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HomeMy WebLinkAboutCOI - Crown Castle International - Expires 2023-04-01Page 1 of 2 ACC)/c/a CERTIFIC TE F LIA ;ILITY INSURANCE MMT(MMMIDNYVY) 03/28/2022 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 lo en ADDITIONAL INSURED, the policy(leo) 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 en endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER wimtv-T Crown Castle Internation Willis Towers Watson Northeast, Inc NONE c/o 26 Century Blvd JAT A P.O. Box 305191 Nashville, TN S72305191 USA , . INSURED Crown Castle International nee Attached Named Insured Iiat 8020 Xaty Wrseway Houston, TX 77024 COVERAGES RE @g[ngE) MAY 0 2 2022 GILROY CITY CLERK'S OFFICE E TIFICATE NUMBER: W24267863 ESs: COIReqUestQcrowncastle.com INSURER(S) AFFORDING COVERAGE INSURER A : Continental Casualty Company aziarOomleppna. (i(A/6.1.4.): wsupum: Berkshire Hdthaway Specialty Insurance Corn NAI0 2044 22276 INSURER C : Continental Insurance, Company 35285INSURER D INSURER E INSURER F; REVISION NUMBER: THIS INDICATED, CERTIFICATE EXCLUSIONS oari LTR IS TO CERTIFY THAT THE POLICIES NOTWITHSTANDING ANY REQUIREMENT, MAY BE ISSUED OR MAY , , " AND CONDITIONS OF SUCH TYPE OF INSURANCEMg OF INSURANCE PERTAIN, POLICIES. AM btillA LISTED BELOW HAVE SEEN TERM OR CONDITION OF ANY THE INSURANCE AFFORDED BY LIMITS SHOWN MAY HAVE BEEN POUCY NU BER ISSUED TO CONTRACT THE POLICIES REDUCED BY POLICY MMODNY YY THE INSURED OR OTHER DESCRIBED PAID CLAIMS. lidEicras." MODNYYY NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, UMN'S X I COMMERCML GENERAL umillim EACH OCCURRENCE , 000,000 I CLAIMS -MADE I X I OCCUR DA MA GMT -EOM!) RBEMAES.Avvoisr9m9.1_ MED EXP (My ono person) $ 1,000, 000 $ 5,000 Y ] Y 7018331477 04/01/2022 04/01/2023 PERSONAL & ADV INJURY $ 2, 00,000 pqNt X AGGREGATE POLICY LIMIT APPLIES 1 28i. PER: I LOG GENERAL AGGREGATE PRODUCTS - COMP/OP AGO $ 4, 0.00, 000 If 4,000, 000 OTHER: $ AUTOMOSILEUABILM --- X ANY AUTO COMBINED SINGLE LIMIT BODILY INJURY (Per pomorq $ 2,000,000 $ OWNED AUTOS ONLY _ SCHEDULED AUTOS Y Y BOA 701 8331432 04/01/2022 04/01/2023 BODILY INJURY (FOr aenklea8 $ HIRED NON -OWNED AUTOS ONLY PROPERTY DAMAGE Aft-W411-____ _____ $ X UMBRELLA LIAR X OCCUR EACHOCC UR RENCE $ 5,000,000 EXCESS - - BED LMB X - RETENT — ONS oumma.mADE 25,000 47-M0-30344$-08 04/01/2022 04/01/2023 AGGREGATE ...._ $... 5, 000, 000 ' WORKERS.COMPENSATION AND EMPLOYERS' LIABILITY X PER STATure OM ER C Y/ N ANYPSOPRIETCONAMTNER/EXECUTIVE 1.-- OFF CEWMEMBEREXCLUDED? NO] (Mendiltory hi NH) NIA 91C7018231446 04/01/2022 04/01/2023 81. EACH ACCIDENT EL. DISEASE EA EMPLOYEE $ 1, .000, 000 , . $ 1,000,000 If yel, clowIa urdor DESCRIPTION op OPERATIONS below EL. DISEASE POLICY. LIMIT $ 1,000,000 DESCRIPTION OP OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, AddiUomg Remarks Samdute, coy ha ettiNhmi It mono opaw IamquImd) : Right -of -Way Agreement between The City of Gilroy and wpath Networks, LLC. Certificate Holder is included as an Additional Insured under the General Liability, Auto Liability and Dribrfel la/Eames:1i Liability policies as their interest may appear and as required by written agreement end only with respect to the liability arising out of the operations performed by or on behele of the Named Insured. CERTIFICATE HOLDER CANCELLATION City oS Gilroy Attn: City Administrator 7351 Rosanna Street ilfiPy, CA 05020 ACORD 25 (2016/03) SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL DE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 41\ ©1986-2016 ACORD CORPORATION. All rights roserved. The ACORD name and logo are registered marks of ACORD XO: 22366978 13ATCH: 2463952 2 of 3 7621 AGENCY CUSTOMER ID: LOC fit: AC R A DITIONAL REMARKS SCHEDULE Page 2 of AGENCY Willis Towers Watson Northeast, Inc. NAMED INSURED Crown Cuatlin antpznntional Sas Attached ktamed Insured Lint 9020 Katy Irrsaway Houston, TIC 77021 POLICY NUMBER 90o Paps: CARRIER Soya )Page 1 NAIC CODE? Page Sae :.Pa e 1 YIE1 eei,s EFFECTIVE DO A I I i'4 ADDITIONAL. REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,. FORM NUMBER: ,. !.5 FORM TITLE: Certificate of Liability Insurance qi bkn a�hb��{c ox fi i�as include a Wai�v4at of General. Liability, Auto Livability, l7mbrmllm/Excess Liability and Wo�'k2r�'4� � � r Subrogation in favor of the Additional Insured when agreed in written contract priorf4:e`'th loss, but always subject to the policy terms, conditions and exclusions as permitted by law. Additional Insureds: City of Gilroy, and its elected and appointed council metlbear , bo rd embers, oonmissionero, officers and officials. © 2008ACOrnD ORPORATION. All rights re wade A ORDI�9(�i0lp) T I& AOO D ly smo cod logo.oro roglota d, marks of AMID> lb: 22366978 SATOH:2463952 CLIC: W24267853 Cram Castle VrIternatiOnal Corp. ConsOdated SubsIdiarles as Named Insureds Edition Date: 10/2021 Name Name Atiantic Coast Communications LLC CC Holdings GS V LLC I.':CiiiteAttaliaitAnaill CC Strategic Investment Corp. ccfm PALLC. • CC Towers Guarantor LIC CC low Mding LLC CCATT Holdings LLC „ • CATIrU C CCATT PR LIC CCPR VI Tower Newco LLC CCTM Holdings LLC cc CCTiV4 LLC CCThO LLC ComSite Venture, Inc, Crown Atlantic Company LIC Crown Castle AS LLC Crown Castle Atlantic LLC Crown CastleGTH„-„oldM0 Sub LLC ,;'.1.6171jrifo74. 040.140004.i: Crown CaStle International. LLC CrOWn,CaStleilwestlIttellt tor Crown Castle investment II Corp. Crown Cod! MUM LIC stl LC Crown Castle Operating CompanyYIrtlng LIC Crown Castle Orlando Corp. frisiOntatk*piviL Crown Castle PR Solutions LLC CrOWnereStieT-U000ilea*CorP.':.. Crown Castle SolOticint:LIC Crown Castle South LIC c414Ie Towers 05 LLC , Crown Castle Towers 06-2 LLC Crown Castle Towers LLC crOfii4CarUMnc Crown Communic CroW.A.C&T—innTinIcationNewYork, kW; Fibertech Facilities Corp, Global -*hal At,c11.11Siffotis Ii LC n LLC Global Signal Acquisitions ill LLC GIObal Signal AcqUisitions IV LLC Global Signal Acquisitions LLC -1; global Signal Holdings RI LLC GoldenState Towers LLC GSPN Intangibles LLC Hth:MhtMfltCbLLC ICI3 Towers LLC Intracoastal City Towers LLC Md7 :Capit;.1 One; LLC LLC OPLLC OP 2 LLC laltion Holdings LIC Pinnacle Towers Acquisition LLC Pln1eTowers Aiiet:aolding.LLC Pinnacle Towers Canada Inc. Pinnade Towers nil LC Pinnacle Towers Limited 1)1111'12.de Towers Lit Pinnacle Towers V lnc. Radio Station weLo LLC - Sidera Networks UK Limited (UK) Tower Davelo.prnant Corporation 3 of 3 7621 Crow Castle international Corp. Consolidated Subsidiaries as Na ned Insureds Name 0 any WCP Wireiessleas9.Subsitary,, "Wg0.;'V001400:11.t4'044:41,07L,t,i4.:'1;-;;;I WCP Wireless Site Holdco LLC WCP' Wireess Site Non -RE Holtico LLC WCP Wireless Site RE Holdco LLC Edition Date: 10/2021