CERTIFICATE OF LIABILITY INSURANCE (10)AE °w CERTIFICATE OF LIABILITY INSURANCE [TE DD1YYYY)
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Page 1 of 2 3/
31/2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. 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).
PRODUCER CONTACT
AME:
Hillis Pennsylvania, Inc. PM
26 Century Blvd. ONO EXT: 877-945-7378 a 888-467-2378
JAI.
P. O. Box 305191 E-MAIL
A cert:ificates@willis.com
Nashville, TN 37230-5191
INSURER(S)AFFORDINGcOVERAGE NAIC #
INSURERA: Federal Insurance Company 20281-005
INSURED CROWN CASTLE INTERNATIONAL CORP INSURER B: New Hampshire Insurance Co. 23841-000
.
See Attached Named insured List
INSURER C:
1220 Augusta Dr. Suite 500
Houston, TX 77057 INSURER D:
INSURER E:
- INSURER F:- .. -r ; . - .
GOVERAGE5 CERTIFICATF NIIMRFR• 15778555 l2=VICIfUJ NtInnRCC-
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPEOFINSURANCE Dp SUVp POLICYNUMBER AOLIDCOYEFF POLICY EXP LIMITS
A GENERAL LIABILITY Y 70210228 4/1/2011 4/1/2012 EACHOCCURRENCE $ 11000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISE Eao curence
$ 11000,000
CLAIMS-MADE OCCUR MED EXP (Anyone person) S 5,000
PERSONAL&ADVINJURY $ 1
000
000
1
,
GENERAL AGGREGATE $ 2
000
000
,
,
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2,000,000
X POLICY JPROECT F7 LOG
$
A AUT OMOBILE LIABILITY Y 70210229 4/1/2011 4/1/2012 (Ea OMB accident) NGLELI I
$ 1,000,000
X ANYAUTO BOD ILY I NJ URY(Per person) $
ALLOWNED
AUTOS S SCHEDULED
AUTOS
BODILYINJURY(Peraccident)
$
HIREDAUTOS NON-OWNED
AUTOS PFIOP?ERTYDAMAGE
Peraident
$
$
B UMBRELLALIAB X OCCUR Y 61844671 4/1/2011 4/1/2012 EACHOCCURRENCE S 5,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 51000,000
DED RETENTION$ $
A WORKERS COMPENSATION Y 71710698 4/1/2011 4/1/2012 X A
AND EMPLOYERS'LIABILITY E
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE
N/A
E.L. EACH ACCIDENT
$ 1,000,000
OFFICERIMEMBER EXCLUDED?
fpandatoryinNHl
describe un er
es
E.L. DISEASE -EA EMPLOYEE
$ 1,000,000
y
,
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT i s 1,000,000
RECEV D
DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach Acord 101, Additonal Remarks Schedule, if more space Is required)
F• . .•..: n -u n -,
RE: COUNTRYSIDE / BV#814424
q
APR
See Attached:
0W ICIAL RECORDS AND
APR 8 2011
LEOISIAWE S:"VCtS DEFT
%.4n r IFI%'m I G nvLvnn l:AN4tL.LA I IUN rKif" - - , ,- - ..... 1
SHOULD ANY OF THE ABOVE DESCr REP POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
THE CITY OF CLEARWATER FLORIDA
ATTN: EARL BARRETT, ENGINEERING DEPT.
P.O. BOX 4748
CLEARWATER, FL 33758-4748
AUTHORIZED REPRESENTATIVE
Coll:3313191 Tp1:1239897 Cert:15718555 01988-2011( CORD CORPORATION. All rights reserved
AfrUr1U 20 (ZUTUlu*) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 713115
LOC#:
"4` °R°® ADDITIONAL REMARKS SCHEDULE
Paged of 2
AGENCY NAMED INSURED
CROWN CASTLE INTERNATIONAL CORP.
Willis of Pennsylvania, Inc. See Attached Named Insured List
POLICY NUMBER 1220 Augusta Dr. Suite 500
Houston, TX 77057
See First Page
CARRIER NAIC CODE
see First Page
EFFECTIVEDATE: See First Page
-71
AUUI 1 IUNAL KLMAKKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
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 b:9alf of the Named Insured.
The General, Automobile, Excess Liability, and Workers Compensation olicies include a waiver of
Subrogation in favor of-the Certificate Holder when required by writ?en contract but always subject
to the policy terms, conditions and exclusions as permitted by law.
ACORD 101 (2008/01) C011:3313191 Tpl:1239897 Cert:15718555 ®2008ACORDCORPORATION. Allrights reserved.
The ACORD name and logo are registered marks of ACORD
Crown Castle International Corp. Consolidated Subsidiaries
AirComm of Avon, L.L.C. Crown Castle Towers 06-2 LLC
Atlantic Coast Communications, Inc. Crown Castle Towers 09 LLC
AZ - CLEC LLC Crown Castle Towers LLC
CA - CLEC LLC Crown Castle USA Inc.
