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<br />' 1 ® DATE IMMIDDIY'ry
<br />ACORO CERTIFICATE OF LIABILITY INSURANCE 06/23/2D20
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED. the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsements .
<br />PRODUCER CT Willis Towers Watson Certificate Center
<br />NAME: — _-
<br />Millie Towers Watson Northeast, Inc. PHONE FAX
<br />c/o 26 Century Blvd �AIO.Wp.Eap[ 1-877-945-7378 _ IALLJoL 1B B8 _4 fi7-23]8
<br />P.D. Beer 305191_AOgUit, certificatesewillis.com
<br />Nashville, IN 372305191 USA INSURERISJ AFFORDING COVERAGE _ NAICI
<br />INSURER^: Federal Insurance Company 20281
<br />INSURED INSURERB: National Onion Fire Insurance Company of P 19445
<br />Croon Castle Internatianal --
<br />see Atrached Named Insured List INSURERC: Berkshire Hathaway Specialty Insurance Cam: 22276
<br />1220 Augusta Dr. Suite 600 INSURERD: Nee Hampshire insurance Company - 23841
<br />Houston, TX 71057
<br />INSURER
<br />INSURER F:
<br />CnVFRar4pR CERTIFICATE NUMRER: W16897547 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR� ADOL SUBR
<br />LTR TYPE OF INSURANCE POLICY NUMBER
<br />�POOOYEFF POLICYEXP LIMBS
<br />MMN MI GIYYYY
<br />X COMMERCIALGENERALLIASILRY
<br />EACH OCCURRENCE S 1,000,000
<br />^
<br />10�E1'6-RENi-ED—._•_._. __.._
<br />1,000,000
<br />CIAIMS-MADE X. OCCUR
<br />PREMISES oca ence) _.. S_ -
<br />.
<br />A
<br />MED EXP (Anyt ona Pem rml 5 10.000
<br />Y y 3605-3335
<br />04/011202D-04/01/2021 pERSONALLADV INJURY S 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER.
<br />—LOC
<br />�GENERALAGGREGATE_;S _ 2,ODD,000
<br />X POLICY: PRO
<br />•___ JECT _.:
<br />PRODUCTS-COMPIOP AGG 5 2,000,000
<br />_
<br />S
<br />OTHER
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT S 1,000,000
<br />X ANY AUTO
<br />BODILY IWURV(Per Parson) S
<br />B OWNED SCHEOULED Y y CA 6631248
<br />04/01/2020 iO4/01/2021' BODILY INJURY(Peracaden0 S
<br />AUTOS ONLY AUTOS
<br />HIRED Nu*VWNEO
<br />—
<br />PROPERTY DAMAGE 5
<br />AUTOS ONLY AUTOS ONLY
<br />�acadenn
<br />L
<br />$.
<br />X UMBRELLALIABI X OCCUR
<br />EACH OCCURRENCE S 5,000,000
<br />C
<br />EXCESS LIAO CLAIMS -MADE
<br />y
<br />Y 41-MO-303445-05
<br />I
<br />04/01/2020'I04/01/2021:AGGREGATE 5,000,000
<br />I 4_
<br />_
<br />DEO X`RETENTIONS 25,000
<br />S
<br />WORKERS COMPENSATION
<br />X 1 PER OTIL
<br />STATUTE ER -__
<br />AND EMPLOYERS' LIABILITY YIN
<br />D ANYPROPRIETMPARTNERJEXECUTTOE
<br />'E.L. EACH ACCIDENT S 1, 000,OOD
<br />OFFICERIMEMBERE%CLUDED7 No
<br />N/A
<br />Y NC 023096097
<br />04/01/2020. 04/01/2021 - 1,000,000
<br />1, 000, 000-
<br />(Mandatory In NIO
<br />:
<br />EI DISEASE -EA EMPLOYEE $
<br />If,'a. desodbe under
<br />DECRI PTION OF OPERATIONS below
<br />I
<br />E.L. DISEASE -POLICY LIMIT $ 1, pp0, 000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101, Additional Remarks Schedule, may be aeached H mom space is required)
<br />This Voids and Replaces Previously Issued Certificate Dated
<br />05/20/2020 WITH ID: W16492000.
<br />RE: MUNICIPAL FACILITIES LICENSE AGREEMENT - Site Location:
<br />Public Rights -of -Way - Various Site Locations - Named
<br />Insured: Craven Castle Fiber LLC
<br />City of Santa Ana (Licensor), its Council members, officers,
<br />and employees are included as Additional Insureds under
<br />City of Santa Me
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Me, CA 92702
<br />REVIEWED&APPROVE,{ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />By Risk MANAGEMENT DIVISI I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />7 ` 202
<br />AUTHORQEDREEPRESENTATWE
<br />VI( I ARFAI ' witt" �P1"'
<br />ACORD
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />sa To 19766834 eAyCT 1722156
<br />reserved.
<br />
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