
GEN. AGGREGATE LIMIT APPLIES PER
PRODUCTS - COMP/OP AGO
$2,000,000
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?X POLICY E] PRO- LOC
7ECT
A AUTOMOBILE LIABILITY 0919443 06/30/2009 06/30/2010 COMBINED SINGLE LIMIT
X ANY AUTO AOS
(Ea accident) $1,000,000
A 0919444 06/30/2009 O6/3D/2010
ALL OWNED AUTOS MA
BODILY INJURY
A SCHEDULED AUTOS 0919445 06/30/2009 06/30/2010 (Per person)
rson)
VA
HIRED AUTOS
BODILY INJURY
NON OWNED AUTOS (Per accident)
Self Insured for PROPERTY DAMAGE
Physical damaoe
(Per accidcot)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT
R ANY AUTO
OTHER THAN EA ACC
AUTO ONLY
AGG
EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE
? OCCUR ? CLAIMS MADE AGGREGATE
DEDUCTIBLE
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A 66199876 --56/30/2009 X wC STATLI- OTH-
WORKERS COMPENSATION AND
' AOS ,
B EMPLOYERS
.LABILITY
N
ANY PROPRIET
R/P
T
60168869
06/30/2009
06/30/2010
E.L. EACH ACCIDENT
$1,000,000
B AR
O
NER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NTT) MMI,MN,NY,WI,WV
60168868
06/30/2009
06/30/2010
E.L. DISEASE-EA EMPLOYEE
$1,0001000
If , descn'bc under SPECIAL PROVISIONS below
OR E L DISEASE-POLICY LIMIT $1,000,000
OTHER
DESCRIPTION OF OPERATTONS/LOCATIONSlVEMCLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
NAMED INSURED INCLUDES: GTE MOBILNET OF TEXAS.
RE: COUNTRYSIDE CELL SITE - CROWN CASTLE SITE BUN #814424 CERTIFICATE HOLDER IS ADDITIONAL INSURED (EXCEPT ON
WORK COMP) AS RESPECTS OPERATIONS OF THE NAMED INSURED TO THE EXTENT AND LIMITS REQUIRED BY CONTRACT.
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CERTIFICATE HOLDER CANCELLATION -
City Of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION _
Attn: Earl Barrett DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
P.O. Box 4748 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Clearwater FL 33758-474$ USA BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2009/01) 01988.2009 ACORD CORPORATION- All rights reserved=
The ACORD name and logo are registered marks of ACORD