05-04-23 CTR0059433 ETC_GAUW.pdf

PDF 168 KB Posted

Attached to
Master Agreement AZ|CTR059433
Contract number
CTR059433
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance issued by Higginbotham Insurance Agency, Inc. on 4/28/2022 for Complete Training Resources dba ETC Compliance Solutions, Inc., located in Tucson, Arizona. The insurance policies are underwritten by Mid-Continent Casualty Company (NAIC #23418) and Twin City Fire Insurance Company (NAIC #29459), with the certificate holder being the Arizona Department of Environmental Quality in Phoenix, Arizona.

The insurance coverage includes Commercial General Liability with a $1,000,000 per occurrence limit, a $3,000,000 general aggregate, and professional liability coverage. The policies are effective from 5/4/2022 to 5/4/2023 and include additional coverage such as Automobile Liability, Umbrella Liability, and Workers' Compensation. The certificate specifies that the Arizona Department of Environmental Quality is included as an Additional Insured with a Waiver of Subrogation on the listed policies per a written contract, ensuring comprehensive insurance protection for the contractual relationship between the parties.

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Text version

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

INSURER(S) AFFORDING COVERAGE

INSURER F :

INSURER E :

INSURER D :

INSURER C :

INSURER B :

INSURER A :

NAIC #

NAME:

CONTACT

(A/C, No):

FAX

E-MAIL

ADDRESS:

PRODUCER

(A/C, No, Ext):

PHONE

INSURED

REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES

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).

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.

OTHER:

(Per accident)

(Ea accident)

N / A

SUBR

WVD

ADDL

INSD

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.

$PROPERTY DAMAGE

BODILY INJURY (Per accident)

BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

AUTOS ONLY

AUTOSAUTOS ONLY

NON-OWNED

SCHEDULEDOWNED

ANY AUTO

AUTOMOBILE LIABILITY

Y / N

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH)

DESCRIPTION OF OPERATIONS below If yes, describe under

ANY PROPRIETOR/PARTNER/EXECUTIVE

E.L. DISEASE - POLICY LIMIT

E.L. DISEASE - EA EMPLOYEE

E.L. EACH ACCIDENT

ER

OTH-

STATUTE

PER

LIMITS(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

POLICY NUMBERTYPE OF INSURANCELTR

INSR

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

EXCESS LIAB

UMBRELLA LIAB $EACH OCCURRENCE

$AGGREGATE

OCCUR

CLAIMS-MADE

DED RETENTION $

$PRODUCTS - COMP/OP AGG

$GENERAL AGGREGATE

$PERSONAL & ADV INJURY

$MED EXP (Any one person)

$EACH OCCURRENCE

DAMAGE TO RENTED

$PREMISES (Ea occurrence)

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

CANCELLATION

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03)

© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

4/28/2022

Higginbotham Insurance Agency, Inc.

PO Box 52534 Tulsa OK 74152-0534

David Vaughan 918-779-7880 918-779-7885 dlvjr@higginbotham.net

Mid-Continent Casualty Company 23418 COMPTRA-02 Twin City Fire Insurance Company 29459

Complete Training Resources dba ETC Compliance Solutions, Inc.

5532 E. Grant Rd Tucson AZ 85712

312625162

A X 1,000,000 X 100,000

X Professional Excluded

1,000,000

3,000,000 X

Y Y 04-GL-001079145 5/4/2022 5/4/2023

3,000,000

A 1,000,000

X X

04-GL-001079145 5/4/2022 5/4/2023

A X 2,000,000 X

04-XS-224256 5/4/2022 5/4/2023

2,000,000

B X

N

38WECAG20BA 5/4/2022 5/4/2023

1,000,000

1,000,000

1,000,000

Certificate holder is included as Additional Insured with Waiver of Subrogation on the policy listed above per written contract.

Arizona Department of Environmental Quality 110 W. Washington St.

Phoenix AZ 85007

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