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F�ATE
<br />AIS ii' CERTIFICATE OF LIABILITY INSURANCEPage Z of 2 03/28+/20171
<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, subjectto the terms and conditions of the policy, certain policies may require an endorsement. A statement
<br />on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME
<br />Willis of Pennsylvania, Inc.
<br />c/o 25 Century Blvd.ACC,NC„EXT)-._$17-945-7378�Q}
<br />P. C. sox 305191
<br />PHONE PAX
<br />888-467-23,78
<br />E MRESS certificates@wiilis.com
<br />Nashville, TN 37230-5191
<br />INSURER(S)AFFORDING COVERAGE_
<br />NAIC #
<br />iINSURERA:gederal Insurance Company
<br />20281-005
<br />EACH OCCURRENCE $ J. 000 000
<br />INSURED
<br />Crown Castle International
<br />NSURERB',Travelers Property Casualty Cc of Amer
<br />----— - --
<br />25674-001
<br />-
<br />INSURERC:serkshire Hathaway Specialty Insurance Co,22276-001
<br />See Attached NamedInsured List
<br />1220 Augusta Dr. Suits 600
<br />Houston, TX 77057
<br />INSURERD-j
<br />INSURER E:
<br />INSURER F:
<br />I
<br />COVERAGES CERTIFICATE NUMBER: 25309041 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 />EXCLUSIONSAND CONDITIONS OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS.
<br />INSR1
<br />TYPEOFINSURANCE pDDL
<br />SUERlNsr) "D POLSCYNUMBER I
<br />POLICY EFF
<br />POLIMM?ICY EXP
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE[il OCCURPI�EMEScaoccurence)
<br />Y
<br />Y
<br />7021-02-28
<br />4/1/2017
<br />4/1/2018
<br />EACH OCCURRENCE $ J. 000 000
<br />$ 1,0 0 000
<br />MED EXP (Any one person) $ 5 000
<br />PERSONAL IADV ENJURY ,$_ 1, 000,000
<br />GENERAL AGGREGATE $ 2 000 D00..,
<br />f
<br />I
<br />GEN'LAGGREGATE LIMIT APPLIES PER:
<br />PRO- j�
<br />POLICY JECT LOC
<br />PRODUCTS COMPlOPgGG $ 2,000 000
<br />Is
<br />OTHER:
<br />B
<br />AUTOMOBILE LIABILITYCOMBINEDSINGLELIMIT
<br />IY
<br />` Y
<br />TC2JCAP-474M4749-17
<br />4/1/2017
<br />4/1/203$ I(Ea..a,
<br />$ 1,000,000
<br />BODILY INJURY(Perperson) S
<br />X ANYAUTO
<br />I
<br />I
<br />I
<br />-I
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTCS
<br />HIRED NON -OWNED
<br />AUTOSONLY AUTOS ONLY
<br />SODILYINJURY(Peraccident) $
<br />11 - -
<br />{Per accident) $
<br />1�X
<br />C
<br />UMBRELLALIAB X
<br />OCCUR
<br />Y
<br />Y
<br />�47 UMO-303445-01
<br />4/l/2017
<br />4/1/2018
<br />OCCURRENCE $ 5 000 000_
<br />_EACH
<br />; AGGREGATE $ 5, 000, 000
<br />1
<br />EXCESS LIAR j
<br />CLAIMS -MADE
<br />DED 1.1 !RETENTION$ 25,00a
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Yf N
<br />ANY PROPRIETOR/PARTNERIEXECUTIVE
<br />OFFICERIMEMREREXCLUDED?
<br />IMandatnryinNH)
<br />F yes, describe under
<br />DESCR€PTICN OF OPERATIONS below
<br />I
<br />N1Aj
<br />Y
<br />[
<br />�TC2,TUB-474M9694-17
<br />TRKUB-474M9701-17
<br />4/1/2017
<br />I
<br />;4/1/2017
<br />1
<br />4/1/2018
<br />,4/l/2QIS
<br />�`
<br />��6
<br />G '+
<br />1{PER$_�-ST.ATUTE_.__I
<br />E. L. EACH ACCIDENT $ 1_ 000,000
<br />---
<br />IE�L.DISEASE-EA EMPLOYEE $ 1,000,000
<br />"-
<br />�, E,L. DIE -POLICY LIMIT T. 1,000,000
<br />I
<br />i
<br />Ie,
<br />DESCRIP71ON Of OPERATIONS I LOCATIONS I VEHICLES IACORD 101, Additional Remarks Schedule, may be attached If eq
<br />SU#845344 - DOWNTOWN SANTA ANA, 1104 CIVIC CENTER DRIVE, SAN Ai3A 3 (951 3/4 West 6th
<br />Street) .
<br />City of Santa Ana, its officers, agents, employees an volunte'?are included as Additional
<br />Insureds under the General, Automobile, and Excess Liability policies as required by written
<br />agreement and only with respect to the liability arising out of the operations performed by or on
<br />behalf of the Named insured.
<br />City of Santa Ana Parks, Rec. & Community Services
<br />20 Civic Center Plaza
<br />PO sox 1988, M-23
<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 />kUTH IZED REPRES ATIVE
<br />Coll: 5053152 Tpl :2134023 Cert:25309041 ©1988-2015ACORD CORPORATION, All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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