1-1-2024_Accord_WC_GL_CL_AL_UL_DBA_Const.pdf
PDF 6 MB Posted
- Attached to
- Master Agreement AZ|CTR055333
- Contract number
- CTR055333
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for DBA Construction, Inc., issued by Commercial West Insurance Agency on behalf of multiple insurers including Phoenix Insurance Company, Travelers Property Casualty Co, Travelers Casualty & Surety, Continental Casualty Co, and Westchester Surplus Lines Insurance. The certificate covers insurance policies effective from January 1, 2023 to January 1, 2024, with the Arizona Game and Fish Department listed as the certificate holder. The policies provide various types of coverage including commercial general liability, automobile liability, umbrella liability, workers' compensation, and additional specialized coverages.
The insurance package includes comprehensive protection for DBA Construction, Inc., with significant coverage limits across different policy types. Commercial general liability is set at $1,000,000 per occurrence with a $2,000,000 general aggregate limit. Automobile liability provides a $1,000,000 combined single limit, and the umbrella liability extends coverage to $10,000,000. Additional specialized coverages include leased and rented equipment, pollution liability, builders' risk, and motor truck legal liability. The policies cover operations in all states excluding monopolistic states (ND, OH, WA, WY), and specifically list the State of Arizona, its departments, agencies, boards, commissions, universities, and their officials as additional insureds when required by written contract.
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Text version
The ACORD name and logo are registered marks of ACORD
CERTIFICATE HOLDER
© 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01)
AUTHORIZED REPRESENTATIVE
CANCELLATION
DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE
LOCJECT
PRO-POLICY
GEN'L AGGREGATE LIMIT APPLIES PER:
OCCURCLAIMS-MADE
COMMERCIAL GENERAL LIABILITY
PREMISES (Ea occurrence) $
DAMAGE TO RENTED
EACH OCCURRENCE $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
$RETENTIONDED
CLAIMS-MADE
OCCUR
AGGREGATE $
EACH OCCURRENCE $UMBRELLA LIAB
EXCESS LIAB
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
INSR
LTR TYPE OF INSURANCE POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY) LIMITS
PER
STATUTE
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
ANY PROPRIETOR/PARTNER/EXECUTIVE
If yes, describe under DESCRIPTION OF OPERATIONS below
(Mandatory in NH)
OFFICER/MEMBER EXCLUDED?
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
HIRED AUTOS
NON-OWNED
AUTOS AUTOS
AUTOS
COMBINED SINGLE LIMIT
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE $
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.
INSD
ADDL
WVD
SUBR
N / A
(Ea accident)
(Per accident)
OTHER:
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 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).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
INSURED
PHONE
(A/C, No, Ext):
PRODUCER
ADDRESS:
FAX
(A/C, No):
CONTACT
NAME:
NAIC #
INSURER A :
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
INSURER(S) AFFORDING COVERAGE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
12/21/2022
Commercial West Insurance Agency 2152 South Vineyard, Suite 107 Mesa AZ 85210
Lori Spelde 480-961-5400 480-961-5401
Lori@trycwi.com
Phoenix Insurance Company 25623 DBACO-1 Travelers Property Casualty Co 25674
DBA Construction, Inc.
P.O. Box 63035 Phoenix AZ 85082-3035
Travelers Casualty & Surety 31194 Continental Casualty Co. 20443 Westchester Surplus Lines Ins 10172
394908436
A X 1,000,000 X 300,000
5,000
1,000,000
2,000,000
X
Y Y DT-CO-9D586889-PHX-23 1/1/2023 1/1/2024
2,000,000
B 1,000,000 X
Y Y 810-2L968980-23-26-G 1/1/2023 1/1/2024
B X X 10,000,000Y Y CUP-0K482811-23-26
10,000,000
1/1/2023 1/1/2024
C
N
Y UB-9J634648-22-26-G 1/1/2023 1/1/2024 X
1,000,000
1,000,000
1,000,000 D E
Leased & Rented Equipment Pollution Liability
6079982568 G70963620004
1/1/2023 1/1/2023
1/1/2024 1/1/2024
Limit/Deductible Limit/Ded
500,000/1,000 5,000,000/10,000
Work Comp applies to all states excluding monopolistic - ND, OH, WA, WY *Blanket Builder's Risk Policy #6079982568|Contienental Casualty Company| Effective 01/01/2023 to 01/01/2024 $1,000,000 Policy Limit* *Motor Truck Legal Liability #6079982568|Continenental Casualty Company| Effective 01/01/2023 to 01/01/2024 $250,000 All Vehicles-Any One Loss* Re #BPM003283. The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees are additional insureds when required by written contract per forms attached.
The Arizona Game and Fish Department, Purchasing Office 5000 W. Carefree Highway Phoenix AZ 85086
DT-CO-9D586889-PHX-22
DT-CO-9D586889-PHX-22DT-CO-9D586889-PHX-22DT-CO-9D586889-PHX-22
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