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HomeMy WebLinkAboutCAG2021-396 - Insurance Certificate - Cities Digital, Inc. (CDI) - Liability Coverage - 04/11/2023 AC�0 DATE(MMIDD/YYYY) �_ CERTIFICATE OF LIABILITY INSURANCE 3/8/2023 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 endorsement(s). PRODUCER CONTACT NAME Jenn Laundrie Spectrum Insurance Group Sandeen Agency PHONE 715 386 58Y5 f' .No•7:15-3f�E-1�66 605 2nd St EMAIL Hudson WI 54016 AD R'ass: enn. .laundrla s eetrumins rou -com INSURER($)AFFORDING COVERAGE NA1C# INSURER A:Sentinel Ins Company Ltd. 11000 INSURED CITIDIG-01 INSURER B:The Hartford-Rated by Mut' le Co Cities Digital Inc 2000 O'Neil Rd#D1 INSURER c:Hartford Accident&Indemnity Company, 22357 Hudson WI 54016 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1741685751 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER (MMPDDrYYYYJ JMMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 83SBAIL5702 4/11/2023 4/11/2024 EACH OCCURRENCE $1,000,000 CLAIMS-MADE �OCCUR DAMAGE T RENTED PREMIS 5. occurrence $1,000,000 MED EXP(Anyone person) $10,000 PERSONAL&ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY "G LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER' 1 $ C AUTOMOBILE LIABILITY 83UECPY4697 4/11/2023 4/11/2024 COMBINED SINGLE LIMIT $1,000,000 !Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED Ix NON-OWNED PROPERTY➢AMAGE $ AUTOS ONLY AUTOS ONLY ?Per arnlde A UMBRELLA LIAB HCIAJM CCUR 83SBAIL5702 4/11/2023 4/11/2024 EACH OCCURRENCE $3,000,000 EXCESS LIAB $-MADE AGGREGATE $ DED I X I RETENTION$In 4lnLI $ B WORKERS COMPENSATION 83VVBCAA3168 4/11/2023 4/11/2024 -X STATUTE RH AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder named as additional insured. 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 Kent 220 Fourth Ave S Kent WA 98032 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD