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HomeMy WebLinkAboutCOI - Crown Castle - Seattle Qwest - 2023Page 1 of 2 DATE (MMfDDrYYYY) oRl7� CERTIFICATE OF LIABILITY INSURANCE 03/30/2023 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(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and co��nd.l��Ions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thit�i�ii.'��Awlirilleu of such endorsement(s). PRODUCER "— e Willis Towers Watson Northeast, Inc. c/o 26 Century Blvd APR 1 1�:2023 P.O. Box 305191 Nashville, TN 372305191 U5A City of Bremerton INSURED Risk Management Crown Castle Inc. E/k/a Crown Castle International Corp. gee Attached Named Insured Liat 8020 Katy Freeway Houston, TX 77024 COVERAGES CERTIFICATE NUMBER: w2B526D56 Crown Castle Inc. @crowncastle.com Continental Casualty Company B: Berkshire Hathaway Specialty Insurance Continental Insurance Company INSURERD; Travelers Property Casualty Company of Ame REVISION NUMBER: 20443 22276 35289 25674 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. IL7R TYPEOFINSURANCE AODL SUER pOLIGY NUMBER MM�DDlYYYY MMrDD YYYY LIMITS X COMMERCIAL GENERAL LIABILITY _ CLAIMS•MADE n OCCUR EACH OCCURRENCE $ 2,000,000 DA AGE TOR T D PREMISES (Ea ocarrrence) i, 000, 000 $ A MED EXP (An one person) $ 10, 000 Y Y 7018331477 04/O1/2023 09/Ol/2024 PERSONALS ADVINJURY $ 2,000,000 GEN'L AGGREGATE LIM17 APPLIES PER: X POLICY u PRO- LOC JECT GENERAL AGGREGATE PRODUCTS•COMPlOPAGG $ 4, 000, 000 $ 4,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accldonl) $ 2, 000, 000 X ANY AUTO . _ BODILY INJURY (Per person) $ A OWNED SCHEDULED AUTOS ONLY AUTOS Y Y 8UA 7018331432 04/O1/2023 04/O1/2024 BODILY INJURY (Peraccldent) $ PROPERTY DAMAGE (Por accldonq $ HIRED NON -OWNED AUTOS pNLY AUTOS ONLY B X — UMBRELLALIAB EXCESSLIAB X OCCUR CLAIMS -MADE Y Y 47-UMO-303495-09 04/O1/2023 04/O1/2029 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RGTENTION$ 25,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNER/EXECUTIVE Y! N OFFICEWMEMBEREXCLUDED7 No (Mandatory In NH) N!A Y WC7018331446 04/O1/2023 D4/O1/2024 X STATUTE ER E.L. EACH ACCIDENT E,L. DISEASE - EA EMPLOYEE $ 1, 000, 000 $ 1, 000, 000 II yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE •POLICY LIMIT $ 1, 000, 000 D All Riak Personal Property QT-630-5D736475-TIL-23 04/O1/2023 04/pl/2024 Limit: $1,000,000 100� Replacement Coet DESCRIPTION OFOPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedulo, may be attached II more space le regUlred) BUiI 880446 - 9EATTLE QWEST - BRE005, 3000 BLOCK, HWY 16 9W, Port Orchard, WA 98367 *Property: Business/Personal Property SEE ATTACHED 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 POLICV PROVISIONS. AUTHORIZED REPRESENTATIVE CITY OF BREMERTON 345 6TH STREET SUITE 100 BREMEATON, WA 98337-1891 Q(K� p �`� \�� ©1988.2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD sn Io; 23930409 BATCH: 2913166 5 of 7 1814 AGENCY NAMED INSURED Willis Towers Watson Northeast, Inc. Crown Cantle Inc. f/k/a Crown Castle international Corp. Sea Attached Named, Insured List 0020 Katy Freeway POLICY NUMBER See Page 1 Houston, TX 77024 CARRIER NAIC CODE See Page 1 See Page I EFFECTIVE DATE: See Page 1 NUMBER:FORM Certificate of Liability Insurance City of Bremerton, and its elected and appointed officers, officials, agent a, employees, representatives, engineers, consultants, and volunteers are included as an Additional Insured under the General 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. City of Bromerton, and its cleated and appointed officers, officials, agents, employees, reprosentativea, engineers, consultants, and volunteers are included as additional insureds as their interest may appear with respect to the Automobile