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HomeMy WebLinkAboutIT13-155 - Insurance Certificate - Verizon Wireless - Property Insurance - 6/30/24 Aon Risk Services 5801 Postal Road PO Box 818037 Cleveland,Ohio 44181-9600 MDG2024 00003906 01 �I��I�II��II'�I�'II���I��III���"IIIII'I'�III�II�'llllll'�'I'�I'I City of Kent 220 4th Avenue South Kent WA 98032 n r v C �C C C C Certificate No: 570106467546 AON City of Kent 220 4th Avenue South Kent WA 98032 USA Friday, June 21, 2024 To whom it may concern: Following a concentrated effort to reduce our environmental footprint and provide timely certificate delivery, Aon will begin delivering our Certificates of Insurance electronically in PDF format. Please utilize one of the following methods to ensure you will receive the electronic copy of your Certificate (Certificate No: 570106467546) for future renewals: - Visit aon.com/e-cert; or - Utilize the OR Code below to enter/validate your information. If your email address has changed or will be changing in the future, or you no longer require this certificate, please let us know using one of the methods above. Thank you for your cooperation and willingness to help us reduce our impact to the environment. Aon Risk Services 5801 Postal Road PO Box 818037 Cleveland, Ohio 44181-9600 ■ ■ ■ ■ a pN ■ ■ O co ■ ■ co 0 O O O O O DATO(6//1B//D20 4YYY) CERTIFICATE OF LIABILITY INSURANCE 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 CONTACTp Aon Risk services Northeast, Inc. NPHONE AME; FAX New York NY Office (A/C,No.Extl; (866) 283-7122 (a.0 No I (800) 363-0105 a One Liberty Plaza ADDRESS: 2 165 Broadway, suite 3201 New York NY 10006 USA INSURERS)AFFORDING COVERAGE NAIC# INSURED INSURER A: LM Insurance Corporation 33600 verizon wireless, LLC INSURERB: Liberty Insurance Corporation 42404 1095 Avenue of the Americas New York NY 10036 USA INSURER C: Liberty mutual Fire Ins Co 23035 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570106467546 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE INSAUUQ WVQ POLICY NUMBER (UWDDIYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY T132 91550568144 EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR PRFMISES Ea occurrence) $2,000,000 X XCU Coverage is Included MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 G£NIAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $2,000,000 m X POLICY ❑PRO- LOC PRODUCTS-COMP/OPAGG $2,000,000 JECT OTHER: r AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT LO I A ANYAUTO BODILY INJURY(Per person) 0 Z OWNED SCHEDULED BODILY INJURY(Per accident) 2 AUTOS ONLY AUTOS 0 NON OW NED PROPERTY DAMAGE 2 HIRED AUTOS V ONLY AUTOS ONLY (Per acciden r UMBRELLALIAB OCCUR EACH OCCURRENCE V EXCESS LIAB CLAIMS-MADE AGGREGATE IDED I RETENTION A WORKERS COMPENSATION AND WA56913550588094 06%30/2024 U6/30/2-025 X PER STATUTE OOTTH- EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN A05 E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A wc5691550588084 06/30/2024 06/30/2025 (Mandatory in NH) WI, MN E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,00C DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space Is required) Named insured includes: SMSA Limited Partnership dba verizon wireless. RE: work, obligations and activities performed by the y owner/developer and authorized by the City of Kent permit are concerned, site Name. Fixed wireless Kent SFU2, site Address: ROW, Ad]]'acent to 10929 SE 235th Street, Kent, WA 98031, Location code: 435000. The City of Kent, its elected and/or appointed - officials, its officers, employers, agents, volunteers and representatives are included as Additional Insured with respect to the General Liability policy. �r a 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 AUTHORIZED REPRESENTATIVE �s r 220 4th Avenue south . Kent WA 98032 USA �� JL 01988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000027366 LOC#: ADDITIONAL REMARKS SCHEDULE �r Page _ of _ AGENCY NAMEDINSURED Aon Risk services Northeast, Inc. Verizon Wireless, LLC POLICY NUMBER See Certificate Number: 570106467546 CARRIER FNAIGDE See Certificate Number: 570106467546 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC# INSURER INSURER INSURER INSURER LAI)DITIONAL POLICIES ll'a policy heluw does 11w include limit inf'ormalion,refer l(I the cc:rlre ponding policy❑n the ACORD certificate form for policy limits. INSR POLICY POLICY ADDL SUER POLICY NUMBER LIMITS LTR TYPE OF INSURANCE INSD WVD EFFECTIVE EXPIRATION DATE DATE (MM/DD/YYYY) (MM/DD/YYYY) WORKERS COMPENSATION B N/A WA769D5SO588074 06/30/2024 06/30/2025 MA ACORD 101(2006/01) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD