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HomeMy WebLinkAboutCITYOFBREMERTON_W39014091SHOULD 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.See Attached Named Insured List8020 Katy FreewayHouston, TX 77024 This Voids and Replaces Previously Issued Certificate Dated 04/02/2025 WITH ID: W38554660. 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 05/14/2025 COIRequest@crowncastle.com ACE American Insurance Company 22667 ACE Property & Casualty Insurance Company Travelers Property Casualty Company of Ame 20699 25674 W39014091 A 2,000,000 1,000,000 10,000 2,000,000 4,000,000 4,000,000 HDO G48933889 04/01/2025 04/01/2026 A 2,000,000 04/01/202604/01/2025ISA H11357131 B 5,000,000 25,000 XEUG47458262 002 04/01/2025 04/01/2026 5,000,000 WLR C72611251A 1,000,000No04/01/2025 04/01/2026 1,000,000 1,000,000 C All Risk Personal Property 100% Replacement Cost Limit:QT-630-5D736475-TIL-25 04/01/2025 04/01/2026 396237327766347SR ID:BATCH: $1,000,000 Crown Castle Inc. Page 1 of 3 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.See Attached Named Insured List8020 Katy FreewayHouston, TX 77024 4 World Trade Center LLC, 4 WTC Holdings LLC ,4 WTC Mezz LLC Greenwich Street IC, LLC, Silverstein Properties LLC, Silverstein Properties, Inc., Silverstein Holdco I LLC, Larry Silverstein as an Individual, Net Lessees’ Association of the World Trade Center, Silverstein 2/3/4 WTC Redevelopment LLC, Silverstein Freedom Tower Development LLC, Silverstein WTC LLC, Silverstein WTC Management and Development LLC, Silverstein WTC Mgmt. Co. II LLC, Silverstein WTC Mgmt. Co. LLC, Silverstein WTC Properties LLC, Spring World Inc., Spring WTC Holdings Inc., The Port Authority of New York and New Jersey, World Trade Center Holdco LLC, World Trade Center Properties LLC, WTC Investors LLC, WTC Investors Management and Development LLC, WTC Management and Development LLC, WTC Redevelopment LLC, WTC Retail LLC 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. 4 World Trade Center LLC, 4 WTC Holdings LLC ,4 WTC Mezz LLC Greenwich Street IC, LLC, Silverstein Properties LLC, Silverstein Properties, Inc., Silverstein Holdco I LLC, Larry Silverstein as an Individual, Net Lessees’ Association of the World Trade Center, Silverstein 2/3/4 WTC Redevelopment LLC, Silverstein Freedom Tower Development LLC, Silverstein WTC LLC, Silverstein WTC Management and Development LLC, Silverstein WTC Mgmt. Co. II LLC, Silverstein WTC Mgmt. Co. LLC, Silverstein WTC Properties LLC, Spring World Inc., Spring WTC Holdings Inc., The Port Authority of New York and New Jersey, World Trade Center Holdco LLC, World Trade Center Properties LLC, WTC Investors LLC, WTC Investors Management and Development LLC, WTC Management and Development LLC, WTC Redevelopment LLC, WTC Retail LLC 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. 4 World Trade Center LLC, 4 WTC Holdings LLC ,4 WTC Mezz LLC Greenwich Street IC, LLC, Silverstein Properties LLC, Silverstein Properties, Inc., Silverstein Holdco I LLC, Larry Silverstein as an Individual, Net Lessees’ Association of the World Trade Center, Silverstein 2/3/4 WTC Redevelopment LLC, Silverstein Freedom Tower Development LLC, Silverstein WTC LLC, Silverstein WTC Management and Development LLC, Silverstein WTC Mgmt. Co. II LLC, Silverstein WTC Mgmt. Co. LLC, Silverstein WTC Properties LLC, Spring World Inc., Spring WTC Holdings Inc., The Port Authority of New York and