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<br />ALC�RD®
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />141
<br />DATE IMM
<br />/2019
<br />03/?9/2019
<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 of Pennsylvania, Inc.
<br />c/o 26 Century Blvd
<br />P.O. Box 305191
<br />CONTACT
<br />NAME:
<br />PHONE 1-877-945-7378 FAX 1-888-467-2378
<br />_(A/C,N_o..Exn' __ IA/C, NoI:
<br />E-MAIL certificates@willis.com
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAICp
<br />Nashville, IN 372305191 USA
<br />INSURERA: Federal Insurance Company 20281
<br />INSURED Crown Castle International ./� ^ 10
<br />�{-n/61,a
<br />See Attached Named Insured List I IIIJJJ«<
<br />INSURER B: National Union Fire Insurance Company of P 19445
<br />INSURER C: Berkshire Hathaway Specialty Insurance Core 22276
<br />INSURER D: New Bampshire Insurance Company 23841
<br />1220 Assgusta Dr. Suite 600
<br />Houston, TX 77057
<br />INSURER E:
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: W10726640 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
<br />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 - ADDL SU BR -- -
<br />LTR TYPE OF INSURANCE POLICYNUMBER MMIDIDY/YYYFY MMIIODY/YYYYT LIMITS
<br />X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $
<br />1,000,000
<br />NED
<br />CLAIMS-MADEDAMAGE TOERET
<br />X OCCUR PREMISES a occunence $
<br />1,000,000
<br />A MED EXP(Any one person) $
<br />10,000
<br />y y 3605-3335 04/01/2019 04/01/2020 PERSONAL BADV INJURY $
<br />1,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER GENERALAGGREGATE I$
<br />2,000,000
<br />_
<br />X POLICY JECT DOC PRODUCTS-COMPIOPAGG $
<br />2,000,000
<br />OTHER. I$
<br />AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
<br />_La accident
<br />$
<br />1,000,000
<br />$
<br />X ANY AUTO BODILY INJURY (Per person)
<br />B - - _ OWNED hi SCHEDULED y y CA 4993141 04/01/2019 04/01/2020 BODILY INJURY (Per scaidenI)I
<br />$
<br />AUTOS ONLY AUTOS
<br />HIRED I�1 NON -OWNED PROPERTY DAMAGE
<br />$
<br />AUTOS ONLY i AUTOS ONLY Per accident
<br />l$
<br />X UMBRELLA LIAR X OCCUR EACH OCCURRENCE
<br />$
<br />5,000,000
<br />C
<br />g
<br />5, 000,000
<br />EXCESS LIAR CLAIMS -MADE 47-WO-303445-03 04/01/2019 04/01/2020 AGGREGATE
<br />g
<br />DED X RETENTION$ 25, 000
<br />WORKERS COMPENSATION PER OTH-
<br />STATUTE I ER
<br />AND EMPLOYERS' UABILITY YIN _X..
<br />1,000,000
<br />D ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
<br />N0 IN y
<br />$
<br />$
<br />1,000,000
<br />OFFICERIMEMBEREXCLUDED7 WC 012717225 04/Ol/2019 04/Ol/2020
<br />(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE,
<br />If yes. describe under
<br />DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT
<br />$
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101, AddiBonal Remarks Schedule, maybe attached if more space h;Zq I
<br />Re: Business Unit # 827015 - Riverview Park at 1817 W. 21st Street Santa AnaryQA,4706.
<br />Certificate Bolder is included as an Additional Insured under the General Liability, An 0,`1�`�L, ility and
<br />Excess/Umbrella Liability policies as their interest may appear and as required by t1it and only
<br />respect to the liability arising out of the operations performed by or on behal �G°N nsured.
<br />with
<br />�
<br />CJ
<br />�G
<br />City of Santa Ana
<br />Attn: Insurance Compliance
<br />20 Civic Center Plasa
<br />E.O. Box 1988
<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 />©1988-2016
<br />ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />-- xo: 17728222 BATCH: 1132061
<br />All rights reserved.
<br />
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