INSR ADDL SUBR
LTR INSR WVD
DATE (MM/DD/YYYY)
PRODUCER CONTACT
NAME:
PHONE FAX
(A/C, No, Ext): (A/C, No):
E-MAIL
ADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER
POLICY EFF POLICY EXP TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
COMMERCIAL GENERAL LIABILITY
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
INSURER(S) AFFORDING COVERAGE NAIC #
Y / N
N / A
(Mandatory in NH)
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
EACH OCCURRENCE $
DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
$
PROOTHER:
JECT LOC
COMBINED SINGLE LIMIT
(Ea accident) $
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS
AUTOS ONLY
HIRED PROPERTY DAMAGE $
AUTOS ONLY (Per accident)
$
OCCUR EACH OCCURRENCE $
CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
PER OTHSTATUTE ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ POLICY
NON-OWNED
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
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.
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 any rights to the certificate holder in lieu of such endorsement(s).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
ACORDTM CERTIFICATE OF LIABILITY INSURANCE
Continental Casualty Company
Continental Insurance Company
American Casualty Company of Reading PA
National Fire Insurance Co. of Hartford
10/20/2022
USI Insurance Services LLC C/L
101 W Main Street STE 900
Norfolk, VA 23510
757 625-1800
Kendall Chartier
757 663-4032
[email protected]
Atlantic Diving Supply, Inc
621 Lynnhaven Parkway # 160
Virginia Beach, VA 23452
20443
35289
20427
20478
A X
X
7018110980 01/01/2022 01/01/2023 1,000,000
1,000,000
15,000
1,000,000
2,000,000
2,000,000
A
X
X X
7018110929 01/01/2022 01/01/2023 1,000,000
B X X
X 10000
7018110994 01/01/2022 01/01/2023 25,000,000
25,000,000
C
D
N
7018114074 (AOS)
7018114415 (CA)
01/01/2022
01/01/2022
01/01/2023
01/01/2023
X
1,000,000
1,000,000
1,000,000
B
B
Defense Base
Foreign Pack
DBA6072787385
WP673010431
01/01/2022
01/01/2022
01/01/2023
01/01/2023
See Desc.
See Desc.
Foreign Package Limits - GL
Occurrence: $1,000,000
Damage to Rented Premises: $1,000,000
Med Exp: $100,000
Personal & Advertising: $2,000,000
(See Attached Descriptions)
The City of Redondo Beach, its
officers, elected and appointed
officials, employees, and volunteers
415 Diamond Street
Redondo Beach, CA 90277
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Client#: 1924131 ATLDIVSU
AXLZP
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SAGITTA 25.3 (2016/03)
DESCRIPTIONS (Continued from Page 1)
General Agg: $2,000,000
Products - Comp/Op Agg: $2,000,000
Foreign Package Limits - Auto
Combined Single Limit: $1,000,000
Foreign Package Limits - WC
Each Accident: $1,000,000
Disease - Each Employee: $1,000,000
Disease - Policy Limit: $1,000,000
Defense Base Act Limits:
Bodily Injury by Accident: $1,000,000 Each Accident
Bodily Injury by Disease: $1,000,000 Each Employee
Bodily Injury by Disease: $1,000,000 Policy Limit
The General Liability policy includes an automatic Additional Insured endorsement that provides Additional Insured status to The City, its officers, elected and appointed officials, employees, and volunteers, only when there is a written contract that requires such status, and only with regard to work performed by or on behalf of the named insured. The General Liability policy contains a special endorsement with Primary and Noncontributory wording, when required by written contract. The General Liability policy includes a Waiver of Subrogation endorsement in favor of the Certificate Holder as referenced above. 2 of 2
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