Liability for liability arising out of the operations or work performed by the named insured if required by written agreement. City of Bremerton, and its elected and appointed officers, officials, agents, employe®s, representatives, engineers, consultants, and volunteers are included as an Additional Insureds under the Umbrella Liability policy 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 include a Waiver of Subrogation in favor of the additional insureds when agreed in written contract prior to the one, but always aubject 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 written aantract prior to the lase, but always aubject to the policy terms, aonditions and exclusions as permitted by law. The Umbrella Liability policy include a Waiver of Subrogation in favor of the Additinnal Insureds when agreed in written contract prior to the lose, but always aubject to the policy terms, conditions and exclusions ae permitted by law. The Workers Compensation policies include a Waiver of Subrogation in favor• of the Additional Insureds when agreed in written contract prior to the loan, lout always aubject to the policy terms, eonditians and exclusions as permitted by law. INSURER AFFORDING COVERAGE: Travelers Property Casualty Company of America POLICY NUMBER: QT-660-15576970-TIL-23 EF&° DATE: Od/01/2023 EXP DATE: 04/Ol/2024 TYPE O&' 2NSURANCE; Property Coverag® - Towers Only LIMIT DESCRIPTION: Limit; LIMIT AMOUNT; �l,no0,nna INSURER AF&'ORDING COVERAGE: Travelers Property Casualty Company of America POLICY NUMBER: QT-660-15577626-TIL-23 EFF DATE: Od/Ol/2023 EXP DATE: 09/O1/2024 TYPE OF INSURANCE: Non -Tower Inland Marine / Contractors Equipment Installation LIMIT DESCRIPTION: Limit: Limit: LIMIT AMOUNT: �1,000,000 $800,000 NAIC#: 25674 NAIC�: 25679 AGAR® 101 (200610i) O 2008 AC®R� CORPORAi1�7N. All rights reserved. the AC®R® name and logo are registered marks of AC(7R® SR ID:23930409 BATCH:2913166 CERT: W20526056 TYPE OF INSURANCE: Non -Tower Inland Marine / Contractors Equipment Installation LIMIT DESCRIPTION: Limit: Limit: LIMIT AMOUNT: �1,000,000 $800,000 NAIC#: 25674 NAIC�: 25679 AGAR® 101 (200610i) O 2008 AC®R� CORPORAi1�7N. All rights reserved. the AC®R® name and logo are registered marks of AC(7R® SR ID:23930409 BATCH:2913166 CERT: W20526056 Crown Castle Inc. Edition Date: 8/01/22 :. }�,�:.� I' i.ltl` `'.��.'l.l �1,1 (17.�."I,A,7 i����."�'.Y il. �.� ( :"�3i `..,. AirComm of Avon, LLC Crown Castle Solutions LLC Assurable Insurance LLC Crawn Castle South LLC Atlantic Coast Communications LLC Crown Castle Towers 05 LLC CC Edge LLC Crown Castle Towers 06-2 LLC CC Holdings G5 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 Cor 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 (UI<) 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 6 of 7 1814 Crown Castle Inc. Edition Date: 8/01/22 Named Insured Tower Ventures III LLC Named Insured (cont.) Fiber Technologies Networks, L,L,C. (NY) TowerOne Partners, LLC Fibernet Direct Florida LLC TrlStar 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 lGlobal Signal Services LLC WCP Wireless Site RE Funding LLC llnfraSource FI, LLC WCP Wireless Site RE Holdco LLC InSITE Fiber of Virginia LLC • InSITE Solutions LLC 24/7 Chesapeake Holdings, LLC IX2 Center, LLC 24/7 Mid -Atlantic Network of Virgini7.7JBCM IX2 Wilshire, LLC 24/7 Mid -Atlantic Network, LLC 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 ILL Q148, 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 2of3 Crown Castle Inc. Edition Date: 8/01/22 Ai• 9.�,`b",- .4' r,; • _ - ilif �1.1� t:%'ai1 �al',��', k�� }r�4�;. � 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 OQ1, 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. 3of3 7 of 7 1814