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HomeMy WebLinkAboutTelecomm Facility - Anderson Creek - INSURANCE 2017 ,O ACORD CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 03/30/2016 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 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 NAME' Willis of Pennsylvania, Inc. PHONE FAX c/o 26 Century Blvd. (A/C NO,EXT). 877-945-7378 (A/l•f1o)• 888-467-2378 • P. 0. Box 305191 " E-MAIL ADDRESS• certificates@Willis.com Nashville, TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC II INSURER A: Federal Insurance Company 20281-005 INSURED CROWN CASTLE INTERNATIONAL CORP. INSURER B: Travelers Casualty & Surety Co. of Americ 31194-002 See Attached Named Insured List INSURER C:North American Elite Insurance Company 29700-001 1220 Augusta Dr. Suite 500 Houston, TX 77057 INSURER D: Travelers Property Casualty Co of Amer 25674-001 INSURER E: INSURER F: i COVERAGES CERTIFICATE NUMBER:24285394 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPM/ LIMITS I TR _ IN D wvn (MM/nn/YYYY) (MDD/YYYY) A X COMMERCIAL GENERAL LIABILITY 7021-02-28 4/1/2016 4/1/2017 EACH OCCURRENCE $ 1,000,000 p ��EE77' ENTED CLAIMS-MADE X OCCUR P ISES aoccurence) $ 1,000,000 MED EXP(Any one person) _$ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRC JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 _ OTHER: $ B AUTOMOBILE LIABILITY TC2JCAP-474M9749-16 4/1/2016 4/1/2017 Ea acciCOMBINEDSdent)INGLELIMIT $ 1r 000,000 ( X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS eracc BODILY INJURY(Per $ _ HIRED AUTOS NON-OWNED PR PERTY DAMAGE AUTOS (Per accident) $ C X UMBRELLA LIAB X OCCUR UMB 2000165-02 4/1/2016 4/1/2017 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION$ 25,000 $ D WORKERS COMPENSATION TC2JUB-474M9694-16 4/1/2016 4/1/2017 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER D ANY PROPRIETOR/PARTNER/EXECUTIVE N I N/A TRKUB-474M9701-16 4/1/2016 4/1/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory.in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 fyes,describeunder DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additonal Remarks Schedule,may be attached if more space is required) RE: 880446 - Lease No. : 147376. 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 POLICY PROVISIONS. City of Bremerton AUTH IZEDREPRES ATIVE ATTN: JUDIE CARLSON 345 6TH ST BREMERTON, WA 98337-1873 Co11:4875753 Tp1:2042329 Cert:24285394 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 713115 LOC#: ACORE) ADDITIONAL REMARKS SCHEDULE Page_2_of AGENCY NAMED INSURED CROWN CASTLE INTERNATIONAL CORP. Willis of Pennsylvania, Inc. See Attached Named Insured List POLICY NUMBER 1220 Augusta Dr. Suite 500 Houston, TX 77057 See First Page CARRIER NAIC CODE See First Page EFFECTIVE DATE: See First Page ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Certificate Holder is included as an Additional Insured under the General Liability, Automobile Liability, and Excess/Umbrella Liability policies as their interest ma 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, Excess/Umbrella Liability, and Workers Compensation policies include a Waiver of Subrogation in favor of the Additional Insured when required by written contract and as permitted by law but always subject to the policy terms, conditions and exclusions. • ACORD101 (2008/01) Co11:4875753 Tp1:2042329 Cert:24285394 ©2008ACORDCORPORATION.Allrightsreserved. The ACORD name and logo are registered marks of ACORD Crown Castle International Corp.Consolidated Subsidiaries as Named Insureds Page 1 of 2 !I Entity Ntime' 9 ' _ ! 121;1812015 edition 2417 Chesapeake Holdings,LLC elf 10/31/2014 Crown Castle Investment II Corp • .(I 2417 Mid-Atlantic Network of Virginia,LLC(eff 10/31/2014) Crown Castle MM Holding Corp. I 24/7 Mid-Atlantic Network.LLC(elf 10/31/2014) Crown Caste MM Holding ILC Access Fiber Group Holdings LLC(ell 5/1412015) Crown Castle MU LLC Access Fiber Group Inc.(eff 5/14/2015) Crown Caste MUPA LLC AirComm of Avon,LL.C. • Crown Castle NG Atlantic LLC.(eff 94/12)fka NextG Networks Atlantic Inc. 1 Atlantic Coast Communications LLC Crown Caste NG Central LLC(eff 513/12)fka NextG Networks of Illinois Inc 1 i CA-CLEC LLC Crown Caste NG East LLC(eff 93/12)aka NexIG Networks of NY Inc 1 • CC Caste International LLC Crown Caste NG Networks Inc.