Crown Communication LLC (formerly Crown
CC Castle International LLC Communication Inc. eff 1/1/11)
CC Finance LLC Crown Communication New York, Inc.
CC Holdings GS V LLC Crown Mobile Systems, Inc
CC Site Acquisitions II LLC CTTY PTY Limited
CC Towers Guarantor LLC DC - CLEC LLC
CC Towers Holding LLC FL - CLEC LLC
CCGS Holdings LLC Global Signal Acquisitions II LLC
CCPE Acquisitions LLC Global Signal Acquisitions III LLC
Coastal Antennas LLC Global Signal Acquisitions IV LLC
.CO-CLEC LLC _ Global Signal Acquisitions. LLC..
Comsite Venture, Inc. Global Signal GP LLC
Coverage Plus Antenna Systems LLC Global Signal Holdings III LLC
Crown Atlantic Company LLC Global Signal Holdings IV LLC
Crown Castle Atlantic LLC Global Signal Operating Partnership, L.P.
Crown Castle Augusta LLC Global Signal Services LLC
Crown Castle Australia Holdings Pty Ltd GoldenState Towers, LLC
Crown Castle Australia Pty Ltd GS Savings Inc.
Crown Castle BP ATT LLC GSPN Intangibles LLC
Crown Castle CA Corp. High Point Management Co. LLC
Crown Castle Europe LLC-inactive 1/1/11 ICB Towers, LLC
Crown Castle GS III Corp. IL - CLEC LLC
Crown Castle OT Company LLC IN - CLEC LLC
Crown Castle GT Corp. In SITE Fiber of Virginia, Inc.
Crown Castle GT Holding Sub LLC InSITE Solutions, LLC
Crown Castle International Corp. Interstate Tower Communications LLC
Crown Castle International Corp. de Puerto Rico Intracoastal City Towers LLC
Crown Castle International LLC JBCM Towers LLC
Crown Castle Investment Corp MA - CLEC LLC
Crown Castle Mexico, S.A. de C.V.-inactive 1/1/11 MD - CLEC LLC
Crown Castle. MM Holding Corp.... Mobile Media California LLC
Crown Castle MM Holding LLC Mobile Media National LLC
Crown Castle MU LLC Modeo LLC
Crown Castle MUPA LLC New Path Networks, Inc.
Crown Castle Nevada LLC New Path Networks, LLC
Crown Castle Operating Company NJ - CLEC LLC
Crown Castle Operating LLC NV - CLEC LLC
Crown Castle Orlando Corp. NY - CLEC LLC
Crown Castle PR LLC OP LLC
Crown Castle PT Inc. PA - CLEC LLC
Crown Castle Puerto Rico Corp. Pinnacle San Antonio L.L.C.
Crown Castle Solutions Corp. Pinnacle St. Louis LLC
Crown Castle South LLC Pinnacle Towers Acquisition Holdings LLC
Crown Castle Towers 05 LLC Pinnacle Towers Acquisition LLC
Pinnacle Towers Asset Holding LLC
Crown Castle International Corp. Consolidated Subsidiaries
Pinnacle Towers Canada Inc.
Pinnacle Towers III LLC
Pinnacle Towers Limited
Pinnacle Towers LLC
Pinnacle Towers V Inc.
Radio Station WGLD LLC
RECC Properties Limited
SC - CLEC LLC
Shaffer & Associates, Inc.
Sierra Towers, Inc.
Thunder Towers LLC
Tower Systems LLC
Tower Technology Company of Jacksonville LLC
Tower Ventures III, LLC
Towers-Finco II LLC - - -
Towers Finco III LLC
Towers Finco LLC
TVHT, LLC
VA-CLEC LLC
WA - CLEC LLC
.. INSURER CANCELLATION TERMS
NAMED INSURED
CROWN CASTLE INTERNATIONAL CORP. POLICY NO.
Various
EFFECTIVE DATE SEE PAGE 1
Person or Organization:
Person(s) or organization(s) that you are obligated, pursuant to written contract or agreement between you and
-such person or organizatra n to provide With notice of canceliation for any reason other an non-payment of
premium, provided that, within 10 days of the date the producer or the first named insured receives a copy of the
notice of cancellation, the producer or the first named insured provides us with a spreadsheet containing the
name, address and, if available, e-mail address of the person(s) or organization(s) to whom such notice of
cancellation is to be sent.
All other terms and conditions remain unchanged.
Cancellation Terms:
When we cancel this policy as described in the Cancellation condition for any reason other than non-payment of
premium, we will also send to the person or organization described in the Schedule a notice of at least 30 days in
advance of the cancellation date.
Any failure on our part to deliver such notice will not:
impose liability of any kind upon us; or
invalidate the cancellation.
Cancellation Terms Apply to the Following Coverages:
General Liability, Automobile Liability and Workers Compensation
W1115 101