1-Attachment - Supplement Insurance.pdf
PDF 131 KB Posted
- Attached to
- Master Agreement AZ|CTR074231
- Contract number
- CTR074231
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance for Rural Community Assistance Corporation, issued by Lamb Insurance Services in New York. The certificate involves multiple insurers, including Security National Insurance Co, Continental Casualty, Wesco Insurance Company, and Peleus Insurance Company. The certificate holder is the Arizona Department of Environmental Quality (ADEQ), located in Phoenix, Arizona.
The insurance coverage includes Commercial General Liability, Automobile Liability, Umbrella Liability, Workers Compensation, and additional policies such as a Fidelity Bond, Directors & Officers/Errors & Omissions/Employment Practices Liability, and Real Estate Developer Professional Liability. The policies are effective from 3/1/2024 to 6/1/2025, with various coverage limits. For example, the Commercial General Liability policy has a $1,000,000 each occurrence limit and a $2,000,000 general aggregate limit. The certificate serves as proof of insurance for the insured organization, demonstrating their comprehensive insurance coverage across multiple risk categories.
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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
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
8/15/2024
Lamb Insurance Services 420 Lexington Avenue Suite 2620 New York NY 10170
212-375-3000 service@lambis.com
License#: PC-1013055 Security National Insurance Co 19879 RURACOM-01 Continental Casualty 20443
RURAL Community Assistance Corporation 3120 Freeboard Dr.
West Sacramento CA 95691
Wesco Insurance Company 25011
PELEUS INSURANCE COMPANY 34118
2019912668
B X 1,000,000 X 100,000
15,000
1,000,000
2,000,000 X
7036868199 3/1/2024 6/1/2025
2,000,000
B 1,000,000
X X
7036860538 3/1/2024 6/1/2025
B X X 1,000,0007036869868 3/1/2024 6/1/2025
1,000,000 X 10,000
A C D
Fidelity Bond D&O/E&O/EPLI/Fiduciary Real Estate Developer PL
SFB180670000
WDO200339500
121RE0209546-02
6/1/2024 6/1/2024 6/1/2024
6/1/2025 6/1/2025 6/1/2025
Limit Limit Limit
1,000,000 2,000,000 2,000,000
Proof of Insurance
Arizona Department of Environmental Quality (ADEQ) 1110 W. Washington Street Phoenix AZ 85007
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