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HomeMy WebLinkAboutAmendment 2 TO 4807 880446Complete Items 1, 2, and.3. Also complete Item 4 It Restricted Delivery Is desired. Print your name and address on the reverse so that we can return the card to you. Attach this card to the back of the mallpleoe, or on the front It space permits. 1. Article Addressed to: F 880446 CITY OF BREMERTON 345 6TH STREET SUITE 600 0 Agent 0 Addie ate of Deli Is delivery address diffeemi! from Item t? 'E3 Ye; If YES, enter delivery address below. C3 No BREMERTON WA 98337-1873 a SerrbelWW o oermied snail CI ftmes fry 0 Registered O Return Receipt for AAerotrerrdise E3 braved man 0 CAD. 4. Restricted Dellvery? F -die Feel 0 Yes 2. Arbqb NUMber- oftwbr ftrite i 701213-46'10 0001' 1655 '2984' ! PS Form 3811, February 2004 Domestic Return Receipt 10zss5.024*3540 EXERCISE OF SECOND OPTION TO RENEW BETWEEN THE CITY OF BREMERTON AND GLOBAL SIGNAL, ACQUISITIONS II LLC FACILITES LEASE AGREEMENT CONTRACT: Gold Mountain Tower Lease Parcels: 332401-3-023-2005, Lease No. 199675 BU 880446 COB contract number 4807 LESSEE Global Signal Acquisitions II LLC EFFECTIVE DATE: February 9, 2019 THIS AGREEMENT SPECIFICALLY AMENDS THE LEASE entered into between the City of Bremerton, a municipal corporation duly organized and existing under the laws of the State of Washington, and Pinnacle Towers LLC, a Delaware limited liability company, effective February 9, 2009, renewed on February 9, 2014 (the "Lease"). All provisions in the Lease shall remain in full force and effect except as expressly modified by this document. WHEREAS, the Lease includes five-year renewal options to extend the lease to February 8, 2034 at the latest; and WHEREAS, the first exercise of option to renew the Lease was exercised by Lessee by letter, dated June 24, 2013, and Lessee exercised a second option to renew the Lease by letter, dated June 22, 2018. WHEREAS, the parties wish to document the renewal as set forth in this document. For valuable consideration and by mutual consent of the parties, the parties renew the Lease as follows: Section 5. Term , of the Lease is hereby supplemented as follows: Lessee has exercised its second option to renew the Lea and accordingly the Parties agree the termination date of the Lease is hereby ext nded from February 8, 2019 to February 8, 2024. Lessee's further options to ren w, as set forth in the Lease, remain in full force and effect. One Time Pam. Lessee shall pay Lessor a one-time payment of Five Hundred Dollars and No Cents ($500.00) within thirty (30) days of the mutual execution of this Exercise of Second Option to Renew. This document will become a supplement to the Lease and all provisions of the Lease shall apply hereto. Crown BU# 880446 Page 1 of 3 Crown Site: Seattle Qwest - BRE005 Second Option to Renew Contract Number: 4807 Rev. 07/18 The parties whose names appear below warrant that they are authorized to enter into this Exercise of Second Option to Renew and that it is binding on the parties to the Lease, as amended hereby. IN WITNESS WHEREOF, the parties have executed this Exerci of Second Option to Renew, effective as of February 9, 2019. Finance Director, DeWayne Pitts, approved to process (Initials and Date) LESSEE: Global Signal Acquisitions II LLC, a Delaware limited liability company By: Glob Signal Services LLC, its Manager By: Printed Name: Its: Date: % Z 12 d CITY: THE CITY OF BREMERTON By: w Print Name. red Wheeler Its: Maw Date: W ` 12 APPROVED AS TO FORM: ATTEST: By: By: ) do ROGER6A/LUBOVICH, Bremerton City ANGEL OODS, City Clerk Attorney ACKNOWLEDGEMENTS