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A C"R CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 03/31/DDJ21606
<br />V DATE
<br />31
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER I CONTACT
<br />Willis of Pennsylvania, Inc.
<br />c/o 26Century Blvd,
<br />P. 0. Box 305191
<br />Nashville, IN 37230-51.91
<br />INSURED ----. __--
<br />Crown Castle International
<br />See Attached Named Insured List
<br />1220 Augusta Dr. Suite 500
<br />Houston, TX 77057
<br />r0VERAGFS r1I✓R7'IFIr'_AT1= MIIIY7tRI=R- 0Al n701)�7
<br />FAX
<br />INSURER(S)AFFORDING COVERAGE NAIL 9
<br />INSURERA:Federal Insurance Company 20281-005
<br />INSURERB:Travelers Casualty & Surety Co. of Americ 31194 002..
<br />INSURERC:North American Elite Insurance Company 29700-001
<br />11 .......... - -- ....._..
<br />INSURERD:Travelers Property Casualty Cc of Amer 25674-001
<br />INSURER E:
<br />.... _..... - -
<br />INSURER F:
<br />0C11101'..e%k1 NI'1 I - -
<br />c,-,.
<br />THIS
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />DDL SUB ...,._.... POLICYEFF --" POLICY EXP .........L9MYT5 .-.--
<br />LTR rYPEOF'INSURANCE POLICY NUMBER
<br />A X COMMERCIALGENERAL LIABILITY y Y 7021-02-28 4/l/201,6 4/1/2017 EACH OCCURRENCE_ ,,. $ 1 00.9..,..0_00
<br />CLAIMS -MADE J( OCCUR PIIEM &E ENTED
<br />Qtn 9ccurence $
<br />l 000,00�} ....
<br />MEDEXP(Anyone person) $ 5..,0.00
<br />i.....PERSONAL &AOVINJURY $_110_00, 000
<br />G.EN'LAGGREGATEUMITAPPLIES PER: '' GENERAL. AGGREGATE $_ 2,'000, 004..........._.
<br />]{ POLICY JE fl L_....,.,1 LOC PRODUCTSr- COMP/OP AG $ 2 0 0 0 O O 0
<br />-'_-
<br />OTHER: -
<br />$
<br />$ AUTOMOBILE LIABILITY j Y Y 'TC2JCAP-4.74.M9749-16 4/l/2016 4/1/201,7 CCFOaBINED SINGLE LIMIT $ 1,000,000
<br />X --- ANYAUTO BODILY INJURY(Per person) ;$
<br />— _..
<br />_ ALOWN'..ED ....SCHEDULE[? BODILY INJURYPeraccirlenrt $ AUTOS AUTOS i )
<br />HIREDAU70S NON -OWNED MOP ERTYDAMAGE ,,,.,
<br />AUTOS
<br />... (Peraccldentt) $
<br />$
<br />C X UM'..BRELLALUAB .X.... OCCUR Y Y UMB 2000165-02... 4/1/2016 4/1,/2017... EACH OCCURRENCE . ..$........ 5, 000, 000_,_,,,...,
<br />EXCESS UAB CLAIMS -MADE
<br />..AGGREGATE .__ $ 5,000, DED X RETENTON$ 25,000 .... .,$ ...®..0.
<br />0
<br />PER
<br />D WORKERS COMPENSATION Y TC2dUB-474M9694-16 4/l/2016 4/l/2017 AND EMPLOYERS' LIABILITY YIN
<br />�D ANY PROPRIETORIPARTNERfEXECUTIVE� N(A TRKUB-474M9701-16 4/1/2016 4/l/2017 E.L. EACH ACCIDENT $ 11000,000
<br />OFFICERIMEMBER EXCLUDED? -
<br />Mandatory in NH) E.L. DISEASE... EA EMPLOYEE $..-.- 1, 000, 000
<br />fI es, describe under - -
<br />DESCRIPTION OF OPERATIONS below
<br />E.L.DISEASE -POLICY LIMIT I,$ 1,000,000
<br />DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES JACORD 101, Additonal Remarks Schedule, may be attached if more space is required) " lit II ,i,g„ w.
<br />BU#845344 - DOWNTOWN SAN'TA ANA, 1.104 CIVIC CENTER DRIVE, SANTA, ANA, CA 92703 (951 3/4 Wes't 6th
<br />Street).
<br />City of Santa Ana, its officers, agents, employees and volunteers are included as Additional
<br />Insureds under the General, Automobile, and. Excess Liability policies as required by written
<br />agreement and only with respect to the liability arising out of the operations performed by or on
<br />behalf of the Named Insured.
<br />VF-n I IFIVM I c nvL-ul=n t.;AV0,I=LLA I IUN
<br />City of Santa Ana Parke, Rec
<br />20 Civic Center Plaza
<br />PO Box 1988, M-23
<br />Santa Ana, CA 92702
<br />& Community Services
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Coli:487b8153 Tp1:2042171 Cert:24307927a1988-2014ACORD CORPORATION. All rights reserved
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />VF-n I IFIVM I c nvL-ul=n t.;AV0,I=LLA I IUN
<br />City of Santa Ana Parke, Rec
<br />20 Civic Center Plaza
<br />PO Box 1988, M-23
<br />Santa Ana, CA 92702
<br />& Community Services
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Coli:487b8153 Tp1:2042171 Cert:24307927a1988-2014ACORD CORPORATION. All rights reserved
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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