ACORD® DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 03/28/2024
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements).
PRODUCER CANA Crown Castle Inc.
Willis Towers Watson Northeast, Inc. PHONE
c/o 26 Century B1vd (A/C. No. Ext):
E-MAIL
P.O. Box 305191 ADDRESS: [email protected]
Nashville, TN 372305191 USA INSURERS) AFFORDING COVERAGE NAIC # INSURERA: Continental Casualty Company 20443
INSURED INSURER B: Berkshire Hathaway Specialty Insurance Com 22276 Crown Castle Inc.
See Attached Named Insured List INSURER C: Continental Insurance Company 35289 8020 Katy Freeway INSURER D: Travelers Property Casualty Company of Ame 25674 Houston, TX 77024
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: W33058068 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBR
LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 2,000,000
DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES (Ea occurrence) 1,000,000
A 10,000
MED EXP (Any one person)
7018331477 04/01/2024 04/01/2025 2,000,000
PERSONAL & ADV INJURY
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 4,000,000
X POLICY PRO-
JECT LOC PRODUCTS - COMP/OP AGG es es 4,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMI $ 2,000,000
Ea accident
X ANY AUTO BODILY INJURY (Per person) $
A OWNED SCHEDULED BUA 7018331432 04/01/2024 04/01/2025 BODILY INJURY (Per accident)
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY (Per accident)
UMBRELLA LIAB X OccUR EACH OCCURRENCE 5,000,000
B
EXCESS LIAB CLAIMS-MADE 47-UMO-303445-10 04/01/2024 04/01/2025 AGGREGATE $ 5,000,000 DED X RETENTION$ 25,000
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
YIN
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? No NIA WC7018331446 04/01/2024 04/01/2025 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE S 1,000,000 ESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 32,00,000
Al1 Risk Personal Property QT-630-5D736475-TIL-24 04/01/2024 04/01/2025 Limit:
1008 Replacement Cost
MICHAEL E. GATES
CITY ATTORNEY
CITY OF HUNTINGTON BEACH
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
City of Huntington Beach
AUTHORIZED REPRESENTATIVE
Public Works
2000 Main Street Jaseph lpinn
Huntington Beach, CA 92648
© 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 25634098 BATCH: 3396656
AGENCY CUSTOMER ID:
LOC #:
ACORD® ADDITIONAL REMARKS SCHEDULE Page 2 of 2
AGENCY
Willis Towers Watson Northeast, Inc.
See Attached Named Insured List
POLICY NUMBER 8020 Katy Freeway
See Page 1 Houston, IX 77024
CARRIER NAIC CODI
See Page 1 See Page EFFECTIVE DATE: See Page 1
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 - FORM TITLE: Cextificate of Liability Insurance BU#823240 - CM090 Fire Station, 19711 BUSHARD ST., Huntington Beach, CA 92646 (T-Mobile: LA02090A) BU#827443 - SC100 Greer Park, 6900 BRUNSWICK DR., Huntington Beach, CA 92647 (T-Mobile: LA02541A) . *Property: Business/Personal Property.
City of Huntington Beach (Lessor), its officers, agents, and employees are included as Additional Insureds under the General Liability and Umbrella/Excess Liability as their interest may appear and as required by written agreement and only with respect to the liability arising out of the operations performed by or on behalf of the Named Insured.
City of Huntington Beach (Lessor), its officers, agents, and employees are included as Additional Insureds as their interest may appear with respect to the Automobile Liability for liability arising out of the operations or work performed by the named insured, if required by written agreement.
General Liability, Automobile Liability, Umbrella/Excess Liability, and Workers Compensation include a Waiver of Subrogation in favor of the Additional Insureds when agreed in written contract prior to the loss, but always subject to the policy terms, conditions and exclusions as permitted by law.
INSURER AFFORDING COVERAGE: Travelers Property Casualty Company of America NAIC#: 25674 POLICY NUMBER: QT-660-1S576470-TIL-24 EFF DATE: 04/01/2024 EXP DATE: 04/01/2025 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
Property Coverage - Limit: $1,000,000
Towers Only
INSURER AFFORDING COVERAGE: Travelers Property Casualty Company of America NAIC#: 25674 POLICY NUMBER: QT-660-1S577626-TIL-24 EFF DATE: 04/01/2024 EXP DATE: 04/01/2025 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
Non-Tower Inland Marine Limit: $1,000,000
Contractors Equipment Limit: $1,000,000
Installation Limit: $800,000
ACORD 101(2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SR ID: 25634098 BATCH: 3396656 CERT: W33058068
•
CNA PARAMOUNT
CNA
Additional Insured - Designated Person Or Organization
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person (s) Or Organization (s) :
CITY OF HUNTINGTON BEACH,
ITS OFFICERS, ELECTED OR APPOINTED OFFICIALS,
EMPLOYEES, AGENTS AND VOLUNTEERS
BOX 711
HUNTINGTON BEACH, CA 92648
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II - Who Is An Insured is amended to include as an additional insured the person (s) or organization (s) shown in the Schedule, but only with respect to liability for bodily injury, property damage or personal and advertising injury in whole or in part, by your acts or omissions or the
acts or omissions of those acting on your behalf:
1. In the performance of your ongoing operations; or
2. In connection with your premises owned by or rented to you.
However:
1. The insurance afforded to such additional insured only 40020007770183314777372 applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such CG2026 04-13 Policy No: 7018331477
CONTINENTAT, CASUALTY COMPANY 1 of Endorsement No:
Effective Date: 04/01/2024
Insured Name: CROWN CASTLE INC.
Copyright CNA All Rights Reserved.
CNA PARAMOUNT
CNA
Additional Insured - Designated Person Or Organization
additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of Insurance shown the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
40020007770183314777373
CG2026 04-13 Policy No: 7018331477
CONTINENTAL CASUALTY COMPANY Effective Date: 04/01/2024 Insured Name: CROWN CASTLE INC.
Copyright CNA All Rights Reserved.
CNA PARAMOUNT
CNA
Primary and Noncontributory - Other Insurance
Condition Endorsement
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
It is understood and agreed that the condition entitled Other Insurance is amended to add the following:
Primary And Noncontributory Insurance
Notwithstanding anything to the contrary, this insurance is primary to and will not seek contribution from any other insurance available to an additional insured under this policy provided that:
a. the additional insured is a named insured under such other insurance; and b. the Named Insured has agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured.
All other terms and conditions of the Policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy.
50020007770183314778126
CNA74987XX (1-15) Policy No: 7018331477
CONTINENTAL CASUALTY COMPANY Effective Date: 04/01/2024 Insured Name: CROWN CASTLE INC.
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.
ENDORSEMENT
This endorsement, effective 12:01AM: 04/01/2024
Forms a part of Policy No.: 47-UMO-303445-10
Issued to: Crown Castle Inc.
By: Berkshire Hathaway Specialty Insurance Company
NOTICE OF CANCELLATION - DESIGNATED ENTITIES OR
INDIVIDUALS ENDORSEMENT
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY POLICY
COMMERCIAL UMBRELLA LIABILITY POLICY
COMMERCIAL RETAINED LIMIT LIABILITY INSURANCE POLICY
FOLLOW FORM EXCESS LIABILITY POLICY
PRODUCTS/COMPLETED OPERATIONS LIABILITY POLICY
The following is added to the policy:
SCHEDULE
Name and Address Notice of Cancellation
(Other Than Non-Payment)
To be provided by Broker 30 days
2000 Corporate Drive
Canonsburg, PA 15317-0000
Except with respect to cancellation for non-payment of premium, the entities and individuals listed in the Schedule of this endorsement shall receive prior written notice of cancellation not less than the number of days listed for them in the Schedule, respectively.
Other than the right to receive notice of cancellation as set forth herein, however, this endorsement confers no rights or status under this policy for any entity or individual listed in the Schedule of this endorsement.
All other terms and conditions of this policy remain unchanged.
CNA Workers Compensation And Employers Liability Insurance Policyholder Notice
NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS
It is understood and agreed that:
If you have agreed under written contract to provide notice of cancellation to a party to whom the Agent of Record has issued a Certificate of Insurance, and if we cancel a policy term described on that Certificate of Insurance for any reason other than nonpayment of premium, then notice of cancellation will be provided to such Certificate Holders at least 30 days in advance of the date cancellation is effective.
If notice is mailed, then proof of mailing to the last known mailing address of the Certificate Holder on file with the Agent of Record will be sufficient to prove notice.
Any failure by us to notify such persons or organizations will not extend or invalidate such cancellation, or impose any liability or obligation upon us or the Agent of Record.
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below.
Form No: 68021A (02-2013) Policy No: WC 7018331446
Policyholder Notice; Page: 1 of 1 Policy Effective Date: 04/01/2024 Underwriting Company: The Continental Insurance Company, 151 N Franklin St, Chicago, IL 60606 Policy Page: 4 of 382 © Copyright CNA All Rights Reserved.
CNA Business Auto Policy
Policy Endorsement
NOTICE OF CANCELLATION TO CERTIFICATEHOLDERS
It is understood and agreed that:
If you have agreed under written contract to provide notice of cancellation to a party to whom the Agent of Record has issued a Certificate of Insurance, and if we cancel a policy term described on that Certificate of Insurance for any reason other than nonpayment of premium, then notice of cancellation will be provided to such Certificateholders at least 30 days in advance of the date cancellation is effective.
If notice is mailed, then proof of mailing to the last known mailing address of the Certificateholder on file with the Agent of Record will be sufficient to prove notice.
Any failure by us to notify such persons or organizations will not extend or invalidate such cancellation, or impose any liability or obligation upon us or the Agent of Record.
All other terms and conditions of the policy remain unchanged This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy.
Form No: CNA68021XX (02-2013) Policy No: BUA 7018331432 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 04/01/2024 Endorsement No: 147; Page: 1 of 1 Policy Page: 590 of 635 Underwriting Company: Continental Casualty Company, 151 N Franklin St, Chicago, IL 60606 • Copyright CNA All Rights Reserved.
CNA
NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS
It is understood and agreed that:
If you have agreed under written contract to provide notice of cancellation to a party to whom the Agent of Record has issued a Certificate of Insurance, and if we cancel a policy term described on that Certificate of Insurance for any reason other than nonpayment of premium, then notice of cancellation will be provided to such Certificate Holders at least 30 days in advance of the date cancellation is effective.
If notice is mailed, then proof of mailing to the last known mailing address of the Certificate Holder on file with the Agent of Record will be sufficient to prove notice.
Any failure by us to notify such persons or organizations will not extend or invalidate such cancellation, or impose any liability or obligation upon us or the Agent of Record.
Form No: CC68021A (02-2013) Policy No: 7018331477
Underwriting Company: Continental Casualty Company
© CNA All Rights Reserved.