ON FOLLOWING PAGE Crown BU# 880446 Crown Site: Seattle Qwest - BRE005 Second Option to Renew Contract Number: 4807 Rev. 07/18 Page 2 of 3 ACKNOWLEDGEMENT STATE OF WASHINGTON ss. COUNTY OF KITSAP I certify that I know or have satisfactory evidence that Vn itjr is the person who appeared before me, and said person ackno legged that s/he signed this instrument, on oath stated that s/he was authorized to execute the instrument and acknowledged it as the Mayor of the City of Bremerton to be the free and voluntary act of such party for the uses and purposes mentioned in the instrument. IN WITNESS YvF, I hereunto set my hand and official seal. Stamp (if requir M Date: 40 V IA Signature: C AWD Cb 1Titleofoffice: 011-er My appointment expires: oc) J) g —LOL ACKNOWLEDGEMENT STATE OF WASHINGTON ss. COUNTY OF KING ) I certify that I know or have satisfactory evidence that is the person who appeared before me, and said person acknowledged that Wlhe signed this instrurrWt, on oath stated that s/he was authorized to execute the instrument and acknowledged it as the (type of authority, e.g., officer, trustee, etc.) of Global Signal Services LLC to be t14 free and voluntary act of such party for the uses and purposes mentioned in the instrument. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Stamp (if required): Date: (--,-)/2 4 /Z0 4% er Tob o •" o tiprat'•••... o •. i3O e Signature: Title of office: My appointment expires: V2 / Crown BU# 880446 Page 3 of 3 Crown Site: Seattle Qwest - BRE005 Second Option to Renew Contract Number: 4807 Rev. 07/18 Page 1 of 2 a- CERTIFICATE OF LIABILITY INSURANCE D Y) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 04/10/ 2019ATE 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. NAME: PHONE FAX c/o 26 Century Blvd 1-877-945-7378 1-688-467-2378AICNExt): AIC No: E-MAIL ADDRESS: certificatesowillis.comP.O. Box 305191 INSURERS AFFORDING COVERAGE NAIC9Nashville, TN 372305191 USA INSURER A: Federal Insurance Company 20281 A INSURED INSURER B: National union Fire Insurance Company of P 19445 Crown Castle International 0 INSURERC: Berkshire Hathaway Specialty Insurance Com 22276SeeAttachedNamedInsuredListQ INSURER D: New Hampshire Insurance Company 238411220AugustaDr. Suite 600 L4 -1 61 Houston, Tx 77057 yCY ) INSURER E: Travelers Property Casualty Company of Ame 25674 INSURER F: 3605-3335 COVERAGES CFRTIFICATF NIIMRFR- w1o872198 RFVICIr1N NIIMRFR• 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. LLTTRR TYPE OF INSURANCE INSD WVD SUER POLICY NUMBER LICY EFF MM/DDY/YYYY POLICY EXP MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY y9 CLAIMS -MADE XOCCUR" EACH OCCURRENCE $ 1,000,000 REMI E TO REN 1, 000, 000PREMISESEaoccurrence $ MED EXP (Any one person) $ 10,000A Y Y 3605-3335 04/01/2019 04/01/2020 oe PERSONAL& ADV INJURY $ 1,000,000 AGGREGATE $ 2,000,000GEN'LAGGREGATE LIMIT APPLIESPER: ItGENERAL l JECT LOCPOLICY1-1 PRO- PRODUCTS - COMP/OPAGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 11000,000Eaaccident BODILY INJURY (Per person) $ X ANY AUTO B OWNED SCHEDULED AUTOS ONLY AUTOS Y Y CA 4993141 04/01/2019 04/01/2020 BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ Per accident C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 51000,000 AGGREGATE $ 51000,000EXCESSLIABCLAIMS -MADE Y Y 47-UNO-303445-03 04/01/2019 01/01/2020 DED 1 X I RETENTION$ 25,000 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITYYIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NO NIA Y WC 012717225 04/01/2019 04/01/2020 X 7—PER--7-OTH- STATUTE I I ER E.L. EACH ACCIDENT $ 