HomeMy WebLinkAboutCAG2021-151 - Insurance Certificate - D B Audio - Liability Coverage - 06/29/2021CERTIFICATE OF LIABILITY INSURANCE
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@ {988-2015 ACORD CORPORA
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DATE (MM/DDTYYYY)
ALTERNEGATIVELYFICATE
TEFICA HOLDER.THUPON CERTICONFERSDRIGHTSNOONLTIONANYMATTEAOFRINFORMAtsTEASlssuEDCETHISRTIFICAAFFORDEDE THEBYCOVERAGTHEOREXTENDENAMTIVELAFFIRMAORYD,NOTDOESCERTITHIS rssE INU INSUGENBETWETH RER(S)ASTITUTE CONTRACTDOESEOTNcoNOFTEINSURANCTHBELOW,CERTIFICAlsESPOLtCI
AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER'
hts to the certlflcate holder ln lleu of suchconfer
MPORTANT;WAIVEDTIONISSUBROGAtfbemustendorsed.theADDITIONALanINSURED,lcy(ies)polhcertlflcatelsolderthetf notdoesthlsoncertiflcateAendorsement.statementancertalnrequlredandltlonscontheofpollclesmaythetotermslcypolaubJect
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(A/C, Nol:
(866)PHONE
(A/C, No, Exo:
E.MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC#
PRODUCER
EMPIRE PACIFIC SOVEREIGN LLC/PHS
52701129
The Hartford Business Service Center
3600 Wiseman Blvd
San Antonlo, TX78251
INSURER A lnsurance
INSURER B :
INSURER C :
INSURER D ]
INSURER E :
INSURER F
DAN BUNKER D/B/A D B AUDIO
204 CORRIN AVE NW
oRTING WA 98360-7461
THAT
MAY
DPOTHEPERIOLICYABOVENAMEDFORTOUEDETHUtNsREDELOWBEENHAVEStsOFPOLICIESRANCEINSULISTEDERTIFYTHHTsSTOTHISURESPECTWITHWHICTOEROTHMDOCUENTANFcoNoTRACTRERMTcoNORoDITIONREQUANYREMENTINDCATED,NOTWITHSTANDI NG ALL THETOtsHEREINSUBJECTDESCRIBEDAFFOCEBRDEDTHEPOLICIESHTINSUERANMAAINPERTAMBEORISSUEDCERTIFICATEMS.CLAIREDBEENCEDUPAIDBSHOWNLIMITSHAVEsOFCHULIPOctEs.EXCLU o ANDNS CONDITIONSTERMS,
LIMITSPOLICY NUMBERTYPE OF lI'ISURAiICE
EACH OCCURRENCE
$300,000
$10,000MED EXP (Any one P€rson)X
X
Liabil
COMMERCIAL GENERAL LIABILITY
CLAIMS"MADE OCCUR
GENERAL AGGREGATE
$2,000,000PRODUCTS - COMP/OP AGG
061291202206t2912021X52 SBA VX6847
X
GEN'L AGGREGATE LIMIT APPLIES PER:
LOCPOLICYPRO-
JECT
A
BODILY INJURY (Per P6rson)
BODILY INJURY (P€r accldent)
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED
AUTOS
SCHEDULED
AUTOS
NON.OWNED
AUTOS
EACH
$1,000,000AGGREGATECLAIMS-
MADE
UMBRELLA LIAB
EXCE88 LIAB 06t291202206t291202152 SBA VX6847
X RETENnoN$ 10,000
A
$1,000,000E.L, EACH ACCIDENT
$1,000,000E.L. DISEASE -EA EMPLOYEE
$1,000,E.L. DISEASE - POLICY LIMIT
06t2912021 0612912022N/A 52 SBA VX6847
ANO EMPLOYERS' LIAEILIW
ANY
PROPRIETOFVPARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory ln NH)
lf yee, doscrlbe undor
Y/N
A
$5,00006t29t2022Each Claim Limit
Aggregate Limit06t2w2a2152 SBA VX6847AEMPLOYMENT PRACTICES
LIABILITY
Those usual to the lnsured's Operations. Certiflcate Holder ls an Addltional lnsured
may bo aftachod lf moro spaco l8 requlred)
per the Business Liability Coverage Form SS0008 attached to this
R6marks(ACORD 101,
BEFORE THE EXPIRATION DATE THEREOF' NOTICE WILL BE
IN ACCORDANCE WITH THE POLICY PROVISIONS'
DELIVERED
POLICIES BEDESCANY OF THE
af*aa.r8 /az6-."xo-:
AUTHORIZED REPRESENTATIVE
City of Kent
220 4TH AVE S
KENT WA 98032-5838
ACORD 25 (2016/03)The ACORD name and logo are reglstered marks of ACORD
TION. All rlghts reserved.
THE
HARTFORD
MB 01 001107
THE HARTFORD
BUSINESS SERVICE CENTER
3600 WISEMAN BLVD
SAN ANTONIO TX 78251
11192 H 5 A
May 31 ,2021
l'1l1l11ll"l1l'lltllt'll,llltt'lllllllltrlrlrrglllllrrrrlllrlrll
Kent Municlpal Court
City of Kent
220 4TH AVE S
KENT WA 98032-5838
Account lnformation:
Pollcy Holder Details :DAN BUNKER D/B/A D B AUDIO
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rP --------------
Gontact Us
Business Service Center
Buslness Hours: MondaY - FridaY
(7AM - 7PM CentralStandard Time)
Phone: (866) 467-8730
Fax: (888) 443-6112
Emall : aqencv.services@thehartford,com
Webslte: https://business.thehartford.com
Enclosed please find a Certificate Of lnsurance for the above referenced Policyholder. Please contact us if you have any
questions or concerns.
Sincerely,
Your Hartford Service Team
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