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HomeMy WebLinkAboutCROWN CASTLE INTERNATIONAL - INSURANCE CERTIFICATEA SRO® CERTIFICATE OF LIABILITY INSURANCE page 1 of 2F�ATE 28/2018 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 have ADDITIONAL INSURED provisions or 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 Willis of Pennsylvania, Inc. c/o 26 Century Blvd. P. O. Box 305191 PHONE FAX 877-945-7378 888-467-2378 AD RFS.S-E-MAIL certificates@willis.com Nashville, TN 37230-5191 INSURER(S)AFFORDINGOOVERAGE NAIC u INSURERA:Federal Insurance Company 20281-005 INSURED Crown Castle International INSURER B:Travelers Property Casualty Co of Amer 25674-001 INSURERC:Berkshire Hathaway Specialty Insurance Co 22276-001 See Attached Named Insured List INSURERD: 1220 Augusta Dr. Suite 600 Houston, TX 77057 INSURER E: INSURER F: CnVFRAC.FR CERTIFICATE NUMBER: 26184838 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 TYPE OF INSURANCE DDL SUB POLICY NUMBER POLICY EFF POLICY EXPITR LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE1OCCUR 7021-02-28 4/1/2018 4/1/2019 -EACHOCCURRENCE$ 11000,000 PREMISEST( aoccurenc.) $ 1,000,000 MED EXP (Any one person) $ 5,000 PERSONAL BADVINJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO ❑ LOC JECT OTHER: GENERALAGGREGATE $ 2,000,000 X PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY TC2JCAP-474M9749TIL18 ',4/1/2018 4/1/2019 EOMBIIaEEDj SINGLE LIMIT $ 1,000,000 BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 47-UMO-303445-02 4/1/2018 4/1/2019 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X :RETENTION$ 25,00 $ B B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOPJPARTNER/EXECUTIVE OFFICERWEMBER EXCLUDED? 4Mandatory in NH) f yes, describe under DESCRIPTION OF OPERATIONS below N/A TRKUB-474M970-1-18 4/1/2018 i TC2JUB-474M969-4-18 4/1/2018 4/1/2019 4/1/2019 X E.L.EACH ACCIDENT- ___ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 i DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: 877023 See Attached CERTIFICATE FORT COLLINS, CITY OF PO BOX 580 ATTN EDNA HOERNICKE FORT COLLINS, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TIVE Coll:5195202 Tpl:2208912 Cert:26184838©1988-2015ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 713115 LOC#: A ADDITIONAL REMARKS SCHEDULE Page 9 of- 2- AGENCY NAMED INSURED Crown Castle International Willis of Pennsylvania, Inc. See Attached Named Insured List 1220 Augusta Dr. Suite 600 POLICY NUMBER Houston, TX 77057 See First Page CARRIER NAIC CODE See First Page EFFECTIVEDATE: See First Page ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORMTITLE: CERTIFICATE OF LIABILITY INSURANCE r Certificate Holder is included as an Additional Insured under the General Liability, Automobile Liability and Umbrella/Excess Liability 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 Taw. ACORD101 (2008/01) Coll:5195202 Tpl:2208912 Cert:26184838©2008ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD