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Francine R. Villareal wa%d,
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<br />A� 0® CERTIFICATE OF LIABILITY INSURANCE
<br />O05/04ATE I/2021')
<br />OS/09/2021
<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 endorsement(s).
<br />PRODUCER
<br />Willis Towers Watson Northeast, Inc.
<br />c/o 26 Century Blvd
<br />CONTACT Crown Castle International
<br />NAME:PHONE
<br />FAX
<br />C o:
<br />E-MAIL
<br />AODR ' COIRequast@crolercastle.com
<br />P.O. Box 305191
<br />Nashville, TN 372305191 USA
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURERA: Federal Insurance Company
<br />20291
<br />INSURED
<br />Crown Castle International
<br />INSURERS: National Union Fire Insurance Company of P
<br />19445
<br />INSURERC: Berkshire Hathaway Specialty Insurance Com
<br />22276
<br />See Attached Named insured List
<br />INSURER D: AIV Insurance Company
<br />19399
<br />1220 Augusta Dr. Suite 600
<br />Houston, TX 77057
<br />NSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: W20873940 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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADOL
<br />J=
<br />SUBR
<br />MD
<br />POLICY NUMBER
<br />POLICYEFF
<br />MMIDDIYYYYI
<br />I POLICYEXP
<br />(MMIDDA'YYY1
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADEFxIOCCUR
<br />EACH OCCURRENCE
<br />g 1,000, 000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occunenca
<br />$ 1,000,000
<br />MEO EXP (An one person)
<br />$ 10,000
<br />A
<br />If
<br />Y
<br />3605-33-35 LIO
<br />04/01/2021
<br />04/01/2022
<br />PERSONAL A ADV INJURY
<br />$ 11000,000
<br />AGGREGATE LIMIT APPLI ES PER:
<br />POLICY 0 jEo- LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L
<br />PRODUCTS-COMP/OP AGG
<br />$ 2,D00,000
<br />$
<br />OTHER:
<br />AUTOMOSILELIABILRY
<br />COMBINED SINGLE LIMIT
<br />Ea accident)
<br />$ 1,000, 000
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />B
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />Y
<br />Y
<br />CA 7030894
<br />04/01/2021
<br />04/01/2022
<br />BODILY INJURY (Per accident)
<br />$
<br />HIRED H NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Par accitlent
<br />$
<br />C
<br />X
<br />UMBRELLAUAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />y
<br />4]-UMO-303445-0]
<br />04/01/2021
<br />04/01/2022
<br />DEO I X I RETENTION$ 25,000
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY y / N
<br />ANYPROPRIETOWPARTNEWEXECUTIVE
<br />OFFICE RIMEMBEREXCLUOEO? No
<br />NIA
<br />Y
<br />WC 016393106
<br />04/01/2021
<br />04/01/2022
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000, 000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatary in NH)
<br />IPTION antler
<br />DESCRIPTION under
<br />If yes,DESCRIPTION OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000, 000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be aNachod if more space is required)
<br />RE: MUNICIPAL FACILITIES LICENSE AGREEMENT - Site Location: Public Rights -of -Way - Various Site Locations - Named
<br />Insured: Crown Castle Fiber LLC
<br />City of Santa Ana (Licensor), its council members, officers, and employees are included as Additional Insureds under
<br />the General Liability and Auto Liability policies as their interest may appear and as required by written agreement
<br />and only with respect to the liability arising out of the operations performed by or on behalf of the Named Insured.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plasa
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZE(DD R� EPREE,SENTTATIVE
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />SR ID: 21058122 BATCH: 2081195
<br />Rk4 Marogmlent DivislaX
<br />k. CREVIEWED & APPROVED BY.
<br />1 f MCKM.[ P. vwm' t _
<br />��- Risk Management Analyst
<br />01
<br />
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