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Home My WebLink AboutCOI CITYOFBREMERTON W22425227 4807 Crown Castle 04012022SHOULD 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 InternationalSee 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 10/06/2021 COIRequest@crowncastle.com Federal Insurance Company 20281 National Union Fire Insurance Company of P Berkshire Hathaway Specialty Insurance Com 19445 22276 AIU Insurance Company 19399 Travelers Property Casualty Company of Ame 25674 W22425227 A 1,000,000 1,000,000 10,000 1,000,000 2,000,000 2,000,000 Y Y 3605-33-35 LIO 04/01/2021 04/01/2022 B 1,000,000 04/01/202204/01/2021YYCA 7030894 C 5,000,000 25,000 Y Y 47-UMO-303445-07 04/01/2021 04/01/2022 5,000,000 WC 016393106DY 1,000,000No04/01/2021 04/01/2022 1,000,000 1,000,000 E All Risk Personal Property 100% Replacement Cost Limit:QT-630-5D736475-TIL-21 04/01/2021 04/01/2022 226108521676986SR ID:BATCH: $1,000,000 Crown Castle International 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 InternationalSee 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-21 EFF DATE: 04/01/2021 EXP DATE: 04/01/2022 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-21 EFF DATE: 04/01/2021 EXP DATE: 04/01/2022 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:Non-Tower Inland Marine Limit: $1,000,000Contractors Equipment Limit: $1,000,000Installation 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 W22425227CERT:2261085BATCH:21676986SR ID: Crown Castle International Corp. Consolidated Subsidiaries as Named Insureds Entity Name 7/23/19 Edition 24/7 Chesapeake Holdings, LLC Crown Castle GT Corp. 24/7 Mid-Atlantic Network of Virginia, LLC Crown Castle GT Holding Sub LLC 24/7 Mid-Atlantic Network, LLC Crown Castle International Corp. Access Fiber Group Holdings LLC Crown Castle International Corp. de Puerto Rico Access Fiber Group, Inc. Crown Castle International LLC AirComm of Avon, L.L.C.Crown Castle Investment Corp. Atlantic Coast Communications LLC Crown Castle Investment II Corp. CA - CLEC LLC Crown Castle MM Holding Corp. CC Castle International LLC Crown Castle MM Holding LLC CC Edge LLC Crown Castle MU LLC CC Edge Solutions LLC Crown Castle MUPA LLC CC Finance LLC Crown Castle NG Atlantic LLC CC FN Holdings LLC Crown Castle NG Central LLC CC Holdings GS V LLC Crown Castle NG East LLC CC Site Acquisitions II LLC Crown Castle NG Networks LLC CC Sunesys Fiber Networks LLC Crown Castle NG West LLC CC TM PA LLC Crown Castle Operating Company CC Towers Guarantor LLC Crown Castle Operating LLC CC Towers Holding LLC Crown Castle Orlando Corp. CC TS LLC Crown Castle PR LLC CCATT Holdings LLC Crown Castle PR Solutions LLC CCATT LLC Crown Castle PT Inc. CCATT PR LLC Crown Castle Puerto Rico Corp. CCGS Holdings Corp.Crown Castle Services LLC CCPE Acquisitions LLC Crown Castle Solutions LLC CCPR VI Tower Newco LLC Crown Castle South LLC CCS & E LLC Crown Castle TDC LLC CCT2 Holdings LLC Crown Castle TLA LLC CCTM Holdings LLC Crown Castle Towers 05 LLC CCTM1 LLC Crown Castle Towers 06-2 LLC CCTM2 LLC Crown Castle Towers 09 LLC CCTMO LLC Crown Castle Towers LLC Chesapeake Fiber, LLC Crown Castle USA Inc. Coastal Antennas LLC Crown Communication LLC ComSite Venture, Inc. Crown Communication New York, Inc. Coverage Plus Antenna Systems LLC Crown Mobile Systems, Inc. Cross Connect Solutions, Inc. (PA)DAS Development Corporation Crown Atlantic Company LLC Fiber Technologies Networks, L.L.C. (NY) Crown Castle AS LLC Fibernet Direct Florida LLC Crown Castle Atlantic LLC Fibernet