11000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000MandatoryinNH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1, 000, 000 E Business Personal Property QT6305D736475TIL19 04/01/2019 04/01/2020 Limit: $1,000,000 All Risk 100% Replacement Cost DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) This Voids and Replaces Previously Issued Certificate Dated 03/29/2019 WITH ID: W10725948. BU# 880446 - SEATTLE QWEST - BRE005, 3000 BLOCK, HWY 16 SW, Port Orchard, WA 98367 Property: Business/Personal Property V CRI Ir II.AIC 1'1VLL)rZM LANttLl_A I IUN City of Bremerton 345 6th Street, Ste 100 BREMERTON, WA 98337 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 17806953 BATCH: 1151d12 AGENCY CUSTOMER ID: LOC #: aoR ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis of Pennsylvania, Inc. Crown Castle International See Attached 1220 Augusta Named Insured List Dr. Suite 600POLICYNUMBER See Page 1 Houston, TX 77057 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 AUDI I IUNAL KtIVIAKr%J THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance City of Bremerton, and its elected and appointed officers, officials, agents, employees, representatives, engineers, consultants, and volunteers areincluded as an Additional Insured under the General Liability, Auto Liability and Umbrella 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 Liability and Workers Compensation policies include a Waiver of Subrogation in favor of the certificate holder when agreed in written contract prior to the loss, but always subject to the policy terms, conditions and exclusions as permitted by law. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 17806953 BATCH: 1151012 CERT: W10872198 Crown Castle International Corp. Consolidated Subsidiaries as Named Insureds 24/7 Chesapeake Holdings, LLC Crown Castle International Corp. 24/7 Mid -Atlantic Network of Virginia, LLC Crown Castle International Corp. de Crown Castle GS III Corp. Puerto Rico 24/7 Mid -Atlantic Network, LLC Crown Castle International LLC Access Fiber Group Holdings LLC Crown Castle Investment Corp. Access Fiber Group, Inc. Crown Castle Investment II Corp. AirComm of Avon, L.L.C. Crown Castle MM Holding Corp. Atlantic Coast Communications LLC Crown Castle MM Holding LLC CA - CLEC LLC Crown Castle MU LLC CC Castle International LLC Crown Castle MUPA LLC CC Edge LLC Crown Castle NG Atlantic LLC CC Edge Solutions LLC Crown Castle NG Central LLC CC Finance LLC Crown Castle NG East LLC CC FN Holdings LLC Crown Castle NG Networks LLC CC Holdings GS V LLC Crown Castle NG West LLC CC Site Acquisitions II LLC Crown Castle Operating Company CC Sunesys Fiber Networks LLC Crown Castle Operating LLC CC TM PA LLC Crown Castle Orlando Corp. CC Towers Guarantor LLC Crown Castle PR LLC CC Towers Holding LLC Crown Castle PR Solutions LLC CC TS LLC Crown Castle PT Inc. CCATT Holdings LLC Crown Castle Puerto Rico Corp. CCATTLCC Crown Castle Services LLC CCATT PR LLC Crown Castle Solutions LLC CCGS Holdings Corp. Crown Castle South LLC CCPE Acquisitions LLC Crown Castle TDC LLC CCPR VI Tower Newco LLC Crown Castle TLA LLC CCS & E LLC Crown Castle Towers 05 LLC CCT2 Holdings LLC Crown Castle Towers 06-2 LLC CCTM Holdings LLC Crown Castle Towers 09 LLC CCTM 1 LLC Crown Castle Towers LLC CCTM2 LLC Crown Castle USA Inc. CCTMO LLC Crown Communication LLC Chesapeake Fiber, LLC Crown Communication New York, Inc. Coastal Antennas LLC Crown Mobile Systems, Inc. ComSite Venture, Inc. DAS Development Corporation Coverage Plus Antenna Systems LLC Fiber Technologies Networks, L.L.C. Cross Connect Solutions, Inc. (PA) Fibernet Direct Florida LLC Crown Atlantic Company LLC