AccoR D® CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
04/28/2023
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).
CONTACT
NAME: Jonathan D Severson
PHOE A/CNNo. Ext): (714) 536-6086 (A/c. No): (714) 536-4054 E-MAIL
ADDRESS: [email protected]
INSURER(S) AFFORDING COVERAGE NAIC #
INSURERA:Sentinel Insurance Company
INSURER B: Hartford Casualty Insurance Co
PRODUCER
Bannister & Associates
CA License #0691071
305 17th Street
Huntington Beach CA 92648
Insurance Agency
INSURED
Barrios and Associate, LLC
dba Communications Lab
701 E Chapman Avenue
Orange CA 92866
COVERAGES
(949) 215-5539
�INSURERC:Philadephia Indemnity Ins Co
1INSURERD:Arch Specialty Insurance Company
INSURER E :
INSURER F :
CERTIFICATE NUMBER: Cert ID 12590
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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A
A
B
CLAIMS -MADE
X
OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO- JECT X LOC
OTHER:
AUTOMOBILE LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
X HIRED
AUTOS ONLY
X UMBRELLA LIAB
EXCESS LIAB
■
SCHEDULED
AUTOS
NON -OWNED
AUTOS ONLY
X
OCCUR
CLAIMS -MADE
DED RETENT ON $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRI ETOR/PARTNER/EXECUTIV E
OFFICER/MEMBEREXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
C Professional Liability
Y/N
N/A
72SBABG0546 04/01/2023 04/01/2024
72SBABG0546 04/01/2023 04/01/2024
72SBABG0546
72WECAW7EH6
PHSD1778561
Deductible: $5,000/claim
04/01/2023 04/01/2024
04/01/2023 04/01/2024
DAMAGE TO RENTED
PREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE
(Per accident)
EACH OCCURRENCE
AGGREGATE
Retention
XPER OTH-
STATUTE ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
04/01/2023 04/01/2024 Limit (per
claim):
Limit (aggregate):
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER
For Informational Purposes Only
ACORD 25 (2016/03)
CANCELLATION
$
$
$
$
$ 6,000,000
$ 6,000,000
$ 10,000
$ 1,000,000
$ 1,000,000
$ 1,000,000
$ 2,000,000
$ 4,000,000
1,000,000
10,000
1,000,000
2,000,000
2,000,000
1,000,000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
© 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
CERTIFICATE COVERAGES OVERFLOW
PRODUCER
Bannister & Associates Insurance Agency
CA License #0691071
305 17th Street
Huntington Beach CA 92648
CONTACT NAME:
Jonathan D Severson
ADDITIONAL COVERAGES
INSR
LTR
TYPE OF INSURANCE
D Cyber Liability
PHONE (A/C, No, Ext):
(714) 536-6086
INSURED
Barrios and Associate, LLC
dba Communications Lab
701 E Chapman Avenue
Orange CA 92866
PHONE (A/C, No, Ext):
(949) 215-5539
CERTIFICATE NUMBER: Cert ID 12540
ADDL SUBR
INSR WVD
POLICY NUMBER
REVISION NUMBER:
POLICY EFF POLICY EXP
(MM/DD/YYYY) (MM/DD/YYYY)
DATE (MM/DD/YYYY)
04/28/2023
LIMITS
C-4LPX-259362-CYBER-2023 05/01/2023 05/01/2024 Limit (per claim/aggregate):
Deductible: $10,000/claim
Certificate Coverages Overflow (11/2010)
$ 2,000,000
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$