CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
Aon Risk services, Inc.
55 East 52nd Street
New York NY 10055
c ER:J7IFI:GAtE OFLIA~I[~Ii:f'Y1 N 5 URA~ce(i'~;'<t~!nli[~;;i' '[l DATE(MM/DD/YY)
. . "i'..': 06/30/06
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
, ACORDTM
of New York
PHONE - (866) 266-7475 FAX - (866) 467-7847
INSURED
GTE MOBILNET OF TEXAS
d/b/a verizon wireless
180 washington valley Road
Bedminster NJ 07921 USA
COMPANY
A
American Home Assurance Co.
COMPANY
B
Insurance company of the State of PA
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COMPANY
C
Illinois National Insurance Co
National union Fire Ins Co of pittsburgh
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.
POLICY EFFECTIVE IpOLICY EXPiRATION
DATE (MMIDDIYY) DATE (MM/DD/YY)
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
LIMITS
FIRE DAMAGE(Any one fire)
$2,000,000
Included
$2,000,000
$2,000,000
$2,000,000
$10,000
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GENERAL LIABILITY
4024042
General Liability
06/30/06
06/30/07
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
PERSONAL & ADV INJURY
EACH OCCURRENCE
A
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 0 OCCUR
OWNER'S & CONTRACTOR'S PROT
A
3851933
Auto L i abi 1 i ty
3852428
Auto Liability - Texas
3852429
Auto Liability-Mass
3852430
Auto Liability-vA
06/30/06
06/30/07
COMBINED SINGLE LIMIT
$2,000,000
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MED EXP (Anyone person)
06/30/06
06/30/07
BODILY INJURY
( Per person)
A
06/30/06
06/30/07
A
06/30/06
06/30/07
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
EXCESS LIABILITY
UMBRELLA FORM
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EACH ACCIDENT
AGGREGATE
EACH OCCURRENCE
AGGREGATE
OTHER THAN UMBRELLA FORM
A . WORKER~~COMPEN~ATION At'IlL 7S7601L. .06/3MOJi 06/30/0L~_
EMPLOYERS' LIABILITY AOS 1,000,000
A THE PROPRIETOR! X INCL 7576019 06/30/06 06/30/07 EL DISEASE-POLICY LIMIT $1,000,000
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL CA $1,000,000 _
EL DISEASE-EA EMPLOYEE
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DESCRIPTION OF OPERATIONS/LOCATlONSNEHICLESlSPECIAL ITEMS
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.
CERnEICATE'HOlDER
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
city of clearwater
Attn: Earl Barrett
P.O. Box 4748
Clearwater FL 33758-4748
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EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
RITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
E TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES.
D REPRESENTATIVE ~mub.9".......u-.-.g:,..,., ..p.Ar..-'io/o-ak
Attachment to ACORD Certificate for GTE MOBILNET OF . TEXAS
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.
COMPANY
INSURED
GTE MOBILNET OF TEXAS
d/b/a verizon wireless
180 washington valley Road
Bedminster NJ 07921 USA
COMPANY
COMPANY
COMPANY
COMPANY
ADDITIONAL POLICIES
If a policy below does not include limit information, refer to the corresponding policy on the ACORD
certificate form for policy limits.
POLICY POLICY
co TYPE OF INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION LIMITS
LTR POLICY DESCRIPTION DATE DATE
WORKERS COMPENSATION
-s ----- - . ,---- ------ -- 7576070 06/30/06 -06/30/07
FL
B 7576072 06/30/06 06/30/07
AR, MA, NV,TN, VA
C 7576073 06/30/06 06/30/07
I, NY, WI
D 7576071 06/30/06 06/30/07
JR
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS
Certificate No:
570018566942