HomeMy WebLinkAboutL15-059 - Insurance Certificate - Verizon Wireless - Insurance Certificate for 6/30/2022-6/30/2023^cQo'CERTIFICATE OF LIABILITY INSURANCE
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DATE(MM/DDA/YYY)
06t15t2022
NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OB ALTER THE COVERAGE AFFORDED BY THE POLICIES
FICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
SUBROGATION lS WAIVED, subiect to the terms and conditions ot the policy'
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CERTIFICATE
BELOW, THIS CEFTI
certain policies may require an endorsement. A statement on this
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
UPON THE CERTIFICATEONLY
to the certificate holder in lieu of such endorsement(s)'certificate does not conler
(866) 283-7L22 (800) 363-01,0s
E.MAIL
ADDRESS:
NAIC #INSUREB(S) AFFORDING COVERAGE
non nisk services Northeast, rnc
New York t'tv office
one uiberty Plaza
165 eroadway, suite 3201
New York NY 10006 usA
PRODUCER
23035rNsuREFAr Liberty Mutual Fire rns co
INSUREF Bl
INSURER Cr
INSUREB Dr
INSUnER Er
INSURER F:
INSUFED
verizon communications rnc.
1095 Avenue of the americas
New York NY 10036 usA
EQUIREMENT, TERM OR CONDITION OF
PERTAIN, THE INSURANCE AFFORDED
THWHICH ISCONTRACTANYOTHERORWDOCUMENTRESPECTITHTOANYNGRNOTWITHSTANDIINDICATED.ts TOSUBJECT THALL TEE RMSTHEBYDESCRPOLtCtESHEREINIBEDBEMAYEISSUORDMAYRTCEIFICATE
RE BY CLAIMS.PAIDCHLIMPOLICIES,SITS NHOW HAVEMAY BEEN DUCEDSIONSEXCLUCONDITIONSANDSUOF shownLimits are
LIMITSPOLICY NUMBERTYPE QF INSURANCEtflthLTF
$5 , 000, 000EACH OCCURRENCE
UAMAUE IU HEI\IEU
PPF[rlQFQ lFr ^n.rrrran^a\
$s,000,000
MED EXP (Any on6 person)$10,000
$s,000,000PERSONAL & ADV INJURY
GENERALAGGREGATE $5,000, uuu
PRODUCTS . COMP/OP AGG $s,000,000
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CLAIMIS.MAOE OCCUR
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Standard LiabilityXConlractual
COMBINED SINGLE LIMIT $5,000,000
BODILY INJURY ( Per person)
BODILY INJURY (Per acciden0
PFOPERTY DAMAGE
06/30/ZOZ
06/30/2022
06/30/2022
06/30/2023
06/30/2023
06/30/2023
AUTOMOBILE LIABILITY
SCHEDULED
AUTOS
NON.OWNED
AUTOS ONLY
AUTOS ONLY
HIRED AUTOS
ONLY
ANYAUTO
OWNED
AS2-691-5 50588- 122
AOS
As2-691-5 505 88-132
ruH - erinary
rL2-691- 5 50588-182
NH - Excess
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EACH OCCURRENCE
AGGREGATE
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UMBRELLA LIAB
EXCESS LIAB
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PER STATUTE lorH"lFp
E.t, EACH ACCIDENT
E.L. DISEASE-EA EMPLOYEE
E.L. DISEASE-POLICY LIMIT
N/A
WORKERS COMPENSATION AND
EMPLOVEFS' LIABILITY
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICEFUMEI\4BEB EXCLUDED?
(Mandatory in NH)
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DESCBIPTION OF OPERATIONS b€|ow
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ruamed tnsured includes: cellco partnership dba verizon Wireless, L80 washington va'll.ey Road,_Bedminster' New rersey,0792L'
nE: Site Name: SEA 4 Corners, Location code: _10248{,.contract.No.: ?9L34, Si.te.Address: 26800,Maple valley Black Dlamond
iiSia si.-ulpie'vaiTev, 'il ij8b56.--iiiv-or-ient ii-inctuoed as Additional-rnsured with respect to the Ceneral liabil.ity policy'
i,i6Ei"-o6.niitieU'nv iiiv.'ihe-r.rimed insirred parties listed herein waive all rights against the certificate ttolder.and each
iiaiiiS.ii i;;;r;a iiliv-iistea-neiein ior'ieiovery of damages to the extent-these-damages are covered by the above-referenced
cenera'l r_iability ahd nirtomobile Liability policies, and, as further limited by written contract between the partles'
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QERTIFICATE HOLDER CANCELLATION
@1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks ot ACORD
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$HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOFE THE
EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVERED IN ACCORDANCE WTH THE
POLTCY PROVtStONS.
-M- @*/%l{*e-tt.-f*,
AUTHOBIZFD REPRESENTATIVEKentcitV clerk
rth'Avenue
98403 usA
Attncity of
220 Fou
KENI WA
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ACORD 25 (2016/03)
Certificate No: 570093625558 AON
City of Kent
Attn: City Clerk
220 Fourlh Avenue
Kent WA 98403 USA
JUL 1 2 20?2
Friday, June 24,2022
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To whom it may concern:
Followino a concentrated effort to reduce our environmental footprint and provide timely certificate
delivery,aon will begin delivering our Certificates of lnsurance electronically in PDF format.
Please utilize one of the following methods to ensure you will receive the electronic copy of your
Certificate (Certificate No: 570093625558) for future renewals:
- Visit aon.com/e-cert; or
- Utilize the QR Code below to enter/validate your information.
lf your email address has changed or will be changing in the future, or you no longer require this
certificate, please let us know u-sing one of the methods above.
Thank you for your cooperation and willingness to help us reduce our impact to the environment.
MSC# 17755 | Aon
P.O. Box 1447
Lincolnshire, lL 60069
RECEIVED
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