Direct Holdings LLC Crown Castle Augusta LLC Fibernet Direct TEL LLC Crown Castle BP ATT LLC Fibernet Direct Texas LLC Crown Castle CA Corp.Fibertech Facilities Corp. (NY) Crown Castle Fiber Holdings Corp. (formerly LTS Group Holdings LLC)Fibertech Holdings Corp. Crown Castle Fiber Enterprise LLC (formerly Sunesys Enterprise LLC)Fibertech Networks, LLC Crown Castle Fiber LLC f/k/a Lightower Fiber Networks II, LLC Freedom Telecommunications, LLC Crown Castle GS III Corp.Global Signal Acquisitions II LLC Crown Castle GT Company LLC Global Signal Acquisitions III LLC Crown Castle International Corp. Consolidated Subsidiaries as Named Insureds Entity Name 7/23/19 Edition Global Signal Acquisitions IV LLC P3 OASA-1, LLC Global Signal Acquisitions LLC P3 PBA-1, LLC Global Signal GP LLC PA - CLEC LLC Global Signal Holdings III LLC Pinnacle San Antonio L.L.C. Global Signal Holdings IV LLC Pinnacle St. Louis LLC Global Signal Operating Partnership, L.P.Pinnacle Towers Acquisition Holdings LLC Global Signal Services LLC Pinnacle Towers Acquisition LLC GoldenState Towers, LLC Pinnacle Towers Asset Holding LLC GS Savings Inc.Pinnacle Towers Canada, Inc. GSPN Intangibles LLC Pinnacle Towers III LLC High Point Management Co. LLC Pinnacle Towers Limited ICB Towers, LLC Pinnacle Towers LLC InfraSource FI, LLC Pinnacle Towers V Inc. InSITE Fiber of Virginia LLC PR Site Development Corporation InSITE Solutions LLC PR TDC Corporation Interstate Tower Communications LLC Princeton Ancillary Services II LLC Intracoastal City Towers LLC Princeton Ancillary Services III LLC IX2 Center, LLC Radio Station WGLD LLC IX2 Wilshire, LLC RGP Tower Group, LLC JBCM Towers LLC Shaffer & Associates, Inc. Light Tower Clearinghouse LLC Sidera Networks UK Limited (UK) Light Tower Fiber New York, Inc. (NY)Sidera Networks, Inc. Light Tower Holdings LLC Sierra Towers, Inc. Light Tower Management, Inc.Sunesys Enterprise LLC n/k/a Crown Castle Fiber Enterprise LLC Light Tower Metro Fiber LLC Sunesys of Massachusetts, LLC Lightower Fiber Infrastructure Corp.Sunesys of Virginia, Inc. Lightower Fiber Networks I, LLC Sunesys, LLC Lightower Fiber Networks II, LLC n/k/a Crown Castle Fiber LLC Thunder Towers LLC LL Q1-18, LLC Tower Development Corporation LTS Buyer LLC Tower Systems LLC LTS Group Holdings LLC n/k/a Crown Castle Fiber Holdings Corp Tower Technology Company of Jacksonville LLC LTS Intermediate Holdings A LLC Tower Ventures III, LLC LTS Intermediate Holdings B LLC TowerOne 2012, LLC LTS Intermediate Holdings C LLC TowerOne Allentown 001, LLC Md7 Capitol One, LLC TowerOne Bethlehem 001, LLC Mobile Media California LLC TowerOne Doylestown, LLC Mobile Media National LLC TowerOne East Rockhill 001, LLC Modeo LLC TowerOne Marple, LLC MW Cell REIT 1 LLC TowerOne Middletown 001, LLC MW Cell TRS 1 LLC TowerOne Middletown 002, LLC NEON Transcom, Inc.TowerOne Middletown 003, LLC NewPath Networks Holding LLC TowerOne North Coventry, LLC NewPath Networks LLC TowerOne Partners, LLC NY - CLEC LLC TowerOne Richland, LLC OP 2 LLC TowerOne Upper Pottsgrove 002, LLC OP LLC TowerOne Upper Pottsgrove, LLC P3 CHB-1, LLC TowerOne Warminster 001, LLC P3 Holdings 2014 LLC TowerOne Warrington 002, LLC Crown Castle International Corp. Consolidated Subsidiaries as Named Insureds Entity Name 7/23/19 Edition Towers Finco II LLC Towers Finco III LLC 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. Willis 101 INSURER CANCELLATION TERMS POLICY NO. Various NAMED INSURED Crown Castle International 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