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ACC?R
<br />'� CERTIFICATE OF LIABILITY II SURANCE Page 1 of 2 03/24/20 5'
<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 he endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER CONTACT
<br />Willis of Pennsylvania, Inc.
<br />PHONE FAX
<br />C/o 26 Century Blvd.
<br />(A(C.NO.EXT). 877-945-737$ (AfC.NO): 888-467-23.7$
<br />P. O. Box 365141
<br />E-MAIL
<br />ADDRESS certifcatas(willis.Com
<br />Nashville, TLV 37230-5191
<br />.. ..... ....._ _...
<br />A }[....... COMMERCIAL GENERALLIABCLITY YY 702.1-02.-28
<br />INSURER(S)AFFORDING COVERAGE NAIL#
<br />INSURER Federal Insurance Company 202,81-005
<br />INSURED
<br />VNSURERB North American Elite Insurance Company..... 2976.0-001..
<br />CROWN CASTLE INTERNATIONAL CORP.
<br />MED EXP (Anyone person) S___...
<br />See Attached Named Insured List
<br />INSURERC.
<br />1220 Augusta Dr. Suite 500
<br />1,000,000
<br />Houston, TX 77057
<br />NSURERD
<br />` -
<br />-P..t�``'-''
<br />INSURER E _
<br />..F ......... ....._ _.......
<br />r;
<br />INSURER
<br />COVERAGES CERTIFICATE NIOMRER:9.2g2AF9R
<br />RFVISION NIIMRFR-
<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 MOTH 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER ...
<br />POLICY EFFLTR _. POLICY EXP _... _.. __.LIMITS
<br />_.
<br />A }[....... COMMERCIAL GENERALLIABCLITY YY 702.1-02.-28
<br />4{1%2015 4%1/2016 E4CHOCCURRENCE S__.11000.,000.._..
<br />CLAIMS --MADE X . OCCUR
<br />�'yyqq��qq�;FFyy'pRa.ocur©ncep 5
<br />M'FiEMIiSk ?E
<br />,OOQ,000
<br />1,000,000
<br />MED EXP (Anyone person) S___...
<br />5..,..000 ....
<br />.......... ......... __.
<br />..PERSONAL&.ADV INJURY S
<br />1,000,000
<br />GEN'LAGGREGATE LIMIT APPLIES PER _
<br />GENERAL AGGREGATE... S
<br />,'i( .._, POLICY ECT LOC
<br />PRODUCTS - COMPIOPAGG $
<br />.........2,000....,..000
<br />.....2, 000:..x_.000
<br />OTHER'
<br />S
<br />A, AUTOMOBILE LIABILITY Y 7021-02-29
<br />4/1/2015 4/1/2016 COMBINED SINGLE LIMIT
<br />(Ea accident) $
<br />11000,000
<br />X ANYAUTO
<br />BODI LY I NJURY(Per person) S
<br />ALO'u1MED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY1NJURY(Peraccident) 5
<br />_.
<br />......... ....
<br />HIREDAUTOS NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE. S
<br />(Per accident)
<br />S
<br />B X UMBRELLALIAB X OCCUR Y Y UMBB 2000165-01
<br />4/1/2015 4/1/2016 EACHCCCURRENCE s
<br />5,000.,000
<br />EXCESS LIAB CLAIMS -MADE
<br />AGGREGATE.... S
<br />.....5, 000_,....000
<br />DOD X RETENTION$ 25,000
<br />S
<br />A WORKERS COMPENSATION Y 7171-06-98
<br />4/1/2015 4/1/2016 X PER OTH-
<br />STATUTE ER
<br />AND EMPLOYERS' LIABILITY
<br />.... ....
<br />ANY PROPRIETORIPARTNER/EXECUTIVE N N/A..
<br />E.LEACHACCIDENT s
<br />... .....
<br />1,000,000
<br />OFFICERIMEMBER EXCLUDED?
<br />I MandatoTy in NH)y '" E..LDISEASE - EA EMPLOYEE s
<br />1,000,000
<br />Ryes describe under V�
<br />...
<br />DESCRIPTION OFOPERATIONS below
<br />5 ,,.�'` ELDISOASE-POLICY LIMIT S
<br />1,000,000
<br />DESCRIPTION OF OPERA.TIONSI LOCATIONS I VEHICLES (ACORD 101, AdditonarRomarks Selye e, m rs space is required:)
<br />BU#8274.79 - SC451 Madison Park RL, 1528 1/2 S. Sta
<br />e, Anaheim -Santa Ana -Ga, CA 92707.
<br />If required in written agreement, the Certificate Holder is added as an Additional. Insured as
<br />their interest may appear to the liability arising out
<br />of the operations performed by or on behalf
<br />of the Named Insured.
<br />Additional Insureds: City of Santa Ana, its officers,
<br />agents, representatives, employees and
<br />volunteers.
<br />CERTIFICATE HOLDER CANCELLATION
<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 />City of Santa Ana AUTH IZEDREPRES ATIVE
<br />Attn: Insurance Compliance
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702.
<br />Coll:4651802 'Tpl:1933410 Cert:22928698 @ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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