CERTIFICATE OF LIABILITY INSURANCE (4)
ACORDT.
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DATE (MM/DD/VV)
07/24/07
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
PRODUCER
Aon Risk services, Inc. of New York
199 Water Street
New York NY 10038-3551
PHONE. (866) 283-7122 FAX - (847) 953-5390
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
C
New Hampshire Ins Co
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COMPANY
B
National union Fire Ins co of pittsburgh
Insurance company of the State of PA
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.
co
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MMlDDIYY) DATE (MMIDDIYY)
LIMITS
06/30/07
06/30/08
BODILY INJURY
( Per person)
00
$2,000,000 0"1
0
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Included '"
0
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$2,000,000 N
0
$2,000,000 0
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LI"O
$2,000,000 Q
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$5,000,000 ...
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A
GENERAL LIABILITY
1595260
General Liability
06/30/07
06/30/08
GENERAL AGGREGATE
PRODUCTS - COMPIOP AGG
PERSONAL & ADV INJURY
EACH OCCURRENCE
A
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 0 OCCUR
OWNER'S & CONTRACTOR'S PROT
FIRE DAMAGE(Any one fire)
MED EXP (Anyone person)
A
1606845
Auto Liability - verizon wirel
1606846
Auto Liability-Mass
1606847
Auto Liability- verizon wirele
06/30/07
06/30/08
COMBINED SINGLE LIMIT
A
06/30/07
06/30/08
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
B EXCESS LIABILITY
X UMBRELLA FORM
OTHER THAN UMBRELLA FORM
BE9834994
umbrella (primary)
06/30/07
06/30/08
EACH OCCURRENCE
AGGREGATE
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
A
X INCL
1608119
work Comp AOS (wireless)
1608120
CA
06/30/07
06/30/08
X
A
WORKER'S COMPENSATION AND
EMPLOYERS' LIABILITY
THE PROPRIETORI
PARTNERS/EXECUTIVE
OFFICERS ARE:
06/30/07
06/30/08
EL DISEASE-POLICY LIMIT
EL DISEASE-EA EMPLOYEE
$2,000,000
$2,000,000
EXCL
DESCRIPTION OF OPERATION5ILOCATIONSNEHICLES/SPECIAL 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.
'.nfitcAtEnHOta:lErt
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 USA
EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~~.9'~~, ~..N_W""'"
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
A 1608121 06/30/07 06/30/08
FL
B 1608122 06/30/07 06/30/08
OR
0 1608123 06/30/07 06/30/08
r'\R, MA, NV,TN, VA
C 1608124 06/30/07 06/30/08
~I, NY, WI
DESCRIPTioN OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
Certificate No:
570024063098