|
Page 1 of 2
<br />A`oRo® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 03/27/2025
<br />7/2025
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsements .
<br />PRODUCER
<br />Willis Towers Watson Northeast, Inc.
<br />c/o 26 Century BlvdINC.Net-
<br />P.O. Hox 305191
<br />CONTACT Crown Castle Inc.
<br />NAME:
<br />PHONE FAX
<br />E-MAIL COIRequescicrowncaetle.com
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAICa
<br />Nashville, TN 372305191 USA
<br />INSURERA: ACE American Insurance Company
<br />22667
<br />INSURED
<br />Crown Castle Inc.
<br />INSURER B
<br />INSURERC:
<br />Sae Attached Named Insured List
<br />INSURER D:
<br />8020 Katy Freeway
<br />Houston, TX 77029
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: W38382427 REVISION NUMBER:
<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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDLSUSR
<br />J=
<br />mn
<br />POLICYNUMBER
<br />POLICY EFF
<br />MM/DDIYYYn
<br />POLICY UP
<br />IMM/D[bYYYY1
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />CLAIMS -MADE Fx] OCCUR
<br />DAfvIAGE TO RENTED
<br />PREMISES Ea occunence
<br />$ 1,000,000
<br />MED UP (Any oneperson)
<br />$ 10,000
<br />A
<br />Y
<br />Y
<br />MO G40933889
<br />04/01/2025
<br />04/01/2026
<br />PERSONAL S ADV INJURY
<br />$ 2,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERALAGGREGATE
<br />$ 4,000,000
<br />GENT
<br />X
<br />POLICY JECTPRO- ❑ LOC
<br />PRODUCTS -COMPIOPAGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />We accident
<br />$ 2,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ANY AUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />Y
<br />Y
<br />I82k H11357131
<br />04/01/2025
<br />04/01/2026
<br />BODILY INJURY (Per accident)
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />A
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />MESS UAB
<br />CLAIMS -MADE
<br />Y
<br />Y
<br />XEUG47458262 002
<br />04/01/2025
<br />04/01/2026
<br />OED X RETENTION$ 25,000
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETOR/PARTNERJEXECUTVE
<br />OFFICERJMEMBEREXCLUDED? No
<br />(Mandatory in Hill
<br />NIA
<br />Y
<br />WIR C72611251
<br />04/01/2025
<br />04/01/2026
<br />X I PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />EL DISEASE -EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />EL DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 191, Additional Remarks Schedule, may be attached If more space Is required)
<br />BU#845344 - DOWNTOWN SANTA ANA, 1104 CIVIC CENTER DRIVE, SANTA ANA, CA 92703 (951 3/4 West 6th Street).
<br />Tu Tran arotlyag"
<br />APPROVED
<br />„eawn
<br />Nguyenp=,.,Tmv ByTuTranNguyen at10d5am,Apr 01,2025
<br />ralsuauras•
<br />CERTIFICATE HOLDER CANCELLATION
<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 />CITY OF SANTA ANA
<br />PO BOX 1988
<br />AUTHORIZED REPRESENTATIVE
<br />PARKS RECREATION AMID CONNONITY
<br />ATTN ROBERT CARROLL
<br />SANTA ANA, CA 92702
<br />©1988-2016 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />sa m: 27488978 Ra,=-: 3893029
<br />
|