CERTIFICATE OF LIABILITY INSURANCE (3)
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ACORD...
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYY)
04102/2007
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA.TE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
JOHN L. WORTHAM & SON, L.P.
P.O. BOX 1388
HOUSTON, TEXAS 77251-1388
068386-558<173
gwp magarcia
INSURERS AFFORDING COVERAGE
INSURED
CROWN CASTLE INTERNATIONAL CORP., ET AL
SEE ATTACHED NAMED INSURED LIST
510 BERING DRIVE
SUITE 500
HOUSTON, TEXAS 77057-1457
COVERAGES
INSURER A: Liberty Mutual Fire Insurance CO.
INSURER B: Liberty Insurance Corporation
INSURER c: Lexin ton Insurance Com any
INSURER 0:
INSURER E:
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 MAYBE 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.
INl: TYPE OF INSURANCE POLICY NUMBER PRH~Y EFFECTIVE POLICY EXPIRATION LIMITS
A ~NERAL LIABILITY TB26914400990 04/01/2007 04/01/2008 EACH OCCURRENCE $ 1,000,000
tI' COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 100,000
I CLAIMS MADE ~ OCCUR MED EXP {Anv one DOrsonl $ 5,000
- PERSONAL & ADV INJURY $ 1,000,000
- GENERAL AGGREGATE $ 2,000,000
~'L AGGRnE LIMIT APFiS PER: PRODUCTS - COMP/OP AGG $ 2,000,000
tI' POLICY ~!J-~ LOC
A ~TOMOBILE LIABILITY AS26914400990 04/01/2007 04/01/2008 COMBINED SINGLE LIMIT
$ 1,000,000
~ ANY AUTO (Ea accident)
~ ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
f--
~ HIRED AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
RRAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG $
C EXCESS LIABILITY 6764272 04/01/2007 04/01/2008 EACH OCCURRENCE $ 1,000,000
~OCCUR D CLAIMS MADE AGGREGATE $ 1,000,000
$
~ DEDUCTIBLE $
tI' RETENTION $ 10,000 $
B WORKERS COMPENSATION AND WA769D4400990 04/01/2007 04101/2008 ~ I WC STATU- I IOJ~- $
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLOYE $ 1,000,000
E.L. DISEASE - POLICY LIMIT $ 1,000,000
OTHER
DESCRIPTION OF OPERATlONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: COUNTRYSIDE / BU#814424
SEE ATTACHED FOR SPECIFIC WORDING
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION (BELOW & SEE REVERSE)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF
THE CITY OF CLEARWATER FLORIDA ANY KIND UPON THE ISSUER, ITS AGENTS OR REPRESENTATIVES.
ATTN: EARL BARRETT, ENGINEERING DEPT.
P.O. BOX 4748 ~t1RI~R~E~NTATI:~J.1
CLEARWATER, FL 33758.4748
I ....,."., . .~. "
ACORD 25-S (7/97) (/ @ACORD CORPORATION 1988
-- I
ACORD CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 DATE
TM 01/25/2008
PRODUCER 877-945-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Willis North America, Inc. 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. INSURER A: Liberty Mutual Insurance Co. 23043-000
See Attached Named Insured List INSURER B: Lexington Insurance Company 19437-000
1220 Augusta Dr. Suite 500
Houston, TX 77057 INSURER C:
INSURER D:
I 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 ~~~~ TYPE OF INSURANCE POLICY NUMBER PRl'+~~~~~6g,wf Pg~!f:/~~~~~N LIMITS
LTR
A ~NEFiAL LIABILITY TB2691440099067 4/1/2007 4/1/2008 EACH OCCU RRENCE $ 1. 000,000
X COMMERCIAL GENERAL LIABILITY ~~~~~To~9E~~~6.7r~nce) $ 10Q,QQL
~"c-, ,- --, <leLAIMS MADEWOc;CUR " - "- .--+-.'-------'- - --._-,---- - < -----'-~--- ," ---- '--:.:....; ~, .-" ..' . . " '.. -'-- , ,. . . '.. . 'm'"
MED EXP (Anyone person) $ 5 000
- PERSONAL & ADV INJURY $ 1. 000.000
GENERAL AGGREGATE $ 2,000 000
-
-;l'L AGGREnE LIMIT APM PER: PRODUCTS - COMP/OP AGG $ 2.000.000
X POLICY ~~,QT LOC
A ~TOMOBILE LIABILITY AS2691440099017 4/1/2007 4/1/2008 COMBINED SINGLE LIMIT
$ 1,000,000
JL ANY AUTO REC EIVED (Ea accident)
- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
- JAN 2 .' 2008
- HIRED AUTOS BODILY INJURY
(Per accident) $
NON-OWNED AUTOS
f--
OFf'rlAl RE :ORDS AND, PROPERTY DAMAGE $
L ["I""N A ~n .- ~~, ,~- /,,\["...~. (Per accident)
-... .