New Jersey, World Trade Center Holdco LLC, World Trade Center Properties LLC, WTC Investors LLC, WTC Investors Management and Development LLC, WTC Management and Development LLC, WTC Redevelopment LLC, WTC Retail LLC 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 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 written contract 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 in written contract prior to the loss, but always subject to the policy terms, conditions and exclusions as 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 loss, but always subject to the policy terms, conditions and exclusions as permitted by law. 2 3 Willis Towers Watson Northeast, Inc. See Page 1 See Page 1 See Page 1 See Page 1 25 Certificate of Liability Insurance W39014091CERT:3962373BATCH:27766347SR ID: 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.See Attached Named Insured List8020 Katy FreewayHouston, TX 77024 INSURER AFFORDING COVERAGE: Travelers Property Casualty Company of America NAIC#: 25674POLICY NUMBER: QT-660-1S576470-TIL-25 EFF DATE: 04/01/2025 EXP DATE: 04/01/2026 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-25 EFF DATE: 04/01/2025 EXP DATE: 04/01/2026 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:Non-Tower Inland Marine Limit: $1,000,000Contractors Equipment Limit: $1,000,000Installation Limit: $800,000 3 3 Willis Towers Watson Northeast, Inc. See Page 1 See Page 1 See Page 1 See Page 1 25 Certificate of Liability Insurance W39014091CERT:3962373BATCH:27766347SR ID: CROWN CASTLE, INC. 4/7/2025 Named Insured List Named Insured (cont.) AirComm of Avon, LLC Global Signal Operating Partnership, LP Assurable Insurance LLC GoldenState Towers LLC Atlantic Coast Communications LLC GS Savings Inc. CC Edge LLC GSPN Intangibles LLC CC Holdings GS V LLC High Point Management Co. LLC CC Site Acquisitions II LLC ICB Towers LLC CC Strategic Investment Corp. Interstate Tower Communications LLC CC TM PA LLC Intracoastal City Towers LLC CC Towers Guarantor LLC Light Tower Clearinghouse LLC CC Towers Holding LLC Md7 Capitol one, LLC CCATT Holdings LLC MIW Cell Reit I LLC CCATT LLC MIW Cell TRS I LLC CCATT PR LLC OP LLC CCGS Holdings corp. OP 2 LLC CCPR VI Tower Newco LLC Pinnacle Towers Acquisition Holdings LLC CCS & LLC Pinnacle Towers Acquisition LLC CCTM Holdings LLC Pinnacle Towers Asset Holding LLC CCTMI LLC Pinnacle Towers Canada Inc. CCTM2 LLC Pinnacle Towers III LLC CCTMO LLC Pinnacle Towers Limited CCVX LLC Pinnacle Towers LLC ComSite Venture, Inc. Pinnacle Towers V Inc. Coverage Plus Antennas Systems LLC PR Site Development Corporation Crown Atlantic Company LLC Radio Station WGLD LLC Crown Castle AS LLC Shaffer & Associates, Inc. Crown Castle Atlantic LLC Sidera Networks UK Limited (UK) Crown Castle CA Corp. Sierra Towers, Inc. Crown Castle Fiber Enterprise LLC Tower Development Corporation Crown Castle Fiber Holdings Corp. Tower Systems LLC Crown Castle Fiber LLC Tower Technology Company of Jacksonville LLC Crown Castle GS III Corp. Tower Ventures III LLC Crown Castle GT Company LLC TowerOne Partners, LLC Crown Castle GT Corp. TriStar Investors LLC Crown Castle GT Holding Sub LLC TVHT LLC Crown Castle Inc. f/k/a Crown Castle International Corp. WCP Wireless Lease Subsidiary, LLC Crown Castle LLC WCP Wireless Site Funding LLC Crown Castle Investment Corp. WCP Wireless Site Holdco LLC Crown Castle Investment II Corp. WCP Wireless Site Non-RE Funding LLC Crown Castle MU LLC WCP Wireless Site Non-RE Holdco LLC Crown Castle MUPA LLC WCP Wireless Site RE Funding LLC Crown Castle NG East LLC WCP Wireless Site RE Holdco LLC Crown Castle Operating Company Fiber Technolies Networks L.L.C. N Crown Castle Operating LLC Fibernet Direct Florida LLC Crown Castle Orlando Corp. Fibernet Direct Holdings LLC Crown Castle PR LLC Fibernet Direct TEL LLC Crown Castle PR Holdings LLC Fibernet Direct Texas LLC Crown Castle PR Solutions LLC Fibertech Holdings Corp. Crown Castle Puerto Rico Corp. Crown Castle Solutions LLC Freedom Telecommunications, LLC Crown Castle South LLC Global Signal Services LLC Crown Castle Towers 05 LLC InfraSource Fl, LLC Crown Castle Towers 06-2 LLC lnSlTE Fiber of Virginia LLC Crown Castle Towers 09 LLC lnSlTE Solutions LLC Crown Castle Towers LLC 1X2 Center, LLC Crown Castle USA Inc. 1X2 Wilshire, LLC Crown Communication LLC JBCM Towers LLC Crown Communication New York, Inc. Light Tower Fiber New York, Inc. (NY) Fibertech Facilities Corp. Light Tower Holdings LLC Global Signal Acquisitions II LLC Light Tower Management, Inc. Global Signal Acquisitions III LLC Light Tower Metro Fiber LLC Global Signal Acquisitions IV LLC Lightower Fiber Infrastructure Corp. Global Signal Acquisitions LLC Lightower Fiber Networks I, LLC Global Signal GP LLC Global Signal Holdings III LLC LL Q1-18, LLC 1 Fibertech Networks, LLC Lightower Fiber Networks II, LLC n/k/a Crown Castle Fiber LLC CROWN CASTLE, INC.4/7/2025 Named Insured (cont.)Merged Entities to Crown Castle Fiber LLC LTS Buyer LLC 24/7 Chesapeake Holdings, LLC LTS Group Holdings LLC n/k/a Crown Castle Fiber Holdings Corp 24/7 Mid-Atlantic Network of Virginia, LLC LTS Intermediate Holdings A LLC 24/7 Mid-Atlantic Network, LLC LTS Intermediate Holdings B LLC Access Fiber Group Holdings LLC TS Intermediate Holdings C LLC Access Fiber Group, Inc. Mobile Media California LLC CA - CLEC LLC Mobile Media National LLC CC Castle International LLC Modeo LLC CC Edge Solutions LLC NEON Transcom, Inc.CC Finance LLC NewPath Networks Holding LLC CC FN Holdings LLC NewPath Nervorks LLC CC Sunesys Fiber Networks LLC NY - CLEC LLC cc -rs LLC P3 CHB-1, LLC CCPE Acquisitions LLC P3 Holdings 2014 LLC CCT2 Holdings LLC P3 OASA-I, LLC Chesapeake Fiber, LLC P3 PBA-1, LLC Coastal Antennas LLC PA - CLEC LLC Cross Connect Solutions, Inc. (PA) Pinnacle San Antonio L.L.C.Crown Castle Atlantic LLC Pinnacle St. Louis LLC Crown Castle Augusta LLC PR TDC Corporation Crown Castle BP ATT LLC Princeton Ancillary Services II LLC Crown Castle International Corp. de Puerto Rico Princeton Ancillary Services III LLC Crown Castle MM Holding Corp. Sidera Networks, Inc.Crown Castle MM Holding LLC Sunesys Enterprise LLC n/k/a Crown Castle Fiber Enterprise LLC Crown Castle NG Atlantic LLC Sunesys of Massachusetts, LLC Crown Castle NG Atlantic LLC Sunesys of Virginia, Inc.Crown Castle NG Central LLC Sunesys, LLC Crown Castle NG Networks LLC Thunder Towers LLC Crown Castle NG West LLC TowerOne 2012, LLC Crown Castle PT Inc. TowerOne Allentown 001, LLC Crown Castle Services LLC TowerOne Bethlehem 001, LLC Crown Castle TDC LLC TowerOne Doylestown, LLC Crown Castle TLA LLC TowerOne East Rockhill 001, LLC Crown Mobile Systems, Inc. TowerOne Marple, LLC DAS Development Corporation TowerOne Middletown 001, LLC RGP Tower Group, 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. 8020 Katy Freeway Realty LLC 2