Fibemet Direct Holdings LLC Crown Castle AS LLC Fibernet Direct TEL LLC Crown Castle Atlantic LLC Fibemet Direct Texas LLC Crown Castle Augusta LLC Fibertech Facilities Corp. (NY) Crown Castle BP ATT LLC Fibertech Holdings Corp. Crown Castle CA Corp. Fibertech Networks, LLC Crown Castle Fiber LLC f/k/a Lightower Freedom Telecommunications, LLCFiberNetworksII, LLC Crown Castle GS III Corp. Global Signal Acquisitions II LLC Crown Castle GT Company LLC Global Signal Acquisitions III LLC Crown Castle GT Corp. Global Signal Acquisitions IV LLC Crown Castle GT Holding Sub LLC Global Signal Acquisitions LLC Global Signal GP LLC Global Signal Holdings III LLC Global Signal Holdings IV LLC Global Signal Operating Partnership, L.P. Global Signal Services LLC GoldenState Towers, LLC GS Savings Inc. GSPN Intangibles LLC High Point Management Co. LLC ICB Towers, LLC InfraSource FI, LLC InSITE Fiber of Virginia LLC InS1TE S 'lutions LLC Interstate Tower Communications LLC Intracoastal City Towers LLC IX2 Center, LLC IX2 Wilshire, LLC JBCM Towers LLC Light Tower Clearinghouse LLC Light Tower Fiber New York, Inc. (NY) Light Tower Holdings LLC Light Tower Management, Inc. Light Tower Metro Fiber LLC Lightower Fiber Infrastructure Corp. Lightower Fiber Networks I, LLC Lightower Fiber Networks II, LLC n/k/a Crown Castle Fiber LLC LTS Buyer LLC LTS Group Holdings LLC LTS Intermediate Holdings A LLC LTS Intermediate Holdings B LLC LTS Intermediate Holdings C LLC Md7 Capitol One, LLC Mobile Mia California LLC Mobile M is National LLC Modeo L MW Cell REIT 1 LLC MW Cell TRS I LLC NEON Transcom, Inc. NewPath Networks Holding LLC NewPath Networks LLC NY - CLEC LLC OP 2 LLC OP LLC P3 CHB-1,,LLC P3 Holdings 2014 LLC P3 OASA-1, LLC P3 PBA -1, LLC PA - CLEC LLC Crown Castle International Pinnacle San Antonio L.L.C. 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. PR Site Development Corporation PR TDC Corporation Princeton Ancillary Services II LLC Princeton Ancillary Services III LLC Radio Station WGLD LLC RGP Tower Group, LLC Shaffer & Associates, Inc. Sidera Networks UK Limited (UK) Sidera Networks, Inc. Sierra Towers, Inc. Sunesys Enterprise LLC Sunesys of Massachusetts, LLC Sunesys of Virginia, Inc. Sunesys, LLC Thunder Towers LLC Tower Development Corporation Tower Systems LLC Tower Technology Company of Jacksonville LLC Tower Ventures III, LLC TowerOne 2012, LLC TowerOne Allentown 001, LLC TowerOne Bethlehem 001, LLC TowerOne Doylestown, LLC TowerOne East Rockhill 001, LLC TowerOne Marple, LLC TowerOne Middletown 001, LLC TowerOne Middletown 002, LLC TowerOne Middletown 003, LLC TowerOne North Coventry, LLC TowerOne Partners, LLC TowerOne Richland, LLC TowerOne Upper Pottsgrove 002, LLC TowerOne Upper Pottsgrove, LLC TowerOne Warminster 001, LLC TowerOne Warrington 002, LLC Towers Finco II LLC Towers Finco III LLC Consolidated Subsidiaries as Named Insureds Towers Finco LLC TriStar Investors LLC TVHT, LLC WA - CLEC LLC WCP Wireless Lease Subsidiary, LLC WCP Wireless Site Funding LLC WCP Wireless Site Holdco LLC WCP Wireless Site Non -RE Funding LLC WCP Wireless Site Non -RE Holdco LLC WCP Wireless Site RE Funding LLC WCP Wireless Site RE Holdco LLC Wilcon Holdings LLC Wilcon Operations LLC Wilshire Connection, LLC Wilshire Services, LLC Wireless Funding, LLC Wireless Realty Holdings II, LLC Wireless Revenue Properties, LLC Yankee Metro Parent, Inc. INSURER CANCELLATION TERMS NAMED INSURED Crown Castle International POLICY NO. 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 Z w 0( 1-2 Q co 00 4_, 0 SEra I 0 -e ra} a\ E \ suo Icu % z Q § // k 2C 0 U 00c ` o \ ®@ \ o oo = \ !§ 3j2 c / co a)( N c, Q o-\ NI 13 t g 0 E / » \ G 2 m ® E 3 w k 2 3CD -2 • r f jz 0\\/ u Cr) z = Lo - J 3 co \ \ / ? \ / \ 2 \ m 2 co m 2\§ 2; g E u) 0 E Co Q 0 - a e E e m m E 5 r::4 '\/ kms t o $ D 2 = ca ® U 2 I 7 ± Z 0 \ / \ \ & O c c / ( \ rc a CD 14 ai8 m J \ /\ z O 2 5 / & j eu1) (D O z = ec G ,-,-0 CM 1 2 « 0 c - t) 0 OD < \ % WO f< c 2 \ / J Mg 2 \ ) , \ / p do \ E VDD- R 0C ccu R9 \ \ f. 4 / 6 -. (D j \ 2' 0 \/ 7D (0 \ [ 3n 2 = n V 2 mo m0- D- \ ] 3 / rD Dc 5'n 0 / \ ,_ 3w J. = 2 a\ ( A 0 Dq q0 r< M CERTIFICATE OF LIABILITY INSURANCE I Page 1 of 2 DATE (MMIDDIYVVV) 04/01/2020 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 ~2ij1~CT Willia Towers Watson Certificate Center Willia Towers Watson Northeast, Inc. fka Willis of Pennsylvania, flJRNJ~ r:vn, 1-877-945-7378 I rti~ No\: 1-888-467-2378 Inc. ifl~~SS: oertifioatea@willia.comc/o 26 Century Blvd P.O. Bo>< 305191 Nashville, TN 372305191 USA IN_S_U_RE __ R~(S) AFFORDING COVERAGE I NAIQJL...___ INSURER A: Federal Insurance Company j202Bl INSURED Crown Castle International See Attached Named Insured List 1220 Augusta Dr. Suite 600 Houston, TX 77057 INSURER B :_ National Union Fire Insurance Company of P 11 19445 INSURERC: Berkshire Hathaway Specialty Insurance Co.ml 22~~-- INSURER D : New Hampshire Insurance Company 23 841 INSURERE: Travelers Property Casualty Company of Amel 25674 INSURER F: COVERAGES CERTIFICATE NUMBER: Wl6071644 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. lt-fSR TYPE OF INSURANCE fAcici(!s0BRj r;~~hliM'tvi POLICY EXP LIMIT$ LTR '""n wvn POLICY NUMBER IMM/00/VVVVl ITTMERCIAL GENERAL LIABILITY I EACH OCCURRENCE 1$ 1,000,000 CLAIMS-MADE [xJ OCCUR I DAMAGE TO RENTED 1,000,000PREf.:11SE$.{Ea_occurrence) .. A I MED EXP (Any one person) $ 10,000 j y y 3605-3335 04/01/2020 04/01/2021 1,000,000PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _$ 2,000,000lBJLJr'RO· LJ LOCPOLICYIJECT PRODUCTS· COMP/OP AGG $ 2,000,000 i OTHER: $ AUTOMOBILE LIABILJTV COMBINED SINGLE LIMIT $ 1,000,000EaaccidenlL ____ X ANY AUTO BODILY INJURY (Per person) $ B -OWNED ~ SCHEDULED y y CA 6631248 04/01/2020 04/01/2021 BODILY INJURY (Per ac<Jidenl) $ -AUTOS ONLY ,_ AUTOS I PROPERTY DAMAGEHIREDNON-OWNED $ - AUTOS ONLY -AUTOS ONLY (Peraccidenl) I I $ tJ oco,e I EACH OCCURRENCE $ s,000,000C I EXCESS LIAB CLAIMS-MADE y y 47-UM0-303445-05 04/01/2020 04/01/2021 AGGREGATE $ 5,000,000 DED !xl RETENTION$ 25,000 I $ WORKERS COMPENSATION XI ~¥fruTE I I0TH AND EMPLOYER$' LIABILITY ERVIN D ANYPROPRIETOR/PARTNERIEXECUTIVE El y E.L. EACH ACCIDENT $ 1,000,000 OFFICEFvMEMBEREXCLUDED? NIA WC 023096097 04/01/2020 04/01/2021 Mandatory In NH) E.l. DISEASE · EA EMPLOYEE $ 1,000,000 II yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE· POLICY LIMIT $ 1,000,000 E All Risk Personal Property I I QT-630-5D736475-TIL-20 04/01/2020 04/01/2021 Limit: $1,000,000 100% Replacement Cost I DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORO 101, Addlllonal Remarks Schedule, may be attached II more space Is required) BU# 880446 -SEATTLE QWEST -BRE005, 3000 BLOCK, HWY 16 SW, Port Orchard, WA 98367 Property: Business/Personal Property City of Bremerton, and its elected and appointed officers, officials, agents, employees, representatives, engineers, consultants, and volunteers areincluded as an Additional Insured under the General Liability, Auto Liability and 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. AUTHORIZED REPRESENTATIVE CITY OF BREMERTON 345 6TH STREET SUITE 100 ~J,, J~~~ BREMERTON, WA 98337-1891 1988·2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 19463626 BATCH: 1635634 17 of25 2206 AGENCY CUSTOMER ID:------------------ LOC #: ---------- ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Willia Towers Wat.son Northenst, Ina. £kn. Willia of Pennsylvania, Inc. Crown Castle International t-------------------------------------1 See Attached Na.med Insured List POLICY NUMBER See Page l CARRIER See Pagel ADDITIONAL REMARKS 1220 Augusta Or. Suite 600 Houston, TX 77057 NAICCODE Se,e Page 1 EFFECTIVE DATE: See Page l THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of •' -'-' 1 ',ty Insurance Page 2 of 2 Umbrella 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 Liability and Workers Compensation policies include a Waiver of Subrogation in favor of the certificate holder when agreed in written contract prior to the loss, but always subject to the policy terms, conditions and exclusions as permitted by law. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 19463626 BATCH: 1635634 CERT: Wl6071644 Crown Cas tl e In ternationa l Co rp. Co nso li dated Subs idi ari es as Na med In sureds Entity Name 7/23/19 Edition 24/7 Chesapeake Holdings , LLC 24/7 Mid -Atlantic Network of Virginia , LLC 24/7 Mid-Atlantic Network , LLC Access Fiber Group Holdings LLC Access Fiber Group , Inc . AirComm of Avon , L.L.C. Atlantic Coast Communications LLC CA -CLEC LLC CC Castle International LLC CC Edge LLC CC Edge Solutions LLC CC Finance LLC CC FN Holdings LLC CC Holdings GS V LLC CC Site Acquisitions II LLC CC Sunesys Fiber Networks LLC CC TM PA LLC CC Towers Guarantor LLC CC Towers Holding LLC CC TS LLC CCATT Holdings LLC CCATT LCC CCATT PR LLC CCGS Holdings Corp . CCPE Acquisitions LLC CCPR VI Tower Newco LLC CCS & ELLC CCT2 Holdings LLC CCTM Holdings LLC CCTM1 LLC CCTM2 LLC CCTMO LLC Chesapeake Fiber, LLC Coastal Antennas LLC ComSite Venture, Inc . Coverage Plus Antenna Systems LLC Cross Connect Solutions, Inc. (PA) Crown Atlantic Company LLC Crown Castle AS LLC Crown Castle Atlantic LLC Crown Castle Augusta LLC Crown Castle BP ATT LLC Crown Castle CA Corp. Crown Castle Fiber Holdings Corp . (formerly LTS Group Holdings LLC) Crown Castle Fiber Enterprise LLC (formerly Sunesys Enterprise LLC) Crown Castle Fiber LLC f/k/a Lightower Fiber Networks II , LLC Crown Castle GS Ill Corp . Crown Castle GT Company LLC Crown Castle GT Corp. Crown Castle GT Holding Sub LLC Crown Castl e International Corp. Crown Castle International Corp. de Puerto Rico Crown Castle International LLC Crown Castle Investment Corp . Crown Castle Investment II Corp . Crown Castle MM Holding Corp. Crown Castle MM Holding LLC Crown Castle MU LLC Crown Castle MUPA LLC Crown Castle NG Atlantic LLC Crown Castle NG Central LLC Crown Castle NG East LLC Crown Castle NG Networks LLC Crown Castle NG West LLC Crown Castle Operating Company Crown Castle Operating LLC Crown Castle Orlando Corp . Crown Castle PR LLC Crown Castle PR Solutions LLC Crown Castle PT Inc . Crown Castle Puerto Rico Corp. Crown Castle Services LLC Crown Castle Solutions LLC Crown Castle South LLC Crown Castle TDC LLC Crown Castle TLA LLC Crown Castle Towers 05 LLC Crown Castle Towers 06 -2 LLC Crown Castle Towers 09 LLC Crown Castle Towers LLC Crown Castle USA Inc . Crown Communication LLC Crown Communication NewYork , Inc. Crown Mobile Systems , Inc . DAS Development Corporation Fiber Technologies Networks , L.L .C. (NY) Fibernet Direct Florida LLC Fibernet Direct Holdings LLC Fibernet Direct TEL LLC Fibernet Direct Texas LLC Fibertech Faciliti esCorp. (NY) Fibertech Holdings Corp . Fibertech Networks , LLC Freedom Telecommunications , LLC Global Signal Acquisitions II LLC Global Signal Acquisitions Ill LLC 18 of25 22 06 