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HomeMy WebLinkAboutWA48169-A-0ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTRINSDWVD PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION$ PER OTH-STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 12/20/2024 (412) 261-1842 (412) 261-4149 25674 SBA Communications Corporation 8051 Congress Ave. Boca Raton, FL 33487 19682 A 1,000,000 X TC2J-GLSA-9P530142-TIL-24 3/15/2024 3/15/2025 1,000,000 1,000,000 2,000,000 2,000,000 1,000,000A TC2J-CAP-474M814A-TIL-24 3/15/2024 3/15/2025 15,000,000A CUP-1T38674A-24-NF 3/15/2024 3/15/2025 15,000,000 10,000 A UB-4L099102-24-51-K 3/15/2024 3/15/2025 1,000,000 1,000,000 1,000,000 A Worker's Comp UB-3L884966 3/15/2024 Each Acc/Policy Lmt 1,000,000 B Prof/Poll 40 CPI HA6405 3/15/2024 3/15/2025 Claim/Agg 5,000,000 Job WA48169 Site Name: Bre001, Site Number: WA48169-A-0 Site Address: 3027 Olympus Drive NE Bremerton, WA 98310 City Of Bremerton Attn: City Clerk 345 Sixth Street, Suite 100 Bremerton, WA 98337 SBACOMM-01 NRCRISWELL Henderson Brothers Inc 920 Ft. Duquesne Blvd. Pittsburgh, PA 15222 mailroom@hendersonbrothers.com Travelers Property Casualty Company of America Hartford Fire Insurance Company Payable X 3/15/2025 X X X X X X X X FORM NUMBER: EFFECTIVE DATE: The ACORD name and logo are registered marks of ACORD ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE FORM TITLE: Page of THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, ACORD 101 (2008/01) AGENCY CUSTOMER ID: LOC #: AGENCY NAMED INSURED POLICY NUMBER CARRIER NAIC CODE © 2008 ACORD CORPORATION. All rights reserved. Henderson Brothers Inc SBACOMM-01 SEE PAGE 1 1 SEE PAGE 1 ACORD 25 Certificate of Liability Insurance 0 SEE P 1 SBA Communications Corporation 8051 Congress Ave. Boca Raton, FL 33487 SEE PAGE 1 NRCRISWELL 1 Named Insureds Continued: SBA GC Holdings, LLC SBA Towers South Africa Proprietary, Limithed F/K/A Atlas Tower Proprietary, Limited SBA Edge (JAX), LLC SBA GC Parent I, LLC Morocco Shareholder, LLC SBA UK Holdings Limited SBA GC Parent II, LLC T.A. Investment Holdings Inc. SBA GC Towers, LLC SBA Towers USVI, Inc. Torres Andinas Holdco, Inc. SBA Guarantor LLC SBA Towers X, LLC Tower Funding, LLC Brazil Shareholder I, LLC SBA Holdings LLC Tower Funding II, LLC Brazil Shareholder II, LLC SBA Holdings e Participaçıes Ltds. TV6 Holdings LLC Central America Equityholder, LLC SBA HQ, LLC Tower Funding III, L.P. Chile Shareholder, LLC SBA Infrastructure, LLC Tower Funding GP, Inc. Colombia Shareholder, LLC SBA Inmuebles Peru, S.A.C. fka MAA Desarrollos E Inversiones Inmoniliarias, S.A.C Costa Rica Quotaholder, LLC SBA Land, LLC fka TCO Land LLC SBA Towers VII, LLC SBA Monarch Steel, LLC Desarrollos Inmobiliarios Inmo Aplicanet SA Desarollos Inmobiliarios INMO-ETC S.A.S Desarrollos Inmobiliarios Inmoavilies S.A. SBA Monarch Towers I, LLC DC Matrix Internet Ltda Ecuador Shareholder, LLC SBA Monarch Towers III, LLC DC Matrix Telecomuncacoes Ltda Ecuador Shareholder II, LLC SBA Negocios Imobiliarios Ltda Minara Tanzania Limited SBA Network Management, Inc. SBA Connect, LLC Minara Zanzibar Limited El Salvador Shareholder I, LLC SBA New Builds, LLC RTGF Holdings Limited El Salvador Shareholder II, LLC SBA Properties, LLC RTGF Midco Limited Guatemala Shareholder I, LLC SBA Puerto Rico, LLC SBA Edge, LLC Guatemala Shareholder II, LLC SBA RSA Holdings, LLC SBA Towers Philippines, Inc SBA Senior Finance II LLC SBA TRS Holdco, LLC SBA Towers Philippines Holdings, Inc. SBA Senior Finance, LLC SBA Ventures, LLC SBA Towers VI, LLC SBA Site Management, LLC SBA Network Services, LLC SBA Towers XI, LLC Memphis Towers, LLC SBA Sites, LLC SBA South Africa Equityholder, LLC SBA Steel LLC SBA Worth Telecom, LLC fka Atlas Tower South Africa Equityholder, LLC SBA Steel II, LLC Torreaviles S.A Crossbar Ventures, LLC Nicaragua Shareholder I, LLC SBA Structures, LLC SBA Carrier Solutions, LLC Golden State Licensing, LLC. SBA Telecommunications, LLC. SBA Connectivity Solutions Canada, ULC OFO LLC SBA Telecomunicaciones Colombia S.A.S. f/k/a/ Torres Andinas S.A.S. Panama Shareholder, LLC SBA Towers, LLC Desarrollos Inmobiliarios INMO-APLICANET-V S.A. Peru Shareholder I, LLC SBA Torres Brasil, Limitada Desarrollos Inmobiliarios INMO-APLICANET-VI S.A. Peru Shareholder II, LLC SBA Torres Chile, Spa K2022383277 (South Africa) Proprietary Limited Quality Tower Developers, LLC SBA Torres Colombia S.A.S SBA Regional Services, S.A.S. SBA Torres Costa Rica, Limitada SBA Towers VIII, LLC DW Tower AT 2024, LLC SBA 2012 TC Assets, LLC SBA Torres Ecuador SBAEC, S.A. Spire Tower PR LLC SBA 2012 TC Assets Land, LLC SBA Torres El Salvador, S.A. De C.V. SBA Connectivity Solutions, LLC SBA 2012 TC Assets PR, LLC SBA Torres Guatemala, S.A. 832 Communications LLC SBA 2012 TC Holdings, LLC SBA Torres Nicaragua, S.A. SBA 2012 TC Land II, LLC SBA Torres Nicaragua II, LLC SBA 2014 PR, Inc. f/k/a Soluwise, Inc. SBA Torres Panama, S.A. SBA 2016 TC USVI, LLC f/k/a TowerCo 2013 USVI LLC SBA Torres Peru, S.A. fka Torres Andinas, S.A. SBA BTS, LLC SBA Towers II LLC SBA Canada Holdings, Inc. SBA Towers III LLC SBA Canada, ULC (fka Jade Tower ULC) SBA Towers IV, LLC SBA Canada II, ULC SBA Towers IX, LLC SBA DAS & Small Cells, LLC SBA Towers V, LLC SBA Depositor LLC SBA Desarrollos Inmobiliarios Ecuador SBAINMO-EC SA