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HomeMy WebLinkAboutCROWN CASTLE INTERNATIONAL CORP - INSURANCE CERTIFICATE (2)``� D® CERTIFICATE OF LIABILITY INSURANCE page 1 of 2 03/29/20 2 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 Willie of Pennsylvania, Inc. c/o 26 Century Blvd. P. o. sox 305191 Nashville, IN 37230-5191 CONTACT NAME _ PHONE WC FAX N EX , 877-945-7378 1 WC. N 888-467-2378 n-DRML E certificates@willis.com ' INSURER(S)AFFORDING COVERAGE NAICk INSURERA: Federal Insurance Company 20281-005 INSURED CROWN CASTLE INTERNATIONAL CORP. INSURERS: New Hampshire Insurance Co. 23841-000 INSURERC: --,See Attached Named Insured List 1220 Augusta Dr. Suite 500 Houston, TX 77057 INSURER D: INSURER E: INSURER F' -- - -I rnVFRAr:FS CFRTIFICATE NUMRER: 17601367 - REVISION NUMBER: 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. INSRLTR TYPE OF INSURANCE DD yry POLICY NUMBER MWDDPOLICY EFF IMWDDPOLICY EX� LIMITS A GENERALLIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 70210228 4/1/2012 4/1/2013 EACHOCCURRENCE S 1,000,000 PREMSESONTED EaEomuremo S 11000,000 MEDEXP(Anyoneperson) S 5,000 PERSONAL B ADV INJURY $ 11000,000 G EN ERAL AGG R EGATE S 2,000,000 GEN'L AGG REGATE LI MIT APPLI ES PER: X POLICY PRO- LOC PRODUCTS COMP/OP AGG 8 2,000,000 $ A AUTO MOBILELIABILITY X ANYAUTO ALLOWNEO SCHEDULED AUTOS AUTOS HIRED AUTOB NON -OWNED AUTOS 70210229 4/1/2012 4/1/2013 COMBINED SINGLE LIMIT (Eaaccident $ 1, 000,000 BODILY NJURY(Per person) $ BODILY INJURY(PeraccideM) $ Per accident) A $ $ B X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE 61844671 4/1/2012 4/1/2013 EACH OCCURRENCE $ 5,000,000 N AGGREGATE $ 5,000,000 DED (RETENTIONS $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNEWEXECUTIVE � OFFICER/MEMBER EXCLUDED? IManda.101 in NH) I yes, tleecribe under DESCRIPTION OF OPERATIONS below N/A 71710698 4/1/2012 4/1/2013 X T E.L. EACH ACCIDENT $ 1,000,000 EL DISEASE -EA EMPLOYEE $ 1, 000, 000 E.L. DISEASE -POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS/VEHICLES (Allach Acord 101, AOditonal Remarks Schedule, if more space is required) RE: 877023 See Attached SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FORT COLLINS, CITY OF AUTHORIZED REPRESENTATIVE PO BOX 580 ATTN EDNA HOERNICXE lI� FORT COLLINS, CO 80522 Qg1,FlA,,(w. LA,�� Coll:3681692 Tp1:1422477 Cert:17601367 ©1988-201 ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 713110 LOC#: ' ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED CROWN CASTLE INTERNATIONAL CORP. Willis of Pennsylvania, Inc. See Attached 1220 Augusta Named Insured List Dr. Suite 500 POLICY NUMBER Houston, TX 77057 See First Page CARRIER NAIC CODE EFFECnVEDATE: See First Page See First Page AOOITIONAL REMARKS 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 policies as re ired by written agreement and only with respect to the liability arising out of t; 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 whenrequired by written contract and as permitted by law but always subject to the policy terms, conditions and exclusions as permitte3 by law. ACORD 101(2008/01) Coll:3681692 Tpl:1422477 Cert:17601367 @2008 ACORD CORPORATION. All rights 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 South LLC Atlantic Coast Communications LLC Crown Castle Towers 05 LLC AZ - CLEC LLC Crown Castle Towers 06-2 LLC CA - CLEC LLC Crown Castle Towers 