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CERTIFICATE OF LIABILITY INSURANCE (11)CERTIFICATE OF LIABILITY INSURANCE DATE(?MIN3?DDD/YYYY) 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 pollcy(les) 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 Aon Risk Services Northeast, Inc. NAME FAX New York NY office, No, Ext); (866) 283-7122 (ANC. No.: (847) 953-5390 199 water street E-MAIL New York NY 10038-3551 USA ADDRESS: ' INSURER(S) AFFORDING COVERAGE NAIC # INSURED Cellco Partnership d/b/a verizon Wireless One Verizon Way Basking Ridge NJ 07920-1097 USA INSURER A: National Union Fire Ins Co of Pittsburgh 19445 INSURER B: New Hampshire ins co 23841 1NSURERC: Illinois National Insurance Co 23817 INSURER D: INSURER E: INSURER F: r+AVCOerYCC /`G0I1GI/_AT0 III IWlril=R• R7nnA?QdAA'A.r% RFVISIAN NIIMRFR- 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE ADO IN R9 SUR WVD POLICY NUMBER LIMITS A GENERAL LIABILITY _ 2449475 A 06/30/2012 EACH OCCURRENCE - S1,000,000 DAMAGE T15 ffMTrM $2 000 000 X COMMERCIAL GENERAL LIABILITY PREMISES Me occurrence , , CLAIMS-MADE OCCUR I" MED EXP (Any one person) $10,000 X XCU Included r? PERSONAL & ADV INJURY $1,000,000 + GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $2,000, 000 X POLICY PRO LOC ,DTI' A AUTOMOBILE LIABILITY CA3506 23 0 1 06 30 2012 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 ADS A X ANY AUTO CA350632 ? x ? /2011 06/30/2012 BODILY INJURY (Per person) ALL OWNED SCHEDULED ... dA, MA E?E BODILY INJURY (Per accident) A AUTOS AUTOS CA3506324 06/30/2011 06/30/2012 PROPERTY DAMAGE HIREDAUTOS P NON-OWNED AUTOS VA Per accidenl jUL UMBRELLA LIAB OCCUR : r EACH OCCURRENCE EXCESS LWB H CLAIMS-MADE ? G A NU ?? Lv DS AGGREGATE ` l . IC? RE CO ? DED RETENTION B WORKERS COMPENSATION AND 0158836 N 06/30/2012 T OTH- X W EMPLOYERS' LIABILITY T ORY LIM IER B ANY PROPRIETOR / PARTNER/ EXECUTIVE YIN [?] NIA ADS 015883657 06/30/2011 06/30/2012 E.L. EACH ACCIDENT $1,000,000 OFFICEJMEMBEREXCLUDED7 (Mandatory in NH) MA,MI,ND,OH,WA,WI,WV,WY E.L. DISEASE-EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Alfach ACORD 1e7, Additional Remarks Sehedule, N more space Is required) NAMED INSURED INCLUDES: GTE MOSILNET OF TEXAS. RE: COUNTRYSIDE CELL SITE - CROWN CASTLE SITE BUN #814424 CERTIFICATE HOLDER IS ADDITIONAL INSURED CEXCEPT ON WORK COMP) AS RESPECTS OPERATIONS OF THE NAMED INSURED TO THE EXTENT AND LIMITS REQUIRED BY CONTRACT. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Clearwater AUTHORIZED REPRESENTATIVE Attn: Earl Barrett P.O. BOX 4748 e ] r??JL Clearwater FL 33758-4748 USA m r c m `m a 0 S rn eo 9 CNI 4 O z R V tr m V III Lx ?S M_ ©7988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010106) The ACORD name and logo are registered marks of ACORD Attachment to ACORD Certificate for Ce11CO Partnership The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of. the coverage afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy. INSURED Cel1C0 Partnership d/b/a verizon wireless one verizon way Basking Ridge NJ 07920-1097 USA INSURER INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSURANCE ADDL INSR SUER wVD POLICY NUMBER/ POLICY DESCRIPTION POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS WORKERS COMPENSATION C - --- - .._ _ ..... ---- WA.,.. FL A N/A 015883659 CA 6/30/2011 06/30/2012 8 N/A 015883660 TX 6/30/2011 06/30/2012 B N/A 015883658 MN 6/30/2011 06/30/2012 Certificate No : 570042948935