:=rAGE LIABILITY AUTO ONLY - EAACCIDENT $
ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG $
B ~ESSlUMBRELLA LIABILITY 6764272 4/1/2007 4/1/2008 EACH OCCURRENCE $ 5 000 000
X OCCUR D CLAIMS MADE AGGREGATE $ 5 000 000
$
H DEDUCTIBLE $
RETENTION $ $
A WORKERS COMPENSATION AND WA769D440099077 4/1/2007 4/1/2008 I WC STATU-~ I IOTH-
EMPLOYERS' LIABILITY X TORY LIMITS ER
A '~~~lb~~MR~t~W~~~m5W~f!,.QllJIVE- .'.,... WC769D440099087 4/1/2007 4/1/2008 E.L. EACH ACCIDENT $ 1. 000,000
'-, " " ~. - --
E.L. DISEASE - EA EMPLOYEE $ La-oo.ooO
If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1 000.000
OTHER
DESCRIPTION OF OPERA TIONSlLOCATIONs/vEHICLESlEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
RE: COUNTRYSIDE / BU#814424
Certificate Holder is included as an Additional Insured under the General, Automobile and Excess
policies as required by written agreement and only with respect to the liabili ty arising out of the
operations performed by or on behalf of the Named Insured. General, Automobile, Excess Liability
and Workers Compensation include a Waiver of Subrogation in favor of the Certificate Holder when
renuired bv written contract but always subiect to the nolicv terms conditions and exclusions.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
ACORD 25 (2001/08)
Coll:2239047 Tpl:734235
@ACORDCORPORATION1988
THE CITY OF CLEARWATER FLORIDA
ATTN: EARL BARRETT, ENGINEERING DEPT.
P.O. BOX 4748
CLEARWATER, FL 33758-4748
~- ~" ~,~
Page 2 of 2
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).
pl~~LAIMER
The Certificate of Insurance on the reverse side of this form 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.
ACORD 25 (2001/08)
Coll:2239047 Tpl:734235 Cert:l0248048
'\ ...
CROWN CASTLE NAMED INSURED LIST
AZ-CLEC, LLOC
CA-CLEC LLC
CCMM I LLC
CROWN ATLANTIC COMPANY LLC
CROWN CASTLE GT COMPANY LLC
CROWN CASTLE INTERNATIONAL CORP.
CROWN CASTLE INTERNATIONA CORP. DE PUERTO RICO
CROWN CASTLE MU LLC
CROWN CASTLE OPERATING COMPANY
CROWN CASTLE PR LLC
CROWN CASTLE PT INC.
CROWN CASTLE SOLUTIONS CORP.
CROWN CASTLE SOUTH LLC
CROWN CASTLE TOWERS 05 LLC
CROWN TOWERS 06 LLC
CROWN CASTLE TOWERS 06-2 LLC
CROWN CASTLE TOWERS LLC
- . -c----CROWN-CASTlE USA INC.
CROWN COMMUNICATION INC.
CROWN COMMUNICATION NEW YORK INC.
DC-CLEC LLC
FL-CLEC LLC
IL-CLEC LLC
IN-CLEC LLC
MD CLEC LLC
MOBILE MEDIA CALIFORNIA LLC
MODEO LLC
NJ-CLEC LLC
NV-CLEC LLC
NY-CLEC LLC
P A-CLEC LLC
V A-CLEC LLC
WA-CLEC LLC
CCGS HOLDINGS LLC
GLOBAL SIGNAL INC.
PINNACLE TOWERS LLC
PINNACLE TOWERS ASSET HOLDING LLC
PINNACLE TOWERS ACQUISITION LLC
PINNACLE TOWERS LIMITED
GLOBA SIGNAL ACQUISITIONS LLC
GLOBAL SIGNA ACQUISITIONS II LLC
GLOBAL-SIGNAT AcaurslTloNSlH LLC
GLOBAL SIGNAL ACQUISITIONS IV LLC
GOLDEN STATE TOWERS LLC
SHAFFER & ASSOCIATES INC.
SIERRA TOWERS INC.
TOWER VENTURES III LLC