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HomeMy WebLinkAboutCROWN CASTLE INTERNATIONAL CORP - INSURANCE CERTIFICATE (6)A� "® CERTIFICATE OF LIABILITY INSURANCE page 1 of 2 FD�ATE 03/30/2016) 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 CONTACT NAME Willis of Pennsylvania, Inc. c/o 26 Century Blvd.NrW P. O. Box 305191 PRONE 877-945-7378 FAX 888-467-2378 E-MAIL certificates@willis.com Nashville, TN 37230-5191 INSURER(S)AFFORDINGCDVERAGE NAIC # INSURERA:Federal Insurance Company 20281-005 INSURED CROWN CASTLE INTERNATIONAL CORP. INSURERS: Travelers Casualty & Surety Co. of Americ 31194-002 INSURERC:North American Elite Insurance Company 29700-001 See Attached Named Insured List 1220 Augusta Dr. Suite 500 Houston, TX 77057 INSURERD:Travelers Property Casualty Co of Amer 25674-001 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 24296072 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. INSR LTR TYPE OF INSURANCE DDL SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 7021-02-28 4/1/2016 4/1/2017 EEAACCHA��OEECTCQpURRRENCE '�$ 11000,000 PFEMf5E5(taoccumnc.) $ 11000,000 MED EXP (Any one person) $ 51000 PERSONAL & ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO JECT CI LOC OTHER: GENERALAGGREGATE $ 2,000,000 X PRODUCTS-COMP/OPAGG $ 2,000,000 $ B AUTOMOBILE LIABILITY X ANYAUTO ALLOWNED SCHEDULED AUTOSBODILY SNON-OOWNED HIREDAUTOSHAUT AUTOS TC2JCAP-474M9749-16 4/1/2016 4/1/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY(Per person) $ INJURY(Per accident) $ PROPERTYDAMA E (Per accident) $ $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UMB 2000165-02 4/1/2016 4/1/2017 EACH OCCURRENCE $ 51000,000 AGGREGATE $ 5,000,000 DED X RETENTION$ 25,00 $ D D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOH/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NSA TC2JUB-474M9694-16 4/1/2016 TRKUB-474M9701-16 4/1/2016 4/1/2017 4/1/2017 X TH- E.L. EACH ACCIDENT $ 11000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additonal Remarks Schedule, may be attached if more space is required) RE: 877023 See Attached 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. FORT COLLINS, CITY OF AUTH IZEDREPRES ATIVE PO BOX 580 ATTN EDNA HOERNICKE FORT COLLINS, CO 80522 Coll:4876048 Tpl:2042328 Cert:24296072©1988-2014ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 713115 LOC#: A� ADDITIONAL REMARKS SCHEDULE Page_ of 2_ AGENCY NAMED INSURED CROWN CASTLE INTERNATIONAL CORP. Willis of Pennsylvania, Inc. See Attached Named Insured List POLICY NUMBER 1220 Augusta Dr. Suite 500 Houston, TX 77057 See First Page _ CARRIER NAIC CODE See First Page EFFECTIVEDATE: See First Page WDITIONAL 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 Liability, Automobile Liability and Umbrella/Excess policies as their interest may appear and as required by written agreement and only with respect to the liability arising out of the operations performed by or on behalf of the Named Insured. General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation include a Waiver of Subrogation in favor of the Additional Insured when required by written contract and as permitted by law but always subject to the policy terms, conditions and exclusions as permitted by law. ACORD101 (2008/01) Coll:4876048 Tpl:2042328 Cert:24296072©2008ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD