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HomeMy WebLinkAboutCITYOFBREMERTON_W28526056SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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 THISCERTIFICATE 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY Willis Towers Watson Northeast, Inc.c/o 26 Century BlvdP.O. Box 305191Nashville, TN 372305191 USA Crown Castle Inc. f/k/a Crown Castle International Corp.See Attached Named Insured List8020 Katy FreewayHouston, TX 77024 BU# 880446 - SEATTLE QWEST - BRE005, 3000 BLOCK, HWY 16 SW, Port Orchard, WA 98367 *Property: Business/Personal PropertySEE ATTACHED CITY OF BREMERTON345 6TH STREET SUITE 100BREMERTON, WA 98337-1891 03/30/2023 COIRequest@crowncastle.com Continental Casualty Company 20443 Berkshire Hathaway Specialty Insurance Com Continental Insurance Company 22276 35289 Travelers Property Casualty Company of Ame 25674 W28526056 A 2,000,000 1,000,000 10,000 2,000,000 4,000,000 4,000,000 Y Y 7018331477 04/01/2023 04/01/2024 A 2,000,000 04/01/202404/01/2023YYBUA 7018331432 B 5,000,000 25,000 Y Y 47-UMO-303445-09 04/01/2023 04/01/2024 5,000,000 WC7018331446CY 1,000,000No04/01/2023 04/01/2024 1,000,000 1,000,000 D All Risk Personal Property 100% Replacement Cost Limit:QT-630-5D736475-TIL-23 04/01/2023 04/01/2024 291316623930404SR ID:BATCH: $1,000,000 Crown Castle Inc. Page 1 of 2 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: Crown Castle Inc. f/k/a Crown Castle International Corp.See Attached Named Insured List8020 Katy FreewayHouston, TX 77024 City of Bremerton, and its elected and appointed officers, officials, agents, employees, representatives, engineers,consultants, and volunteers are included as an Additional Insured under the General Liability policies as theirinterest may appear and as required by written agreement and only with respect to the liability arising out of theoperations performed by or on behalf of the Named Insured. City of Bremerton, and its elected and appointed officers, officials, agents, employees, representatives, engineers,consultants, and volunteers are included as additional insureds as their interest may appear with respect to theAutomobile Liability for liability arising out of the operations or work performed by the named insured if required bywritten agreement. City of Bremerton, and its elected and appointed officers, officials, agents, employees, representatives, engineers,consultants, and volunteers are included as an Additional Insureds under the Umbrella Liability policy as theirinterest may appear and as required by written agreement and only with respect to the liability arising out of theoperations performed by or on behalf of the Named Insured. General Liability include a Waiver of Subrogation in favor of the additional insureds when agreed in written contractprior to the loss, but always subject to the policy terms, conditions and exclusions as permitted by law. Automobile Liability includes a Waiver of Subrogation in favor of the additional insureds when agreed in writtencontract prior to the loss, but always subject to the policy terms, conditions and exclusions as permitted by law. The Umbrella Liability policy include a Waiver of Subrogation in favor of the Additional Insureds when agreed inwritten contract prior to the loss, but always subject to the policy terms, conditions and exclusions as permitted bylaw. The Workers Compensation policies include a Waiver of Subrogation in favor of the Additional Insureds when agreed inwritten contract prior to the loss, but always subject to the policy terms, conditions and exclusions as permitted bylaw. INSURER AFFORDING COVERAGE: Travelers Property Casualty Company of America NAIC#: 25674POLICY NUMBER: QT-660-1S576470-TIL-23 EFF DATE: 04/01/2023 EXP DATE: 04/01/2024 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:Property Coverage - Limit: $1,000,000Towers Only INSURER AFFORDING COVERAGE: Travelers Property Casualty Company of America NAIC#: 25674POLICY NUMBER: QT-660-1S577626-TIL-23 EFF DATE: 04/01/2023 EXP DATE: 04/01/2024 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:Non-Tower Inland Marine / Limit: $1,000,000Contractors Equipment Installation Limit: $800,000 2 2 Willis Towers Watson Northeast, Inc. See Page 1 See Page 1 See Page 1 See Page 1 25 Certificate of Liability Insurance W28526056CERT:2913166BATCH:23930404SR ID: Crown Castle Inc. Edition Date: 8/01/22 Named Insured Named Insured (cont.) AirComm of Avon, LLC Crown Castle Solutions LLC Assurable Insurance LLC Crown Castle South LLC Atlantic Coast Communications LLC Crown Castle Towers 05 LLC CC Edge LLC Crown Castle Towers 06-2 LLC CC Holdings GS V LLC Crown Castle Towers 09 LLC CC Site Acquisitions II LLC Crown Castle Towers LLC CC Strategic Investment Corp.Crown Castle USA Inc. CC TM PA LLC Crown Communication LLC CC Towers Guarantor LLC Crown Communication New York, Inc. CC Towers Holding LLC Fibertech Facilities Corp. CCATT Holdings LLC Global Signal Acquisitions II LLC CCATT LLC Global Signal Acquisitions III LLC CCATT PR LLC Global Signal Acquisitions IV LLC CCGS Holdings Corp. Global Signal Acquisitions LLC CCPR VI Tower Newco LLC Global Signal GP LLC CCS & E LLC Global Signal Holdings III LLC CCTM Holdings LLC Global Signal Operating Partnership, LP CCTM1 LLC GoldenState Towers LLC CCTM2 LLC GS Savings Inc. CCTMO LLC GSPN Intangibles LLC ComSite Venture, Inc.High Point Management Co. LLC Coverage Plus Antennas Systems LLC ICB Towers LLC Crown Atlantic Company LLC Interstate Tower Communications LLC Crown Castle AS LLC Intracoastal City Towers LLC Crown Castle Atlantic LLC Light Tower Clearinghouse LLC Crown Castle CA Corp. Md7 Capitol One, LLC Crown Castle Fiber Enterprise LLC MW Cell Reit 1 LLC Crown Castle Fiber Holdings Corp.MW Cell TRS 1 LLC Crown Castle Fiber LLC OP LLC Crown Castle GS III Corp.OP 2 LLC Crown Castle GT Company LLC Pinnacle Towers Acquisition Holdings LLC Crown Castle GT Corp.Pinnacle Towers Acquisition LLC Crown Castle GT Holding Sub LLC Pinnacle Towers Asset Holding LLC Crown Castle Inc. f/k/a Crown Castle International Corp.Pinnacle Towers Canada Inc. Crown Castle International LLC Pinnacle Towers III LLC Crown Castle Investment Corp.Pinnacle Towers Limited Crown Castle Investment II Corp.Pinnacle Towers LLC Crown Castle MU LLC Pinnacle Towers V Inc. Crown Castle MUPA LLC PR Site Development Corporation Crown Castle NG East LLC Radio Station WGLD LLC Crown Castle Operating Company Shaffer & Associates, Inc. Crown Castle Operating LLC Sidera Networks UK Limited (UK) Crown Castle Orlando Corp.Sierra Towers, Inc. Crown Castle PR LLC Tower Development Corporation Crown Castle PR Solutions LLC Tower Systems LLC Crown Castle Puerto Rico Corp. Tower Technology Company of Jacksonville LLC 1 of 3 Crown Castle Inc. Edition Date: 8/01/22 Named Insured Named Insured (cont.) Tower Ventures III LLC Fiber Technologies Networks, L.L.C. (NY) TowerOne Partners, LLC Fibernet Direct Florida LLC TriStar Investors LLC Fibernet Direct Holdings LLC TVHT LLC Fibernet Direct TEL LLC WCP Wireless Lease Subsidiary, LLC Fibernet Direct Texas LLC WCP Wireless Site Funding LLC Fibertech Holdings Corp. WCP Wireless Site Holdco LLC Fibertech Networks, LLC WCP Wireless Site Non-RE Funding LLC Freedom Telecommunications, LLC WCP Wireless Site Non-RE Holdco LLC Global Signal Services LLC WCP Wireless Site RE Funding LLC InfraSource FI, LLC WCP Wireless Site RE Holdco LLC InSITE Fiber of Virginia LLC Merged Entities to Crown Castle Fiber LLC InSITE Solutions LLC 24/7 Chesapeake Holdings, LLC IX2 Center, LLC 24/7 Mid-Atlantic Network of Virginia, LLC IX2 Wilshire, LLC 24/7 Mid-Atlantic Network, LLC JBCM Towers LLC Access Fiber Group Holdings LLC Light Tower Fiber New York, Inc. (NY) Access Fiber Group, Inc. Light Tower Holdings LLC CA - CLEC LLC Light Tower Management, Inc. CC Castle International LLC Light Tower Metro Fiber LLC CC Edge Solutions LLC Lightower Fiber Infrastructure Corp. CC Finance LLC Lightower Fiber Networks I, LLC CC FN Holdings LLC Lightower Fiber Networks II, LLC n/k/a Crown Castle Fiber LLC CC Sunesys Fiber Networks LLC LL Q1-18, LLC CC TS LLC LTS Buyer LLC CCPE Acquisitions LLC LTS Group Holdings LLC n/k/a Crown Castle Fiber Holdings Corp CCT2 Holdings LLC LTS Intermediate Holdings A LLC Chesapeake Fiber, LLC LTS Intermediate Holdings B LLC Coastal Antennas LLC LTS Intermediate Holdings C LLC Cross Connect Solutions, Inc. (PA)Mobile Media California LLC Crown Castle Atlantic LLC Mobile Media National LLC Crown Castle Augusta LLC Modeo LLC Crown Castle BP ATT LLC NEON Transcom, Inc. Crown Castle International Corp. de Puerto Rico NewPath Networks Holding LLC Crown Castle MM Holding Corp. NewPath Networks LLC Crown Castle MM Holding LLC NY - CLEC LLC Crown Castle NG Atlantic LLC P3 CHB-1, LLC Crown Castle NG Central LLC P3 Holdings 2014 LLC Crown Castle NG Networks LLC P3 OASA-1, LLC Crown Castle NG West LLC P3 PBA-1, LLC Crown Castle PT Inc.PA - CLEC LLC Crown Castle Services LLC Pinnacle San Antonio L.L.C. Crown Castle TDC LLC Pinnacle St. Louis LLC Crown Castle TLA LLC PR TDC Corporation Crown Mobile Systems, Inc. Princeton Ancillary Services II LLC DAS Development Corporation Princeton Ancillary Services III LLC 2 of 3 Crown Castle Inc. Edition Date: 8/01/22 Named Insured Named Insured (cont.) RGP Tower Group, LLC Sidera Networks, Inc. Sunesys Enterprise LLC n/k/a Crown Castle Fiber Enterprise LLC Sunesys of Massachusetts, LLC Sunesys of Virginia, Inc. Sunesys, LLC Thunder Towers 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 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 Towers Finco LLC WA - CLEC 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. 3 of 3