Cro wn Castle Internation al Co rp. Conso lidated Sub sidi aries as Named Insured s Entity Name 7/23/19 Edition Global Signal Acquisitions IV LLC Global Signal Acquisitions LLC Global Signal GP LLC Global Signal Holdings Ill LLC Global Signal Holdings IV LLC Global Signal Operating Partnership , L.P . Global Signal Services LLC GoldenState Towers , LLC GS Savings Inc. GSP N Intangibles LLC High Point Man ageme nt Co . LLC ICBTowers , LLC lnfraSource Fl , LLC lnSIT EFiber of Virgini aLLC lnSITESolutions LLC Interstate Tower Communications LLC lntracoasta lCity Towers LLC IX2 Center, LLC IX2 Wilshir e, LLC JBCM Tower s LLC Light Tower Clearinghouse LLC Light Tower Fiber New York , Inc. (NY) Light Tower Holdings LLC LightTower Management, Inc . Light Tower Metro Fiber LLC Lightower Fiber Infrastructure Corp . Lightower Fiber Networks I, LLC Lightower Fiber Networks II , LLC n/k/a Crown Castle Fiber LLC LL 01-18, LLC LTS Buyer LLC LTS Group Holdings LLC n/k/a Crown Castle Fiber Holding s Corp LTS Intermed iate Holdings ALLC LTS Interm ediate Holdings BLLC LTS Intermed iate Holdings C LLC Md7 Capitol One, LLC Mobile Media CaliforniaLLC Mobil e Med iaNational LLC Modeo LLC MW Cell REIT 1LLC MW Cell TRS 1LLC NEON Transcom, Inc. NewPath Networks Holding LLC NewPat h Networks LLC NY -C LEC LLC OP 2LLC OP LLC P3 CHB -1, LLC P3 Holdings 2014 LLC P3 OASA -1, LLC P3 PBA-1, LLC PA -CLEC LLC Pinnacle San Antonio L.L.C. Pinnacle St. Louis LLC Pinnacle Towers Acquisition Holdings LLC Pinnacle Towers Acquisrtion LLC Pinnacle Towers Asset Holding LLC Pinnacle Towers Canada, In c. Pinnacle Towers Ill LLC Pinnacle Towers Limited Pinnacle Towers LLC Pinnacle Towers V Inc . PR Site Development Corporation PR TDC Corporation Princeton Ancillary Serv ices II LLC Princeton Ancillary Serv ices Ill LLC Rad io Station WGLD LLC RGP Tower Group , LLC Shaffer & Associates, Inc . Sidera Networks UK Limited (UK) Sidera Networks , Inc . Sierra Towers, Inc. Sunesys Enterprise LLC n/k/a Crown Castle Fiber Enterprise LLC Su nesys of Massachusetts , LLC Sunesys of Virginia , Inc . Sunesys , LLC Thunder Towers LLC Tower Development Corporation Tower Systems LLC Tower Technology Compan y of Jacksonville LLC Tower Ventures Ill , LLC TowerOne 2012 , LLC TowerOne Allentown 001 , LLC TowerOne Bethlehem 001 , LLC TowerOne Doylestown , LLC TowerOne East Rockhill 001, LLC TowerOne Marple, LLC TowerOne Middletown 001 , LLC TowerOne Middl etown 002 , LLC TowerOne Middletown 003 , LLC TowerOne North Coventry , LLC TowerOne Partners , LLC TowerO ne Richland , LLC TowerOne Upper Pottsgrove 002 , LLC TowerO ne Upper Pottsgrove , LLC TowerOne Warm inster 001 , LLC TowerOne Warrington 002, LLC Crown Castle Internat iona l Co rp. Co nso li dated Subs idia ri es as Named In su reds Entity Name 7/23/19 Edition Towers Finco II LLC Towers Finco Ill LLC Towers Finco LLC TriStar Investor sLLC TVHT , LLC WA -CLEC LLC WCP Wireless Lease Subsidiary, LLC WCP Wireless Site Funding LLC WCP Wireless Site Holdco LLC WCP Wireless Site Non -RE Funding LLC WCP Wireless Site Non -REHoldco LLC WCPWireless Site REFunding LLC WCP Wireless Site RE Holdco LLC Wilcon Holding sLLC Wilcon Operations LLC Wilshire Connection , LLC Wilshire Services , LLC Wireless Funding , LLC Wirele ss Realty Holding s II , LLC Wireless Revenu e Properti es, LLC Yank ee Metro Parent, Inc . 19 of25 2206 INSURER CANCELLATION TERMS NAMED INSURED POLICY NO. Crown Castle International 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 ofthe 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 llabillty 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