(elf 513/12)Ika NextG Networks Inc CC Finance LLC Crown Caste NG West LIC(eff 5/3112)fka NextG Networks of California Inc CC Holdings GS V LLC Crown Caste Operating Company CC Site Acquisitions II LLC Crown Castle Operating LLC ' CC Sunesys Fiber Networks LLC(elf 8128/2015) Crown Caste Orlando Corp. • CC TM PA LLC(ell 10/31/2012) Crown Caste PR LLC CC Towers Guarantor LLC Crown Caste PR Solutions LLC(elf 9/10/13) ( CC Towers Holding LLC Crown Castle PT Inc. CC TS LLC Crown Caste Puerto Rico Corp. I CCATT Holdings LLC Crown Castle Services LLC(eff 6/24/2011) . CCATT LLC Crown Caste Solutions Corp. CCATT PR LLC Crown Caste South LLC j CGGS Holdings Corp. Croom Caste ILA LLC CCPE Acquisitions LLC Crown Castle Towers 05 LLC CCPR VI LLC Crown Castle Towers 06-2 LLC . '! CCPR VI Tower LLC Crown Caste Towers 09 LLC ` CCS&E LLC Feb.10,2014 Crown Castle Towers LLC i' CCT2 Holdings LLC June 27,2014 Crown Castle USA Inc. CCTM Holdings LIC(elf 10731/2012) Crown Communication LLC(IormedyCrown Communication Inc.eff 1/1/11) f CCTMI LLC(eff 11/30/12) Crown Communication New York,Inc. I' CCTM2 LLC(effective 11/30/12) Crown Mobile Systems,Inc . CCTMO LLC(eff 10/31/2012) Global Signal Acquisitions II LLC ,1 ' Chesapeake Fiber,LLC(elf 10/31/2014) Global Signal Acquisitions III LLC Coastal Antennas LLC Global Signal Acquisitions IV LLC ;1 Comsite Venture,Inc. Global Signal Acquisitions LLC • Coverage Plus Antenna Systems LLC Global Signal GP LLC CPS Holdco,LLC eff 12115/14 Global Signal Holdings III LLC Cram Atlantic Company LLC Global Signal Holdings IV LLC Crown Castle AS LLC(eft 4/29/11) Gtobal Signal Operating Partnership.LP. . i I Crown Castle Atlantic LLC Global Signal Services LLC Crown Castle Augusta LLC GoldenState Towers,LLC . Crown Castle BP ATT LLC GS Savings Inc. Crown Castle CA Corp. GSPN Intangibles LLC 1 Crown Castle GS III Corp. High Point Management Co.LLC Crown Castle GT Company LLC ICB Towers,LLC - -- Crown Caste GT Corp. In SITE Fiber of Virginia LLC Crown Castle GT Holding Sub LLC InfraSouce Fl.LLC h Crown Castle International Corp. InSITE Solutions,LLC Crown Castle International Corp.de Puerto Rico Interstate Tower Communications LLC '.Y Crown Castle International LLC Intracoastal City Towers LLC k i Crown Castle Investment Corp JBCM Towers LLC . h ' ! .1 Crown Castle International Corp.Consolidated Subsidiaries as Named Insureds Page 2 of 2 Entity. .° 1— . .'12118/2015 edition. 1 LL 01-15 LLC Towers Finco LLC LL 02-15 LLC TriStar Investors LW(eff 12/15/14) LL 03-15 LLC efi 12/07/2015 TVHT,LLC Mdl Capitol One,LLC WA-CLEC LLC Mobile Media California LLC WCP Wireless Lease Subsidiary,LLC(eff 1131/2012) Mobile Media National LLC WCP Wireless Site Funding LLG(eff 1/31/2012) Modeo LLC WCP Wireless Site Holdco LLC(eff 1/31/2012) MW Gel REIT 1 LLC(eff 1/31/12) WCP Wireless Site Non-RE Funding LLC(eff 1/31/2012) MW Cell TRS 1 LLC(eff 1/31/12) WGP Wireless Site Non-RE Holdco LLC(eff 1/31/2012) New Path Networks Holding LLG WCP Wireless Site RE Funding LLC(eff 1131/2012) New Path Networks,LLC WGP Wireless Site RE Holdco LLC(eff 1131/2012) NY-CLEC LLC Wireless Funding,LLC(eff 1131/2012) OP 2 LLC Wireless Realty Holdings II,LLC(effective 5/19/11) OP LLG Wireless Revenue Properties,LLC(elf 1/3112012) PA-CLECLLC - • - Pinnacle San Antonio L-LC- Pinnacle St.Louis LLC Pinnacle Towers Acquisition Holdings LLC Pinnacle Towers Acquisition LLC • Pinnacle Towers Asset Holding LLC Pinnacle Towers Canada Inc. Pinnacle Towers Ill LLC Pinnacle Towers Limited Pinnacle Towers LLC Pinnacle Towers V Inc. Princeton Ancillary Services II LLC Formed 2/28/14 Princeton Ancillary Services III LLC Formed 2/28/2014 . Radio Station WGLD LLC Shaffer&Associates,Inc. Sierra Towers,Inc. Sunesys Enterprise LLC Sunesys of Massachusetts,LLC(elf 4/30/2015) Sunesys of Virginia,Inc.(eff 4/30/2015) Sunesys,LLC(elf 413012015) Thunder Towers LLC • Tower Systems LLG Tower Technology Company of Jacksonville LLC Tower Ventures III,LLC TowerOne 2012,LLC(eff 3/2/2012) TowerOne Allentown 001,LLC(elf 3/212012) TowerOne Doylestown,LLC(elf 312/2012) TowerOne Middletown 003,LLC(eff 3/2/2012) . TowerOne North Coventry LLC(eff 3/2/2012) TowerOne Partners,LLC(elf 3/2/2012) TowerOne Upper Pottsgrove 002,LLC(eff 3/2/2012) TowerOne Warminster 001,LLC(elf 3/212012) TowerOne Warrington 002,LLC(elf 3/2/2012) Towers Finco II LLC Towers Finco III LLC • INSURER CANCELLATION TERMS NAMED INSURED POLICY NO. CROWN CASTLE INTERNATIONAL CORP. 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 Willis 101