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HomeMy WebLinkAboutKingDanbyMicro_eSNAP_Certificate of Liability_20230210.pdf RecordID 27726 DATE(MM/DD/YYYY) ,a�ofzo® CERTIFICATE OF LIABILITY INSURANCE 02/03/2023 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 w/ p y, policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). d PRODUCER CONTACT '6 NAME: AOn rusk Services Northeast, Inc. PHONE FAX New York NY Office (A/C.No.E.t): (866) 283-7122 (A/C.No.): CBOO) 363-0105 -00 one Liberty Plaza E-MAIL 2 165 Broadway, Suite 3201 ADDRESS: New York NY 10006 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Liberty Mutual Fire Ins CO 23035 Verizon wireless, LLC INSURER B: LM Insurance Corporation 33600 1095 Avenue of the Americas New York NY 10036 USA INSURERC: Liberty Insurance Corporation 42404 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570097687333 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 MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, Limits shown are as requested INSR ADDL SUBR EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (POLICYMM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY TB2691550588142 06/30/2022 06/30/2023 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $2,000,000 X XCU Coverage is Included MED EXP(Any one person) $1.0,000 PERSONAL&ADV INJURY $1,000,000 M GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $2,000,000 r X POLICY ❑PRO ❑LOC PRODUCTS-COMP/OP AGG $2,000,000 O JECT rn OTHER: o r A AUTOMOBILE LIABILITY A52-691-550588-122 06/30/2022 06/30/2023 COMBINED SINGLE LIMIT AOS (Ea accident) $2,000,000 A J ANY AUTO A52-691-550588-132 06/30/2022 06/30/2023 BODILY INJURY(Per person) GOWNEDSCHEDULED NH - Primary BODILY INJURY(Per accident) Z AAUTOS ONLY AUTOS TL2-691-550588-182 06/30/2022 06/30/2023 PROPERTYDAMAGE I HIRED AUTOS NON-OWNED U ONLY AUTOS ONLY NH - Excess (Per accident) 1= O1 UMBRELLA LIAB OCCUR EACH OCCURRENCE L) EXCESS LAB CLAIMS-MADE AGGREGATE DED I RETENTION B WORKERS COMPENSATION AND WA569D550588092 06/30/2022 06/30/2023 X PER STATUTE ORTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/ Y/N AOS E.L.EACH ACCIDENT $1,000,000 B EXECUTIVEOFFICER/MEMBER N N/A WC5691550588082 06/30/2022 06/30/2023 (Mandatory in NH) WI, MN E.L.DISEASE-EA EMPLOYEE $1,000,000 Dyes,describe under $1,000,000 DESCRIPTION ow OPERATIONS bel E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Named Insured includes: Bell Atlantic Mobile Systems LLC dba verizon wireless. RE: Project No. 20222362994, Location Code: 1 392588, Project Name: Icing Danby Micro Attn: Real Estate Mgr., 1100 Danby Road, Ithaca, New York 14850. Town of Ithaca is � included as Additional Insured with respect to the General Liability policy. y� �J CERTIFICATE HOLDER CANCELLATION �} s_ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ± DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Ithaca AUTHORIZED REPRESENTATIVE Attn: Code Compliance 215 N. Tioga St. � Ithaca NY 14850 USA tXXa�a V e./�Q�GtttoeD mina cJ c/�' ■. ©1988-2015 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 Page _ of _ AGENCY NAMED INSURED Aon Risk Services Northeast, Inc. Verizon Wireless, LLC POLICY NUMBER See Certificate Numbe 570097687333 CARRIER I NAIC CODE see Certificate Numbe 570097687333 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liabilitv Insurance INSURER(S)AFFORDING COVERAGE NAIC# INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information,refer to the corresponding policy on the ACORD certificate form for policy limits. POLICY POLICY INSR ADDL SUBR POLICY NUMBER TYPE OF INSURANCE LIMITS EFF'ECE EXPIRATION DATE LTR INSD WVD DATE (MM/DD/YYYY) WORKERS COMPENSATION C N/A WA769D550588072 06/30/2022 06/30/2023 MA ACORD 101(2008101) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD