DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 06/02/2026
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 Adrienne Colvard
NAME:
Chastain & Associates Ins PHONE (706) 543-2575 FAX (706) 543-4847
(A/C, No, Ext): (A/C, No):
P.O. Box 1908 E-MAIL adrienne@chastain-assoc.com
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
Athens GA 30603 INSURER A : State Auto Mutual 25135
INSURED INSURER B : Western Surety Co 13188
Nisewonger Audio Visual Center, Inc. INSURER C : Evanston Insurance Co 35378
1125 Cripple Creek Drive INSURER D :
INSURER E :
Lawrenceville GA 30043 INSURER F :
COVERAGES CERTIFICATE NUMBER: CL256547202 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 SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED 500,000
CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $
MED EXP (Any one person) $ 10,000
A Y Y 10177569CP 06/13/2025 06/13/2026 PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
PRO- 2,000,000
POLICY JECT LOC PRODUCTS - COMP/OP AGG $
OTHER: Employee Benefits $ 1,000,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
(Ea accident)
ANY AUTO BODILY INJURY (Per person) $
A OWNED SCHEDULED Y Y 10177641CA 06/13/2025 06/13/2026 BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
Uninsured motorist $ 1,000,000
combined single limit
UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000
A EXCESS LIAB CLAIMS-MADE Y Y 10177642CU 06/13/2025 06/13/2026 AGGREGATE $ 1,000,000
DED RETENTION $ 10000 $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY STATUTE ER
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000
A OFFICER/MEMBER EXCLUDED? Y N/A Y 10177574WC 06/13/2025 06/13/2026
(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
Empl. Dishonesty Limit 10,000
Employee Dishonesty 3/28/2025-2026
B/C Excess Liability 6/13/2025-2026 15122654 / EZXS3161248 Excess Liab Occur Limit 4,000,000
Excess Liab Agg Limit 4,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
ITB 25-519 General Liability Extension Endorsement 8-E-3548 Ed. 7-2011-Additional Insured -Owners, Lessees or Contractors-Completed Operations CG
20 37 04 13 Primary and Non-Contributory-Other Insurance Condition CG 20 01 04 13 Commercial Automobile Extension Endorsement 8-E-2419- ED.
04-2017 Waiver of our Right to Recover from Others Endorsement WC 00 03 13
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
DeKalb County School District ACCORDANCE WITH THE POLICY PROVISIONS.
1701 Mountain Insdustrial Blvd
AUTHORIZED REPRESENTATIVE
Stone Mountain GA 30083-1027
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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