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ACCOR" � DATE (MMIDD,YYYY)
CERTIFICATE OF LIABILITY INSURANCE 03/30/2020
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).
PRODUCER CONTACT Willis Towers Watson Certificate Center
NAME:
Willis Towers Watson Northeast, Inc. fka Willis of Pennsylvania, PHONE 1-877-945-7378 FAX 1-888-467-2378
IncI A/C No
c/o 26 Century Blvd ADDRESS: certificates@willia.com
P.O. Box 305191 INSURERS AFFORDING COVERAGE NAIC tt
Nashville, TN 372305191 USA Federal Insurance Company 20281
INSURER A : � Y
INSURED INSURER B : National Union Fire Insurance Company of P' 19445
Crown Castle International -
See Attached Named Insured List INSURER C : Berkshire Hathaway Specialty Insurance Com; 22276
1220 Augusta Dr. Suite 600 INSURER D : New Hampshire Insurance Company 23841
Houston, TX 77057 USA
COVERAGES CERTIFICATE NUMBER: W15968530 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.
AODL'I TR ' TYPE OF INSURANCE INSD WVD SUER POLICY NUMBER MAMiDDIYYYY MMIDD YYYY ? LINTS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $DAMAGE
1,000,000
TO RPTrM5_
CLAIMS MADE X OCCUR PREMISES (Ea occurrenoo) _ $
1,000,000
A
MED EXP (Any one person) $
10,000
Y Y 3605-3335 04/01/2020'04/01/2021' PERSONAL 8 ADV INJURY $
1,000,000
GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $
--,
2,000,000
-
_
PRO- r -
%� POLICY JECT LOC PRODUCTS COMP�OP AGG $
-
2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
_ Ea accident)_-
1, 000, 000
X ANY AUTO BODILY INJURY (Per person) $
S
OWNED SCHEDULED Y Y CA 6631248 04/01/2020' 04/01/2021 BODILY INJURY (Per accident) $
AUTOS ONLY _J AUTOS
HIRED NON -OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY _(_Per accident)
C
)(,UMBRELLA LIAR X OCCUR
EACH OCCURRENCE $
5,000,000
EXCESS UAB CLAIMS -MADE
Y Y 47-UMO-303445-05 04/01/2020!04/01/2021!AGGREGATE g
51000,000
DED I'I X RETENTION$ 25,000
$
WORKERS COMPENSATION X
; STATUTE ER
AND EMPLOYERS' LIABILITY YIN
-
D ANYPROPRIETORIPARTNERIEXECU I IVE E.L. EACH ACCIDENT $
No NIA Y WC 023096097 04/01/202W O41/0l/2021 � - - -
1,000,000
OFFICE RiMEMBER EXCLUDED?
1, 000, 000
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEES $
11 yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE • POLICY LIMIT $
11000,000
i
DESCRIPTION OF OPERATIONS! LOCATIONS t VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space is required)
Re: Right -of -Way Agreement between The City of Gilroy and Newpath Networks, LLC.
Certificate Holder is included as an Additional Insured under the General Liability, Auto Liability and
Umbrella/Excess 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.
CFRTIFICATF 14nl nFR 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 Gilroy
Attn: City Administrator
7351 Rosanna Street
AUTHORIZED REPRESENTATIVE
p
Gilroy, CA 95020
l
01988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
sn ID: 19444265 m►TM 1632527
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