09 LLC CC Castle International LLC Crown Castle Towers LLC CC Finance LLC Crown Castle USA Inc. Crown Communication LLC (formerly Crown CC Holdings GS V LLC Communication Inc. eff 1/1/11) CC Site Acquisitions 11 LLC Crown Communication New York, Inc. CC Towers Guarantor LLC Crown Mobile Systems, Inc CC Towers Holding LLC CTTA Pty Limited (eff 8/13/08) CCGS Holdings Corp. DC - CLEC LLC CCPE Acquisitions LLC - FL - CLEC LLC Coastal Antennas LLC Global Signal Acquisitions 11 LLC CO-CLEC (11/19/09) Global Signal Acquisitions III LLC Comsite Venture, Inc. Global Signal Acquisitions IV LLC Coverage Plus Antenna Systems LLC Global Signal Acquisitions LLC Crown Atlantic Company LLC Global Signal GP LLC Crown Castle AS LLC (eff 4/29/11) Global Signal Holdings III LLC Crown Castle Atlantic LLC Global Signal Holdings IV LLC Crown Castle Augusta LLC Global Signal Operating Partnership, L.P. Crown Castle Australia Holdings Pty Ltd Global Signal Services LLC Crown Castle Australia Ply Ltd GoldenState Towers, LLC Crown Castle BP ATT LLC GS Savings Inc. Crown Castle CA Corp. GSPN Intangibles LLC Crown Castle GS III Corp. High Point Management Co. LLC Crown Castle GT Company LLC ICB Towers, LLC Crown Castle GT Corp. IL - CLEC LLC Crown Castle GT Holding Sub LLC IN - CLEC LLC Crown Castle International Corp. In SITE Fiber of Virginia, Inc. Crown Castle International Corp. de Puerto Rico InSITE Solutions, LLC Crown Castle International LLC Interstate Tower Communications LLC Crown Castle Investment Corp Intracoastal City Towers LLC Crown Castle MM Holding Corp. JBCM Towers LLC Crown Castle MM Holding LLC KAW Consulting Ply Ltd (eff 12112/01) Crown Castle MU LLC MA - CLEC LLC Crown Castle MUPA LLC MD - CLEC LLC Crown Castle Nevada LLC Mobile Media California LLC Crown Castle NG Acquisitions Corp (eff 12/14/11) Mobile Media National LLC Crown Castle No 1 Ply Ltd (eff 6/14/11) Modeo LLC Crown Castle Operating Company MW Cell REIT 1 LLC (eff 1/31/12) Crown Castle Operating LLC MW Cell TRS 1 LLC (eff 1/31/12) Crown Castle Orlando Corp. New Path Networks, Inc. Crown Castle PR LLC New Path Networks, LLC Crown Castle PT Inc. NJ - CLEC LLC Crown Castle Puerto Rico Corp. NV - CLEC LLC Crown Castle Service LLC (eff 6/24/2011) NY - CLEC LLC Crown Castle Solutions Corp. OH CLEC LLC (effective 7/20111) OF LLC PA - CLEC LLC Pinnacle San Antonio L.L.C. Crown Castle International Corp. Consolidated Subsidiaries Pinnacle St. Louis LLC Pinnacle Towers Acquisition Holdings LLC Pinnacle Towers Acquisition LLC Pinnacle Towers Asset Holding LLC 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 (eff 9/20/05) 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 WCP Wireless Lease Subsidiary, LLC (eff 1/31/2012) WCP Wireless Site Funding LLC (eff 1/31/2012) WCP Wireless Site Holdco LLC (eff 1/31/2012) WCP Wireless Site Non -RE Funding LLC (eff 1/31/2012) WCP Wireless Site Non -RE Holdco LLC (eff 1/3i/2012) WCP Wireless Site RE Funding LLC (eff 1/31/2012) WCP Wireless Site RE Holdco LLC (eff 1/31/2012) Inactive Entities Crown Castle Europe LLC eff 12/9/2009 Crown Castle Mexico, S.A. de C.V. eff 12/2010 INSURER CANCELLATION TERMS CROWN CASTLE INTERNATIONAL CORP. I 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 organization, to provide with notice of cancellation for any reason other than 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 Willis 101